Barriers Associated with Adherence to Cervical Cancer Screening Among Women Living with HIV in Nkhatabay District, Malawi: A Mixed-Methods Study

Figures & data

Table 1 Qualitative Data Analysis and Theme Development

Codes	Categories	Themes
Uncomfortable to be screened by male provider	Uncomfortable with male providers embarrassment	Individual values
Uncomfortable to be screened by young providers
Feeling of embarrassment to undress in front of male providers
Unwillingness to be screened	Low perceived importance of CCS	Knowledge gap about CCS
Unwillingness to hear about CC
Competing priorities
Lack of interest
Rumours that CC has no cure	Knowledge gap on CCS services
Lack of CCS message
Inadequate information on benefits of going for CCS
Lack of knowledge on CCS protocols among WLHIV
Fear of death during the procedure	Anxiety
Fear of being diagnosed with CC
Fear of VIA procedure
Hilly area	Long distances to access VIA Services	Geographical location
Walking long distance to facility access CCS services
Lack of CCS outreach services

Table 2 Distribution of Selected Demographic Variables

Variable	Frequency (n)	Percentage (%)
Facility
Nkhatabay District Hospital	137	66.8
Chintheche Rural Hospital	68	33.2
Age
25–30	25	10.2
30–35	20	9.8
35–40	32	15.6
40–45	54	26.3
45–50	78	38.1
Marital Status
Married	106	51.7
Single	6	2.9
Divorced	37	18.1
Widow	56	27.3
Parity
Nulliparous	4	2.0
1–3	77	37.6
4–6	108	52.7
7–8	26	7.8
Educational level
No Education	21	10.2
Primary Level	149	72.7
Secondary Level	34	16.6
Tertiary Level	1	0.5
Occupation
Not Employed	24	11.7
Employed	18	8.8
Farmer	105	51.2
Business	58	28.3
Denomination
Christian	203	99.1
Moslem	2	0.9

Table 3 Distribution of Selected Outcome Variables

Variable	Frequency (n)	Percentage (Col%)
Ever Screened
Yes	78	38.4
No	126	61.6
Years on ART
1 - <3	18	8.7
3 - <5	30	14.6
5 - <10	97	47.1
10 >	61	29.6
Missed Year
Did not miss screening schedule	11	5.4
Missed	193	94.6
Year Screened
2017 - <2019	65	31.7
2019 - <2021	45	22.0
Not Screened/No Evidence	95	46.3
Source of Information on VIA
Hospital	116	56.9
Radio	37	18.1
Church	1	0.5
Hospital/Radio/Church	42	20.6
Other	8	3.9
Willingness to be Screened
Yes	204	100.0
No	0	0.0

Table 4 Effects of Selected Demographic Variables on Cervical Cancer Screening, Results from Multivariable Logistic Regression Analysis

Variable	Odds Ratio	95% Confidence Interval		P-value
		Lower	Upper
Age
< 30	Baseline
30 - < 35	0.2	0.0	1.0	0.1
35 - < 40	0.5	0.1	2.1	0.4
40 - < 45	1.8	0.3	9.8	0.5
45–50	4.2	0.7	26.8	0.1
Facility
Nkhatabay	Baseline
Chintheche	0.0	0.007	0.1	<0.001
Marital Status
Married	Baseline
Single	0.8	0.1	7.4	0.8
Divorced	0.8	0.2	2.5	0.6
Widowed	1.0	0.3	2.9	1.0
Parity
Nulliparous	0.01	0.00	0.4	0.02
1–3	0.2	0.02	2.1	0.2
4–6	0.2	0.02	1.4	0.1
7–9	Baseline
Education
Never Attended	Baseline
Primary Level	2.2	0.6	8.8	0.3
Secondary level	2.4	0.4	13.7	0.3
Occupation
Employed	Baseline
Not Employed	0.4	0.05	3.4	0.4
Business	0.4	0.1	1.9	0.2
Farmer	0.5	0.1	3.1	0.5
Years on ARVs
< 3	Baseline
3–5	1.3	0.2	7.0	0.8
6–10	5.1	1.1	23.3	0.03
> 10	6.0	1.1	33.2	0.04
Constant	7.8	0.3	217.9	0.2

Table 5 Association Between Cervical Cancer Screening and Selected Barriers, Results from Chi-Square Tests

Variable	Ever Screened for Cervical Cancer		χ^2 (P-value)
	Not Screened (Col %)	Screened (Col %)
Lack of Information
Not True	23(29.5)	42(33.6)	0.9(0.6)
Slightly True	5(6.4)	11(8.8)
Very True	50(64.1)	72(57.6)
Lack of Interest
Not True	32(41.0)	32(25.6)	8.5(0.02)
Slightly True	11(14.1)	11(8.8)
Very True	35(44.9)	82(65.6)
Fear of Procedure
Not True	19(24.5)	13(10.4)	14.2(0.001)
Slightly True	9(11.5)	4(3.2)
Very True	80(64.1)	108(86.4)
Lack of Money
Not True	77((98.7)	122(97.6)	1.4(0.5)
Slightly True	0(0.0)	2(1.6)
Very True	1(1.3)	1(0.8)
Once a Week
Not True	57(73)	119(95.2)	20.4(<0.001)
Slightly True	0(0.0)	0(0.0)
Very True	21(26.9)	6(4.8)
Long Waiting Time			-
Not True	74(94.9)	101(80.8)	8.8(0.012)
Slightly True	0(0.0)	7(5.6)
Very True	4(5.1)	17(13.6)
Male Provider
Not True	67(85.9)	82(65.6)	13.6(<0.001)
Slightly True	4(5.1)	4(3.2)
Very True	7(9.0)	39(31.2)
Service Unavailability
Not True	67(85.9)	98(79.0)	2.7(0.3)
Slightly True	0(0.0)	3(2.4)
Very True	11(14.1)	23(18.6)
Stigma
Not True	77(98.7)	121(96.8)	0.9(0.6)
Slightly True	0(0.0)	1(0.8)
Very True	1(1.3)	3(2.4)