Skip to main content
Download PDF
  • Systematic Review
  • Open access
  • Published:

Cervical cancer screening utilization and associated factors among women living with HIV in Ethiopia, 2024: systematic review and meta-analysis

BMC Women's Health volume 24, Article number: 521 (2024) Cite this article

Abstract

Background

Cervical cancer is a significant global health challenge, with the majority of cases and deaths occurring in low-resource regions like sub-Saharan Africa including Ethiopia. Women living with HIV (WLHIV) in this area face a six-fold higher risk of cervical cancer compared to women living without HIV Both the availability of screening services and their utilization remain low, particularly among WLHIV, hindering efforts to reduce the cervical cancer burden in this vulnerable population.

Objective

This study aimed to synthesize the current research on the prevalence of cervical cancer screening utilization and the associated factors among women living with HIV in Ethiopia.

Method

We conducted a comprehensive systematic review and meta-analysis, searching databases such as Google Scholar, PubMed, and the Cochrane Library for relevant studies published from 2015 up to 2023 and the search period for these relevant articles was from April 1 up to April 30, 2024. Data from included studies was extracted, organized in Excel, and then analyzed using STATA 17. The overall effect across all studies was calculated using a random-effect model. Potential publication bias and heterogeneity in the results between studies were assessed using Egger’s test, forest plot, and I² statistic, respectively.

Result

According to the systematic review and meta-analysis, the overall prevalence of cervical cancer screening utilization among women living with HIV in Ethiopia was 24% (17 − 32%). Several factors were independently associated with cervical cancer screening utilization, including age (40–49) years (OR = 3.95, 95% CI: 3.307–4.595), age (18–29) years (OR = 5.021, 95% CI: 1.563–9.479), education level greater than college (OR = 3.293, 95% CI: 1.835–4.751), having good knowledge (OR = 3.421, 95% CI: 2.928–3.915), early initiation of sexual intercourse (OR = 3.421, 95% CI: 2.928–3.915), awareness of cervical cancer (OR = 3.551, 95% CI: 2.945–4.157), having information about cancer (OR = 3.671, 95% CI: 2.606–4.736), CD4 count less than 500 cell/mm3 (OR = 4.001, 95% CI: 1.463–6.539), government employee (OR = 5.921, 95% CI: 1.767–10.076), and perceived susceptibility (OR = 2.950, 95% CI: 2.405–3.496).

Conclusion

This systematic review and meta-analysis show that the pooled prevalence of cervical cancer screening rates among Women living with HIV in Ethiopia is notably low, at only 24%. Factors influencing service utilization include age, education level, knowledge about cervical cancer, early sexual initiation, awareness of the disease itself, and HIV-related conditions. To enhance screening rates, interventions must target these factors and address systemic healthcare deficiencies.

Peer Review reports

Background

Cervical cancer is the fourth most common cancer among women globally, with approximately 660,000 new cases diagnosed in 2022. The disease disproportionately affects low and middle-income countries, accounting for 94% of the estimated 350,000 deaths that year. Sub-Saharan Africa carries the heaviest burden of cervical cancer incidence and mortality [1]. Women living with HIV face a substantially increased risk of developing cervical cancer compared to those without the virus. This heightened risk is primarily due to higher rates of HPV infection and the increased persistence of these infections in individuals with weakened immune systems [1, 2]. HIV-positive women are at a significantly heightened risk of developing cervical cancer compared to the general population, accounting for an estimated 5% of all cervical cancer cases [1, 3]. This devastating disease disproportionately impacts younger women, leading to a tragic outcome where one in five children losing their mothers to cancer are victims of this specific illness [1, 4]. Cervical cancer is a devastating crisis in sub-Saharan Africa, with Eastern Africa facing an alarming 40 cases per 100,000 women. This crisis is expected to worsen dramatically due to population growth and aging. The impact on families is tragic: for every 100 mothers lost, 14 children die prematurely and 210 become orphans, highlighting the severe social consequences of the disease [5]. This represents more than half of the global cervical cancer burden. Within sub-Saharan Africa, women living with HIV make up a disproportionately high 60% of the 348 new cervical cancer cases per 1 million women each year [6]. More than two-thirds of cervical cancer cases in sub-Saharan Africa are diagnosed at a late stage when survival rates are much lower. This is largely due to limited access to cervical cancer information and screening services for many women in the region. Even for those diagnosed, treatment options like surgery and radiotherapy are often lacking, too expensive, or simply unavailable in many low-resource countries in sub-Saharan Africa, including Ethiopia [7]. In Ethiopia, cervical cancer has become the second leading cause of cancer-related morbidity and mortality among women. Each year, there are approximately 7,095 new cases of cervical cancer diagnosed, and 4,732 women die from the disease in the country [8].

In developing countries, women living with HIV have a significantly higher risk of being diagnosed with cervical cancer, with a six-fold greater chance compared to women living without HIV counterparts. This disparity is especially pronounced across Southern and Eastern Africa. To address this major public health challenge, the World Health Organization (WHO) has developed a strategic action plan to eliminate cervical cancer as a public health problem. This strategy involves the “90-70-90” target that must be met by the year 2030. The three components of this comprehensive approach target the different stages of cervical cancer’s natural history: first, 90% of girls are fully vaccinated against HPV, the primary cause of cervical cancer. Second 70% of women screened with a high-performance test by age 35 and again by age 45. Third 90% of women identified with cervical disease receive treatment like surgery, radiotherapy, or chemotherapy [9].

Cervical cancer can be prevented and effectively treated, especially when detected early. This means that the burden of morbidity and mortality from cervical cancer could be significantly reduced through timely screening and appropriate management. In Ethiopia, in some health facilities, both organized cervical cancer screening programs and opportunistic screening services are currently available. Many women in the country are expected to benefit from these screening services. However, the utilization of cervical cancer screening among women living with HIV in Ethiopia is much lower than the national recommended coverage target of 80% [8, 10,11,12,13,14].

