Dorcas Obori-Yeboah and team Knowledge and experience of human papillomavirus and cervical cancer screening in a cohort of HIV-positive and HIV-negative Ghanaian women  Dorcas Obiri- Yeboah School of Medical Sciences, UCC 11/27/2018 Dorcas Obori-Yeboah and team

Dorcas Obori-Yeboah and team Problem statement Understanding the screening process and the benefits of early treatment are fundamental to women engaging in follow-up care (Hansen et al. 2011) Yet, knowledge and experience of women who have had cervical screening is under-researched; esp among HIV positive women with a higher risk Background Barriers to women attending screening include embarrassment related to sample collection, fear of pain, and fear of cancer diagnosis (Marlow et al. 2015) 11/27/2018 Dorcas Obori-Yeboah and team

Aim To examined knowledge and understanding of HPV and cervical cancer and evaluate experiences of screening in a cohort of HIV positive and negative women.

Methodological issues Research design Mixed method Method Survey and FGDs Target population Undergoing HPV testing and Pap Screening 6 mths Sampling technique Systematic sampling Sample 131 women: HIV-positive n=55; 2 groups of 8 Study site CCTH ART Centre and General OPD Ethical Clearance  UCC/LSHTM institutional review boards 11/27/2018 Dorcas Obori-Yeboah and team

Dorcas Obori-Yeboah and team Results 11/27/2018 Dorcas Obori-Yeboah and team

Knowledge scores- HIV negatives vs. positives Questions with the highest proportion of correct responses: HPV being sexually transmitted (86.7%, 100%) HPV being the cause of cervical cancer (91.9%, 98.2%) condoms being partially protective (82.7%, 94.6%) cervical cancer being preventable (90.8%, 94.6%). 11/27/2018 Dorcas Obori-Yeboah and team

Questions with the highest proportion of incorrect/unsure responses:   HIV-negative (%*) N=76 HIV-positive (%*) N=55 p value HPV infection is rare: not many people have it True 20.0% 25.5% 0.06 False 41.3% 21.8% Unsure 38.6% 52.7% Cervical cancer is rare in Ghana 33.3% 0.005 40.0% 23.6% 26.7% 54.6% There are no stages to cervical cancer; either you have it or you don’t 29.7% 67.3% <0.001 51.4% 18.9% 7.3% 11/27/2018 Dorcas Obori-Yeboah and team

Dorcas Obori-Yeboah and team HPV acquisition “The way through which we come to get it [HPV virus] is if we and men about three or four have sex.” (P01, HIV-positive) Nature of the disease “Me too I think that if you are there with someone and he has it, you will see that his skin is changing” (P141, HIV-positive). 11/27/2018 Dorcas Obori-Yeboah and team

Dorcas Obori-Yeboah and team Prevention “Eeeem… some people do not like condom so they will have to, reduce the men they do sex with and all that” (P41, HIV-positive) “If education could be given on radio and TV, for me, I believe it would help us.” (P157, HIV-negative) 11/27/2018 Dorcas Obori-Yeboah and team

Experience of screening: Negatives vs. Positives 30.7% vs. 35.0% agreed that screening was embarrassing most women did not find screening painful (85.3% vs. 85.0%). 11/27/2018 Dorcas Obori-Yeboah and team

“source of fears/concerns” “The way the doctor said it on TV made it sound scary.” (P164, HIV-negative) “I was scared, waiting for the result was very scary. I could not even sleep.” (P316, HIV-negative) 11/27/2018 Dorcas Obori-Yeboah and team

Dorcas Obori-Yeboah and team Around a third found screening embarrassing Need to explore self-sampling methods (Obiri- Yeboah, Adu- Sarkodie et al. 2017) Recommendations Significant anxiety around waiting for results Better counselling and reduce waiting time (McCaffery et al. 2006) Specific misconceptions highlighted through the FGDs, with stigmatising language used around the acquisition of HPV Need to explore more tailored educational messages (Williams et al. 2013)(White et al. 2012) 11/27/2018 Dorcas Obori-Yeboah and team

Dorcas Obori-Yeboah and team Conclusion A standardised education tool explaining cervical screening and specifically HPV-DNA testing in Ghana is needed, which should be accessible to women with low formal education, and should take into account the different needs of HIV-positive women. 11/27/2018 Dorcas Obori-Yeboah and team

Dorcas Obori-Yeboah and team Thank you 11/27/2018 Dorcas Obori-Yeboah and team