Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria

F. A. Magaji; M. I. Mashor; S. A. Anzaku; A. R. Hinjari; N. T. Cosmas; B. V. Kwaghe; J. M. Ali; Elizabeth N. Christian; A. S. Sagay; Ariel Chandler; Imran Khan; Robert L. Murphy; Lifang Hou; J. Musa

doi:10.1186/s12889-024-17739-z

Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria

F. A. Magaji^*, M. I. Mashor, S. A. Anzaku, A. R. Hinjari, N. T. Cosmas, B. V. Kwaghe, J. M. Ali, Elizabeth N. Christian, A. S. Sagay, Ariel Chandler, Imran Khan, Robert L. Murphy, Lifang Hou, J. Musa

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria. Methods: A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software. Results: Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past. Conclusions: The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.

Original language	English (US)
Article number	193
Journal	BMC public health
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s12889-024-17739-z
State	Published - Dec 2024

Funding

I acknowledge the funding support from the Northwestern-Nigeria HIV/AIDS Associated Malignancy Research Training Program funded by NIH D43TW009575 (MPIs: Hou L, Murphy R) and the funding donations from the Strohm’s family through the Robert J. Havey MD Institute for Global Health to provide access to cervical cancer screening for indigent women through the community cervical cancer screening project in Jos, Nigeria. The contributions of Dr Jonathan Bulus and Dr Jerry Ogwuche, both coordinators of adult HIV/AIDS clinics in PSSH and OLA hospital, Jos-metropolis, Nigeria, respectively. The contributions of Janet Musa, RN and Joyce Asufi, RN, BNsc of the Gyne-oncology research teams in BHUTH and JUTH, respectively. Lastly, Nenrot Danjuma, the REDCaps database officer for creating the electronic database template for the community cervical cancer screening project, and Simon Sati Atuji (BSc Mathematics) and Uwaeme Ijeoma Matinda (BSc. Med Lab Science) for the project data entry, and finally the women that participated in the study. I acknowledge the funding support from the Northwestern-Nigeria HIV/AIDS Associated Malignancy Research Training Program funded by NIH D43TW009575 (MPIs: Hou L, Murphy R) and the funding donations from the Strohm’s family through the Robert J. Havey MD Institute for Global Health to provide access to cervical cancer screening for indigent women through the community cervical cancer screening project in Jos, Nigeria. The contributions of Dr Jonathan Bulus and Dr Jerry Ogwuche, both coordinators of adult HIV/AIDS clinics in PSSH and OLA hospital, Jos-metropolis, Nigeria, respectively. The contributions of Janet Musa, RN and Joyce Asufi, RN, BNsc of the Gyne-oncology research teams in BHUTH and JUTH, respectively. Lastly, Nenrot Danjuma, the REDCaps database officer for creating the electronic database template for the community cervical cancer screening project, and Simon Sati Atuji (BSc Mathematics) and Uwaeme Ijeoma Matinda (BSc. Med Lab Science) for the project data entry, and finally the women that participated in the study.

Keywords

Adult HIV-clinic
Cervical precancer and cancer
Indigent women
Jos-Nigeria
Pap test

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s12889-024-17739-z

Cite this

Magaji, F. A., Mashor, M. I., Anzaku, S. A., Hinjari, A. R., Cosmas, N. T., Kwaghe, B. V., Ali, J. M., Christian, E. N., Sagay, A. S., Chandler, A., Khan, I., Murphy, R. L., Hou, L., & Musa, J. (2024). Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria. BMC public health, 24(1), Article 193. https://doi.org/10.1186/s12889-024-17739-z

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title = "Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria",

abstract = "Background: High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria. Methods: A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software. Results: Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past. Conclusions: The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.",

keywords = "Adult HIV-clinic, Cervical precancer and cancer, Indigent women, Jos-Nigeria, Pap test",

author = "Magaji, {F. A.} and Mashor, {M. I.} and Anzaku, {S. A.} and Hinjari, {A. R.} and Cosmas, {N. T.} and Kwaghe, {B. V.} and Ali, {J. M.} and Christian, {Elizabeth N.} and Sagay, {A. S.} and Ariel Chandler and Imran Khan and Murphy, {Robert L.} and Lifang Hou and J. Musa",

note = "Publisher Copyright: {\textcopyright} 2024, The Author(s).",

year = "2024",

month = dec,

doi = "10.1186/s12889-024-17739-z",

language = "English (US)",

volume = "24",

journal = "BMC public health",

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TY - JOUR

T1 - Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria

AU - Magaji, F. A.

AU - Mashor, M. I.

AU - Anzaku, S. A.

AU - Hinjari, A. R.

AU - Cosmas, N. T.

AU - Kwaghe, B. V.

AU - Ali, J. M.

AU - Christian, Elizabeth N.

AU - Sagay, A. S.

AU - Chandler, Ariel

AU - Khan, Imran

AU - Murphy, Robert L.

AU - Hou, Lifang

AU - Musa, J.

PY - 2024/12

Y1 - 2024/12

N2 - Background: High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria. Methods: A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software. Results: Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past. Conclusions: The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.

AB - Background: High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria. Methods: A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software. Results: Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past. Conclusions: The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.

KW - Adult HIV-clinic

KW - Cervical precancer and cancer

KW - Indigent women

KW - Jos-Nigeria

KW - Pap test

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DO - 10.1186/s12889-024-17739-z

M3 - Article

C2 - 38229083

AN - SCOPUS:85182467800

SN - 1471-2458

VL - 24

JO - BMC public health

JF - BMC public health

IS - 1

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ER -

Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria

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UN SDGs

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