Cervical cancer is a significant public health concern in Ethiopia. To address this issue, the country has adopted the World Health Organization’s (WHO) cervical cancer prevention and control guidelines [15]. These guidelines emphasize regular cervical cancer screening for all women, regardless of HIV status, at least every five years following a negative result. Women living with HIV (WLWH) require more frequent screenings due to increased risk. Despite these guidelines, cervical cancer screening coverage remains low, particularly in HIV clinics. This leaves WLWH vulnerable to preventable cervical cancer, undermining progress in HIV treatment. To combat this, Ethiopia has implemented a comprehensive strategy with a phased approach: Prevention: Reducing HPV infection through vaccination and promoting safe sexual practices, Early Detection: Regular cervical cancer screening to identify precancerous lesions early and Treatment: Providing treatment for advanced cancer through surgery, radiation, and chemotherapy. This strategy involves collaboration between healthcare providers, policymakers, and community members to implement and monitor progress [16, 17].

This study aimed to identify the prevalence of cervical cancer screening utilization and associated factors among adult women with HIV in Ethiopia. This is an important area of research, as improving screening and early detection is critical to reducing the disproportionately high cervical cancer burden among WLWH in Ethiopia.

Methods and materials

Sources of data and ways of search

The results of this review were reported under the guidelines set forth by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) [18].

The authors conducted a comprehensive and exhaustive search for studies delineating cervical cancer screening utilization among women living with HIV in Ethiopia. They searched several medical and scientific databases, including Science Direct, PubMed, Google Scholar, Embase, HINARI, and the Cochrane Library, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A PRISMA flow diagram [19], was used to illustrate the article screening and selection process (supplementary file.1).

The search included. Published articles on cervical cancer screening and associated factors among Women living with HIV in Ethiopia, covering the period from 2015 to September 2023.

The search terms used included “cervical cancer “, “screening”, “utilization”, “uptake”, “predictors”, “factors”, “barriers”, “HIV”, ”women living with HIV”, ” HIV infections”, and “Ethiopia”. These terms were used individually and in combination with Boolean operators like “OR” and “AND”. The citations identified through the search were imported into EndNote-X9 software, and duplicate articles were removed. The full texts of the selected articles were then thoroughly reviewed to assess the quality of the studies.

Operational definitions

Cervical cancer screening: is the process of examining women for precancerous or cancerous cells on the cervix using diagnostic tests such as the Pap smear, HPV test, or visual inspection with acetic acid (VIA). These tests involve collecting cervical cells for microscopic examination or detecting the presence of HPV, a virus linked to cervical cancer.

Cervical cancer screening utilization: refers to the extent to which eligible women participate in cervical cancer screening within a defined population and period.

Inclusion and exclusion criteria

This review included studies that reported either the use of cervical cancer screening utilization or the factors associated with cervical cancer screening in Women living with HIV in Ethiopia. The authors retrieved all published Studies reported in the English language from 2015 up to 2023 and the search period from May 1 up to May 30, 2024, to assess their eligibility for inclusion. However, the review excluded certain types of studies, including case reports, surveillance data, conference abstracts, articles without full-text access, and studies that did not report the outcome of interest.

The article selection process involved several steps. Two reviewers (ANY and AN) independently evaluated the retrieved articles for inclusion based on their titles, abstracts, and full-text reviews. Any disagreements during the selection process were resolved through consensus between the reviewers. The full texts of the selected articles were then further evaluated against the pre-defined eligibility criteria. In cases where duplicates were encountered, only the full-text article was retained for the review, and articles with cross-sectional studies were included in the study.

Information extraction for included studies

Two researchers independently collected data from articles about the utilization of cervical cancer screening among WLWH. They used a standardized format in a Microsoft Excel spreadsheet. The data included: author names, publication years, research locations, study designs, sampling techniques, sample sizes, the number of participants with the desired outcome, prevalence of cervical cancer screening utilization, and related factors. First, the researchers screened articles by title and abstract to identify those relevant to cervical cancer screening.

Measurement of the outcome of interest

The first outcome focused on whether women had received cervical cancer screening or not. This information was collected through a thorough examination by healthcare professionals using the appropriate tools or instruments. The prevalence of screening was calculated by dividing the number of women who had been screened by the total number of women in the study, then multiplying by 100% to express it as a percentage.

Study quality and risk of bias

The authors used the Joanna Briggs Institute (JBI) reviewers’ manual for systematic reviews of prevalence and incidence studies to assess the quality of the evidence [20]. The reviewers critically appraised the included studies based on several key criteria: Sample representativeness, Participant recruitment methods, Sample size estimation, Reliability of the measurement tools used, and the analysis of the outcomes. Studies that scored 50% or higher on this comprehensive quality assessment were included in the review.

The authors assessed the potential for publication bias in the included studies using Egger’s [21] and Begg’s [22] statistical tests and used a funnel plot. They used a p-value threshold of less than 0.05 to determine the presence of significant publication bias. Additionally, the authors employed the I2 statistic to evaluate the degree of heterogeneity between the included studies, and it was regarded as high, moderate, or low when the I2 test statistics results were 75%, 50%, or 25%, respectively [23].

Statistical analysis

Data extracted from a primary study by employing a format ready in Microsoft Excel Version 19 spreadsheet were imported to the STATA version-17 statistical software package for meta-analysis. A meta-analysis of cervical cancer screening was performed using the random-effects (DerSimonian and Laird) method to adjust for the determined variability [24]. In studies that did not delineate standard error (SE), an SE was calculated in Microsoft Excel. Then, the calculated standard error as well as the prevalence of every study was imported into the STATA version 17 software to calculate the pooled prevalence rate with 95% CI. To ensure the reliability of our findings, we adopted a conservative approach by requiring a minimum of two studies to include a specific determinant in the meta-analysis. This threshold was chosen to mitigate potential biases from limited evidence. Given the substantial number of studies available, we were able to analyze a comprehensive range of determinants. Due to significant variations among study findings, a random-effects model with a 95% CI was employed, which is considered more conservative than the fixed-effect model and effectively addresses heterogeneity in meta-analyses. Subgroup analysis based on sample size was conducted to provide additional insights. To detect publication bias, we utilized funnel plot analysis, Egger’s weighted regression, and Begg’s rank correlation tests, with a P-value of < 0.05 indicating statistically significant publication bias. The meta-analysis results were visually represented using forest plots.

Results

Results of the literature search

In the initial search, a total of 1,136 studies were retrieved from various databases and sources, including PubMed, Google Scholar, Embase, HINARI, and the Cochrane Library, and gray literature, regarding the quality of cervical cancer screening utilization and associated factors. Out of this initial pool of 1,136 studies, 1,033 were excluded after a step-by-step review process because they were omitted based on the title or abstract. An additional 75 articles were excluded because they were duplicates. The remaining 28 articles had their full texts read and assessed for eligibility based on the predetermined criteria. Ultimately, 15 of the 28 articles were excluded one study was also excluded because it had no primary outcome result, and the final systematic review and meta-analysis included 12 eligible studies (Fig. 1)

Fig. 1
figure 1

PRISMA flow chart diagram describing the selection of studies for systematic review and meta-analysis on the prevalence of cervical cancer screening utilization among women living with HIV in Ethiopia

Full size image

Study characteristics

The systematic review and meta-analysis included 12 studies to assess the overall prevalence of cervical cancer screening utilization. In total, 4905 participants were involved in these studies with sample sizes ranging from 302 to 496 individuals. All studies employed published a cross-sectional design, with 11 out of 12 using systematic random sampling. The remaining study used a multi-stage sampling technique. Two [12, 27] were conducted in Addis Ababa, four [28,29,30,31] in the Amhara region, one [32] in the Tigray region, two [11, 13] in the Oromia region and two [8, 33], in Southern Nations and Nationalities of Ethiopia (SNNPR) region and One [14] in Harer. Cross-sectional study design was employed in every study, ). A large proportion of studies were conducted in the Amhara region. All twelve studies had a sample size above three hundred. The minimum and maximum sample sizes were 302 and 496 respectively [30, 31]. All studies were carried out between 2015 and 2023 (Table 1)

Table 1 Characteristics of the twelve studies included in systematic review and meta-analysis
Full size table

Publication bias

In this study we used a funnel plot, Egger’s regression test, and Begg’s rank correlation test to assess the presence of publication bias. The Begg rank correlation statistic had a p-value of 0.0049, and the Egger weighted regression statistic for the studies on cervical cancer prevalence had a p-value of 0.0000. These results indicate that there is evidence of publication bias. Additionally, the funnel plot visually depicts the presence of publication bias before the adjustment of the funnel plot (Fig. 3a), and after the adjustment of the funnel plot (Fig. 3b). These Twelve [12]studies, which examined the prevalence of cervical cancer screening utilization among Women living with HIV, demonstrated significant heterogeneity, as indicated by the Cochrane Q test (p = 0.00) and I2 test (98.04%), warranting the use of a random-effects model. To decrease the heterogeneity, subgroup analysis was performed based on the sample size of the mean (Fig. 4).

Fig. 2
figure 2

Forest plots of twelve studies on the prevalence of cervical cancer screening utilization and associated factors among Women living with HIV in Ethiopia: 2024

Full size image
Fig. 3
figure 3

A Funnel plot of studies before adjusted (a), and after adjusted (b) conducted on the Prevalence of cervical cancer screening utilization and associated factors among Women living with HIV in Ethiopia: 2024

Full size image
Fig. 4
figure 4

Sub-group analysis based on the sample size of the mean of study on the prevalence of utilization of cervical cancer screening in Ethiopia, 2024

Full size image

Trim and fill analysis

A trim and fill analysis was conducted to estimate the number of potentially missing studies and to adjust for publication bias in the included studies. After this adjustment, the estimated pooled prevalence of cervical cancer screening utilization among Ethiopian women living with HIV was 21% (95% CI: 13–29%) (Fig. 6).

Fig. 5
figure 5

Leave-one-out sensitivity analysis of the prevalence of cervical cancer utilization and associated factors among women living with HIV in Ethiopia: 2024

Full size image
Fig. 6
figure 6

Trim and fill analysis for the prevalence of cervical cancer screening service utilization among women living with HIV

Full size image

Prevalence of cervical cancer screening utilization among women living with HIV in Ethiopia

Overall pooled prevalence of cervical cancer screening utilization was found to be 24% (17- 32%). The test statistic showed high non-uniformity among every study (I 2 = 98.6%, P = 0.000) (Fig. 2) However, after adjusting for publication bias using the trim and fill method, the pooled prevalence was revised to 21%( 95% CI: 13, 29). Due to this reason, the random effects model was accustomed to estimate the DerSimonian and Laird overall effect. Furthermore, during this meta-analysis, subgroup analysis was strictly performed depending on the mean of the sample size of the studies conducted. The highest pooled prevalence of cervical cancer screening utilization was determined in studies their sample size was less than the mean (25% [16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35]) and the lowest prevalence of cervical cancer utilization was determined in studies their sample size was greater than the mean (23% [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]) (Fig. 4)

Meta-regression

Meta-regression was performed with the mean of sample size considered as covariates, employing a random-effects model. The outcome indicated the presence of heterogeneity based on the sampling size of the study (p = 0.0000) (Table 2).

Table 2 Meta-regressions of cervical screening service utilization among women living with HIV by sampling size of study of included studies in Ethiopia, 2024
Full size table

Sensitivity analysis

The findings showed that the prevalence estimates obtained when omitting each study still fell within the confidence interval of the overall pooled prevalence estimate. This indicates that none of the individual included studies had a significant impact on the final pooled prevalence estimate. The results demonstrated the robustness of the overall pooled prevalence estimate to the influence of any single study (Fig. 5)

Factors associated with cervical cancer utilization among women living with HIV in Ethiopia

We utilized various determinants of adjusted data in this meta-analysis to ensure a more accurate assessment of the relationship between the primary determinant of interest and the outcome. By controlling for other confounding factors, this approach helps to isolate the true effect of the primary determinant.

Before doing the pooled associated factors, there were twelve associated factors for cervical cancer utilization among women living with HIV, age [12, 14, 28, 40,41,42,43,44,45,46,47,48,49], age [14, 18,19,20,21,22,23,24,25,26,27,28,29, 31], education level greater than college level [12, 28,29,30, 33], having good knowledge [14, 30,31,32,33], early initiation of intercourse [8, 29], Awareness of cervical cancer [11, 12, 29], having information about cancer [11, 12, 32, 34], CD4 count less than 500 cell/mm3 [30, 33], government employee [8, 11], perceived susceptibility [31, 32], perceived benefit [8, 13], perceived self-efficacy [8, 13](Table 3)

Cervical cancer screening utilization was significantly higher among women living with HIV aged 40–49 compared to women living without HIV. A meta-analysis of three studies [12, 14, 28] demonstrated that women in this age group were 3.95 times more likely to have undergone cervical cancer screening (OR = 3.95, 95% CI: 3.307–4.595).

Multivariate analyses of two studies [14, 31] found that women aged 18–29 years were five times more likely to utilize cervical cancer screening compared to older women (OR = 5.021, 95% CI: 1.563–9.479). A meta-analysis of five studies [12, 28,29,30, 33] found a significant association between educational status and cervical cancer screening utilization. Women living with HIV with a college education or higher were 3.3 times more likely to utilize screening compared to women with no formal education (OR = 3.293, 95% CI: 1.835–4.751). Pooled analysis of five studies [14, 30,31,32,33], identified knowledge as the strongest predictor of cervical cancer screening utilization. Women with HIV with good knowledge were 3.4 times more likely to undergo cervical cancer screening utilization compared to those with poor knowledge (OR = 3.421, 95% CI: 2.928–3.915).

The odds of two studies [8, 29], revealed that initiation of sexual intercourse in cervical cancer screening utilization, women who have early initiation of sexual intercourse were 2 times more likely to utilize cervical cancer screening than women who did have not early initiation of sexual intercourse (OR = 2.034 95%CI 1.590–2.478).

The pooled effect of three studies [11, 12, 29] revealed that women having awareness about cervical cancer screening is highly linked with cervical cancer utilization. Women who have an awareness of cancer had 3.55 times more screening service utilization than their counterparts (OR = 3.551 95%CI 2.945–4.157).

Meta-analysis of four studies [11, 12, 32, 34] demonstrated a significant association between receiving information about cervical cancer screening and service utilization among HIV-positive women. Women who received such information were 3.67 times more likely to utilize cervical cancer screening services compared to those who did not (OR = 3.671, 95% CI: 2.606–4.736).

The odds of two studies [30, 33], revealed a significantly higher likelihood of cervical cancer screening utilization among women living with HIV with CD4 counts below 500 cells/mm³ were 4 times more likely to utilize cervical cancer screening compared to a woman whose CD4 counts greater than 500 cells/mm³(OR = 4.001, 95% CI: 1.463–6.539). The odds of two studies [8, 11] showed that being a government employee was a major predictor for cervical cancer screening utilization, women who were government employees were 5.9 times more likely to utilize cervical cancer screening compared to their counterparts(OR = 5.921 95%CI 1.767–10.076).

The pooled effect of two studies [31, 32] also revealed that the perceived susceptibility to cervical cancer was another predictor of cervical cancer screening utilization in Ethiopia. Women who had perceived susceptibility to cervical cancer were 3 times more likely to utilize cervical cancer screening than their counterparts (OR = 2.950, 95% CI: 2.405–3.496).

Table 3 The pooled odds ratios of factors associated with cervical cancer screening utilization among women living with HIV in Ethiopia
Full size table

Discussion

Ethiopia has a substantial burden of both HIV infection and cervical cancer. Also, cervical cancer screening rates among women living with HIV remain low [35]. Women living with HIV are at heightened risk of developing cervical precancerous lesions, which can significantly impact their health [36,37,38]. This increased susceptibility stems from a higher likelihood of HPV infection, accelerated progression to precancerous lesions, reduced regression of these lesions, and a higher recurrence rate following treatment. To inform targeted prevention and control strategies, including HPV vaccination for women living with HIV. This meta-analysis assessed the prevalence of cervical cancer screening utilization and associated factors among women living with HIV in Ethiopia.

In this study, the estimated pooled prevalence of cervical cancer screening utilization among women living with HIV in Ethiopia was 24% (95% CI: 17–32%). However, after adjusting for publication bias using the trim and fill method, the pooled prevalence was revised to 21%( 95% CI: 13, 29). The result reported in this study is similar to the finding from the studies done in Tanzania 22.6% [39]), Kenya 27.5% [40], Addis Abeba, Ethiopia 24.8% and 25.5 [12, 41], Adama 26.9% [11], southern ethiopia27.8% [8], Hadiya zone, Hosanna 24.2% [42], and Bishoftu town, Ethiopia (25%) [13], Northwest Ethiopia 24% [31] but higher than the studies conducted in Nigeria 9.4% [44], Morocco (9%) [45], north shoa [28], Gondar (10%) [30], Southern Tigray (8%) [32] and Addis Ababa (11.5%) and 10% [12, 46]. On the other hand, our finding is lower than that of studies done in Italy 91% [47], England 85.7% [48], Catalonia, Spain 50.6% [49], and Nairobi Kenya 46% [50], Hawassa, Ethiopia 40% [33], Mekele 29.8% [43], and also This finding is lower than the national target addressing to reach at least 80% [13]. The possible reason for this variation could be Differences in population and sampling: The demographic characteristics, risk factors, and screening practices of the populations studied may vary between the different locations, leading to variations in the observed cervical cancer prevalence rates, Differences in screening methods and coverage, The cervical cancer screening programs, accessibility, and uptake may differ across the countries/regions, impacting the detection and reporting of cases, Variations in study methodologies, sample sizes, data collection, and analysis approaches between the different studies could contribute to the discrepancies and Socioeconomic and cultural factors: Differences in socioeconomic status, cultural beliefs, and health [51]-seeking behaviors between the populations studied may affect cervical cancer screening and detection.

This finding revealed that women aged 40–49 years had 3.95 times higher odds of undergoing cervical cancer screening compared to those aged 50 and older furthermore women aged 18–29 years had 5.02 times higher odds of undergoing cervical cancer screening compared to those aged more than 50 years women, this result is similar with the studies conducted in Ethiopia [51,52,53,54]. This disparity may be due to that younger women are often in their most productive and reproductive years. They may have more frequent gynecological examinations, prenatal care, and exposure to sexual/reproductive health services, which provides opportunities to receive information and access cervical cancer screening, Younger women may perceive themselves to be at higher risk of cervical cancer, and thus be more proactive about getting screened. Conversely, older women over 50 may feel they are at lower risk and be less inclined to seek out screening and Younger generations of women may have received more education and awareness about the importance of cervical cancer screening, which motivates them to get tested regularly.

These findings revealed that women’s educational level is associated with cervical cancer screening. Women with tertiary-level education were 3.29 times more likely to undergo cervical cancer screening than those with no formal education. This finding is supported by studies conducted in India, Ghana, and Ethiopia [51, 55, 56]. The possible reason may be due to Women with higher education may have greater health awareness and access to screening services, which empowers them to be more proactive about cervical cancer prevention. Conversely, lack of education can limit women’s knowledge, resources, and agency to seek out and utilize preventive healthcare like cervical cancer screening.

The research findings indicate that women’s knowledge of cervical cancer and screening is strongly associated with their utilization of screening services. Women who had good knowledge about cervical cancer and the importance of screening were approximately 3.4 times more likely to utilize the available screening services compared to those with poor knowledge of the topic. This result is consistent with findings from similar studies conducted in Italy, Korea, Taiwan, Uganda, Tanzania, Botswana, and Ethiopia [53, 57,58,59,60,61,62,63]. The researchers suggest that the increased knowledge and awareness about cervical cancer and the benefits of screening directly motivates and enables women to access and utilize the available screening services.

Women who have early initiation of sexual intercourse have predicted cervical cancer screening utilization. The odds of women who have early initiation of cervical cancer were 2.04 more times screened than their counterparts. This result is supported by studies conducted in Ethiopia [8, 29]. Possible reason Women who start sexual activity at an earlier age may perceive themselves to be at higher risk of developing cervical cancer, which motivates them to be more proactive about getting regularly screened as a preventive measure also Younger age at sexual initiation at an early age increased risk of acquiring human papillomavirus (HPV) infection, a major risk factor for cervical cancer. Women who start sexual activity at an earlier age may recognize this high vulnerability, leading them to seek out cervical cancer screening more frequently compared to their counterparts with later sexual debuts.

In this study, women who had awareness about Cervical Cancer screening were about 3.55 times more likely to utilize Cervical cancer screening than those who had no awareness This finding was supported in studies conducted in Tanzania, Kenya, and Ethiopia [11, 12, 27, 39, 48]. The possible reason is that Women with greater awareness about cervical cancer screening are better informed about the importance, benefits, and availability of these preventive services. This understanding motivates them to actively seek out and utilize the screening services, compared to women who lack such awareness and may not perceive the need or value of regular cervical cancer screening.

The odds of Cervical Cancer screening service utilization were 3.67 times more likely among women who get information about Cervical Cancer screening than those who did not hear about Cervical Cancer [64, 65]. this finding may be due to those women who were exposed to information about cervical cancer screening are likely to have a better understanding of the importance, benefits, and availability of these preventive services, This increased knowledge empowers them to make more informed decisions about seeking out and utilizing cervical cancer screening, The information provided may have included details about where to access cervical cancer screening services, how to schedule appointments, and any financial/insurance coverage details, The educational information about cervical cancer may have increased the woman’s perception of personal risk, and the consequently getting screened regularly and also Information dissemination can help normalize cervical cancer screening as a routine and recommended healthcare practice.

Our study shows that women having a CD4 count of less than 500 cells/mm3 were 4 times more likely to be screened for Cervical cancer than those who had more than or equal to 500 cells/mm3 [7, 30, 33, 66]. A possible explanation is women with lower CD4 counts, indicating weaker immune systems, maybe more aware of their increased susceptibility to cervical cancer and other opportunistic infections. This risk perception can motivate them to be more proactive about obtaining regular cervical cancer screening, Healthcare providers may be more vigilant about recommending and facilitating cervical cancer screening for women with compromised immune function, as they are at higher risk of developing cervical cancer and other complications, Women with lower CD4 counts are likely receiving regular medical care and monitoring for their underlying condition. This increased interaction with the healthcare system may provide greater opportunities for cervical cancer screening to be offered and accessed and Women with weaker immune systems may be more focused on preventive healthcare measures, including cervical cancer screening, as a way to maintain their health and manage their increased disease vulnerability.

This study demonstrated that government employees had highly predicted cervical cancer screening and women as government employees had 5.92 times more cervical cancer screening utilization than non-government employees. This finding is supported by the studies conducted in Latin America, Ghana, and Ethiopia [11, 67,68,69]. The possible explanation is government employees may have better access to comprehensive healthcare coverage, including preventive services like cervical cancer screening, through their employer-provided health insurance plans. Government employers may provide more robust health education and awareness campaigns to their staff on the importance of preventive care on cervical cancer screening, Government workplaces may foster a culture that prioritizes employee health and wellness, encouraging and facilitating participation in preventive healthcare programs.

The odds of perceived susceptibility were significantly associated with cervical cancer screening women who have high perceived susceptibility were 2.95 times more than that of low perceived susceptibility. This result is in line with the study conducted in Uganda, Ethiopia [32, 43, 70,71,72] possible reason is Women who perceive themselves to be at higher risk of developing cervical cancer are more likely to be motivated to take proactive steps to detect and prevent the disease through regular screening, Women with a high perceived susceptibility to cervical cancer may have a better understanding of the importance and benefits of regular screening in detecting the disease early and reducing their risk and also women who perceive themselves to be at high risk may be more receptive to recommendations and encouragement from healthcare providers to undergo regular cervical cancer screening.

Implications of the study

The systematic review and meta-analysis found the overall pooled prevalence of cervical cancer screening utilization among women living with HIV in Ethiopia to be 21%. Significant factors associated with higher screening utilization included older age (40–49 years), higher education level, good knowledge, early sexual initiation, awareness of cervical cancer, access to information about cervical cancer, low CD4 count, government employment, and perceived susceptibility to cervical cancer. The objective was that targeted interventions are needed to improve cervical cancer screening utilization, especially among younger, less educated, and less informed women living with HIV in Ethiopia.

Strengths and limitations of the study

A comprehensive literature search and rigorous selection process with clear inclusion/exclusion criteria. Furthermore, it employs established quality assessment methods and robust statistical analysis. The authors used appropriate statistical methods, such as random-effects meta-analysis, to pool the estimates and account for the heterogeneity between studies and we also assessed publication bias using statistical tests and visual inspection of funnel plots.

The review was limited to studies published in English, potentially leading to the exclusion of relevant research in other languages. The studies included demonstrated moderate to high heterogeneity, likely due to variations in study populations, settings, and outcome measurements. Furthermore, the limited number of studies with high heterogeneity may restrict the generalizability of the pooled estimates. Additionally, the quality assessment of studies using the Joanna Briggs Institute (JBI) manual may have been inconsistent, as the application of criteria can vary across reviewers, potentially impacting the reliability of the assessment.

Conclusion and recommendation

Overall pooled prevalence of cervical cancer screening utilization among women living with HIV in Ethiopia was found to be 21% (13- 29%), with high non-uniformity across studies (I2 = 98.6%, P = 0.000), Subgroup analysis showed the highest pooled prevalence (25% [16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35]) was in studies with sample sizes less than the mean, and the lowest (23% [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]) was in studies with sample sizes greater than the mean.

Several factors were found to be significantly associated with cervical cancer screening utilization: Age 40–49 years, Age 18–29 years, Education level greater than college, Having good knowledge, Early initiation of sexual intercourse, Awareness of cervical cancer, Having information about cervical cancer, CD4 count less than 500 cells/mm3, Being a government employee, Perceived susceptibility to cervical cancer but Perceived benefit and perceived self-efficacy were also associated factors, but the pooled estimates were not statistically significant.

To address the low cervical cancer screening utilization among women living with HIV in Ethiopia, a multifaceted approach is necessary. Prioritized interventions should target women aged 18–29 and 40–49, with a strong focus on improving education levels and increasing awareness about cervical cancer. Integrating cervical cancer screening service into routine antenatal care, coupled with enhanced healthcare infrastructure and provider training, is crucial. Additionally, addressing knowledge gaps through targeted interventions and community engagement is essential. By implementing a robust monitoring and evaluation system and considering factors such as cost-effectiveness, equity, and partnerships,

Data availability

All data included in a systematic review and meta-analysis are available in the main manuscript.

Abbreviations

GRADE:

Grading of Recommendations Assessment, Development and Evaluation

HIV:

Human Immune Deficiency Virus

HPV:

Human Papillomavirus

JBI:

Joanna Briggs Institute

PRISMA:

Preferred Reporting Items for Systematic Review and Meta-Analysis

SNNPR:

Southern Nations and Nationalities of Ethiopia

WHO:

World Health Organization

WLWH:

Women living with HIV

References

  1. cervical cancer. WHO. 2024. pp. 589–94.

  2. Joura EA, Giuliano AR, Iversen O-E, Bouchard C, Mao C, Mehlsen J et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. 2015;372(8):711–23.

  3. Stelzle D, Tanaka LF, Lee KK, Khalil AI, Baussano I, Shah AS, et al. Estimates of the global burden of cervical cancer associated with HIV. 2021;9(2):e161–9.

    CAS  Google Scholar 

  4. Guida F, Kidman R, Ferlay J, Schüz J, Soerjomataram I, Kithaka B et al. Global and regional estimates of orphans attributed to maternal cancer mortality in 2020. 2022;28(12):2563–72.

  5. Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO global cervical. Cancer Elimination Initiative. 2023;11(2):e197–206.

    CAS  Google Scholar 

  6. World Health Organization %J. Geneva SW. Global report: UNAIDS report on the global AIDS epidemic 2010. 2010.

  7. Teame H, Addissie A, Ayele W, Hirpa S, Gebremariam A, Gebreheat G et al. Factors associated with cervical precancerous lesions among women screened for cervical cancer in Addis Ababa, Ethiopia: a case control study. 2018;13(1):e0191506.

  8. Mesfin AH, Gufue ZH, Alemayehu MA, Kedida BD, Legese B, Gejo NGJB. Usage of cervical cancer screening services among HIV-positive women in Southern Ethiopia: a multicentre cross-sectional study. 2023;13(7):e068253.

  9. Organization WH. Global strategy to accelerate the elimination of cervical cancer as a public health problem. World Health Organization; 2020.

  10. Louie KS, De Sanjose S, Mayaud PJTM, Health I. Epidemiology and prevention of human papillomavirus and cervical cancer in sub-Saharan Africa: a comprehensive review. 2009;14(10):1287–302.

  11. Mohamed ZK, Amare YW, Getahun MS, Negussie YM, Gurara AMJSON. Cervical cancer screening service utilization and associated factors among women living with HIV receiving anti-retroviral therapy at Adama Hospital Medical College. Ethiopia. 2023;9:23779608231152072.

    Google Scholar 

  12. Belete N, Tsige Y. Mellie HJGor, practice. Willingness and acceptability of cervical cancer screening among women living with HIV/AIDS in Addis Ababa, Ethiopia: a cross sectional study. 2015;2:1–6.

  13. Solomon K, Tamire M, Kaba MJB. Predictors of cervical cancer screening practice among HIV positive women attending adult anti-retroviral treatment clinics in Bishoftu town. Ethiopia: Application Health Belief Model. 2019;19:1–11.

    CAS  Google Scholar 

  14. Tesfaye D, Weldegebreal F, Ayele F, Dheresa MJFO. Cervical cancer screening uptake and associated factors among women living with human immunodeficiency virus in public hospitals. East Ethiopia. 2023;13.

  15. Ethiopia FJF. OCTOBER. National cancer control plan, 2016–2020. 2015.

  16. Mboumba Bouassa R-S, Prazuck T, Lethu T, Jenabian M-A, Meye J-F, Bélec LJEroa-it. Cervical cancer in sub-saharan Africa: a preventable noncommunicable disease. 2017;15(6):613–27.

  17. Layet F, Murungi T, Ashaba N, Kigongo E, Opollo MSJBWH. Factors associated with utilization of cervical cancer screening services among HIV-positive women aged 18 to 49 years at Lira regional referral hospital. North Uganda. 2024;24(1):114.

    Google Scholar 

  18. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. 2000;283(15):2008–12.

  19. Stovold E, Beecher D, Foxlee R, Noel-Storr, AJSr. Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram. 2014;3:1–5.

  20. Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A et al. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. 2020;18(10):2127–33.

  21. Egger M, Smith GD, Schneider M, Minder CJB. Bias in meta-analysis detected by a simple. Graphical test. 1997;315(7109):629–34.

    CAS  Google Scholar 

  22. Begg CB, Mazumdar MJB. Operating characteristics of a rank correlation test for publication bias. 1994:1088–101.

  23. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella JJP. Assessing heterogeneity in meta-analysis: Q statistic or I² index? 2006;11(2):193.

  24. DerSimonian R, Laird NJC. Meta-analysis in clinical trials revisited. 2015;45:139–45.

  25. McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of clostridium difficile disease. Am J Gastroenterol. 2006;101(4):812–22.

    Article  PubMed  Google Scholar 

  26. Teshome HM, Ayalew GD, Shiferaw FW, Leshargie CT, Boneya DJ. The prevalence of depression among diabetic patients in Ethiopia: a systematic review and meta-analysis, 2018. Depression research and treatment. 2018;2018:6135460.

  27. Emru K, Abebaw T-A, Abera AJWH. Role of awareness on cervical cancer screening uptake among HIV positive women in Addis Ababa, Ethiopia: a cross-sectional study. 2021;17:17455065211017041.

  28. Chuko BM, Gindaba MY, Marami SN, Feyisa M, Kibrat FA, Geda GM. Utilization of cervical cancer screening and associated factors among HIV-positive women attending public hospitals in North Shoa, Ethiopia, mixed study. 2024.

  29. Nega AD, Gedamu S, Kumar PJM. Self-perceived risk of cervical cancer and associated factors among HIV positive women attending adult HIV/AIDS care and follow up clinic in Gondar University Referral Hospital, Northwest Ethiopia, 2016. 2016.

  30. Nega AD, Woldetsadik MA, Gelagay AAJB. Low uptake of cervical cancer screening among HIV positive women in Gondar University referral hospital, Northwest Ethiopia: cross-sectional study design. 2018;18:1–7.

  31. Erku DA, Netere AK, Mersha AG, Abebe SA, Mekuria AB, Belachew, SAJGor et al. Comprehensive knowledge and uptake of cervical cancer screening is low among women living with HIV/AIDS in Northwest Ethiopia. 2017;4:1–7.

  32. Gebrekirstos LG, Gebremedhin MH, Tafesse TT, Tura TS, Geleso MG, Wube TBJCC. Determinants of cervical cancer screening service utilization among HIV-positive women aged 25 years and above attending adult ART clinics in Southern Tigray. Ethiopia. 2022;29:10732748221126944.

    Google Scholar 

  33. Assefa AA, Astawesegn FH, Eshetu BJB. Cervical cancer screening service utilization and associated factors among HIV positive women attending adult ART clinic in public health facilities, Hawassa town, Ethiopia: a cross-sectional study. 2019;19:1–11.

  34. Abebaw T, Emru K. Abaerei AJAc-ss. Role of awareness on cervical cancer screening uptake among HIV positive women in Addis Ababa, Ethiopia. 2019.

  35. Derbie A, Mekonnen D, Nibret E, Misgan E, Maier M, Woldeamanuel Y, et al. Cerv cancer Ethiopia: Rev Literature. 2023;34(1):1–11.

    Google Scholar 

  36. Tesfaye E, Kumbi B, Mandefro B, Hemba Y, Prajapati KK, Singh SC, et al. Prevalence of human papillomavirus infection and associated factors among women attending cervical cancer screening in setting of Addis Ababa, Ethiopia. Sci Rep. 2024;14(1):4053.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Geremew H, Tesfa H, Mengstie MA, Gashu C, Kassa Y, Negash A et al. The association between HIV infection and precancerous cervical lesion. A systematic review and meta-analysis of case–control studies. 2023;6(8):e1485.

  38. Achdiat PA, Septharina R, Rowawi R, Dharmadji HP, Puspitosari D, Usman HA et al. A review and case study of genital and extragenital human papillomavirus type 6 and 11 infections in men who have sex with men accompanied by human immunodeficiency virus infection. 2024:175–82.

  39. Lyimo FS. Beran TNJBph. Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: three public policy implications. 2012;12:1–8.

  40. Lukorito J, Wanyoro A, Kimani HJRiO. Gynecology. Uptake of cervical cancer screening among HIV positive women in comrehensive care centres in Nairobi. Kenya. 2017;5(1):1–6.

    Google Scholar 

  41. Emru K, Abebaw TA, Abera A. Role of awareness on cervical cancer screening uptake among HIV positive women in Addis Ababa, Ethiopia: a cross-sectional study. Women’s Health (London England). 2021;17:17455065211017041.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Aweke YH, Ayanto SY. Ersado TLJPo. Knowledge, attitude and practice for cervical cancer prevention and control among women of childbearing age in Hossana Town, Hadiya zone, Southern Ethiopia: Community-based cross-sectional study. 2017;12(7):e0181415.

  43. Bayu H, Berhe Y, Mulat A, Alemu AJP. Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle Zone, Northern Ethiopia, 2015: a community based study using health belief model. 2016;11(3):e0149908.

  44. Dim CC, Onyedum CC, Dim NR, Chukwuka JCJJIAPAC. Cervical cancer screening among HIV-positive women in Nigeria: an assessment of use and willingness to pay in the absence of donor support. 2015;14(3):241–4.

  45. Belglaiaa E, Souho T, Badaoui L, Segondy M, Prétet J-L, Guenat D et al. Awareness of cervical cancer among women attending an HIV treatment centre: a cross-sectional study from Morocco. 2018;8(8):e020343.

  46. Shiferaw S, Addissie A, Gizaw M, Hirpa S, Ayele W, Getachew S, et al. Knowledge about cervical cancer and barriers toward cervical cancer screening among HIV-positive women attending public health centers in Addis Ababa city. Ethiopia. 2018;7(3):903–12.

    Google Scholar 

  47. Dal Maso L, Franceschi S, Lise M, De’Bianchi PS, Polesel J, Ghinelli F et al. Self-reported history of pap-smear in HIV-positive women in Northern Italy: a cross-sectional study. 2010;10:1–6.

  48. Ogunwale AN, Coleman MA, Sangi-Haghpeykar H, Valverde I, Montealegre J, Jibaja-Weiss M et al. Assessment of factors impacting cervical cancer screening among low-income women living with HIV-AIDS. 2016;28(4):491–4.

  49. Stuardo V, Agustí C, Casabona J. Low prevalence of cervical cancer screening among HIV-positive women in Catalonia (Spain). 2013.

  50. Njuguna E, Ilovi S, Muiruri P, Mutai K, Kinuthia J, Njoroge PJIJRCOG. Factors influencing cervical cancer screening in a Kenyan health facility: a mixed qualitative and quantitative study. 2017;6(4):1180–5.

  51. Aynalem BY, Anteneh KT, Enyew MM. Utilization of cervical cancer screening and associated factors among women in Debremarkos town, Amhara region, Northwest Ethiopia: Community based cross-sectional study. PLoS ONE. 2020;15(4):e0231307.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Belete N, Tsige Y, Mellie H. Willingness and acceptability of cervical cancer screening among women living with HIV/AIDS in Addis Ababa, Ethiopia: a cross sectional study. Gynecologic Oncol Res Pract. 2015;2:6.

    Article  Google Scholar 

  53. Tesfaye D, Weldegebreal F, Ayele F, Dheresa M. Cervical cancer screening uptake and associated factors among women living with human immunodeficiency virus in public hospitals, eastern Ethiopia. Front Oncol. 2023;13:1249151.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Endalew DA, Moti D, Mohammed N, Redi S, Wassihun Alemu B. Knowledge and practice of cervical cancer screening and associated factors among reproductive age group women in districts of Gurage Zone, Southern Ethiopia. A cross-sectional study. PLoS ONE. 2020;15(9):e0238869.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Gebrekirstos LG, Gebremedhin MH, Tafesse TT, Tura TS, Geleso MG, Wube TB. Determinants of cervical cancer screening service utilization among HIV-positive women aged 25 years and above attending adult ART clinics in Southern Tigray, Ethiopia. Cancer Control: J Moffitt Cancer Cent. 2022;29:10732748221126944.

    Article  Google Scholar 

  56. Nene B, Jayant K, Arrossi S, Shastri S, Budukh A, Hingmire S, et al. Determinants of womens participation in cervical cancer screening trial, Maharashtra, India. Bull World Health Organ. 2007;85(4):264–72.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Lin SJ. Factors influencing the uptake of screening services for breast and cervical cancer in Taiwan. J Royal Soc Promotion Health. 2008;128(6):327–34.

    Article  Google Scholar 

  58. Lyimo FS, Beran TN. Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: three public policy implications. BMC Public Health. 2012;12:22.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Dal Maso L, Franceschi S, Lise M, De’ Bianchi PS, Polesel J, Ghinelli F, et al. Self-reported history of pap-smear in HIV-positive women in Northern Italy: a cross-sectional study. BMC Cancer. 2010;10:310.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Ayenew AA, Zewdu BF, Nigussie AA. Uptake of cervical cancer screening service and associated factors among age-eligible women in Ethiopia: systematic review and meta-analysis. Infect Agents cancer. 2020;15(1):67.

    Article  Google Scholar 

  61. Mingo AM, Panozzo CA, DiAngi YT, Smith JS, Steenhoff AP, Ramogola-Masire D, et al. Cervical cancer awareness and screening in Botswana. Int J Gynecol cancer: Official J Int Gynecol Cancer Soc. 2012;22(4):638–44.

    Article  Google Scholar 

  62. Vigneshwaran E, Goruntla N, Bommireddy BR, Mantargi MJS, Mopuri B, Thammisetty DP, et al. Prevalence and predictors of cervical cancer screening among HIV-positive women in rural western Uganda: insights from the health-belief model. BMC Cancer. 2023;23(1):1216.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Chang HK, Myong JP, Byun SW, Lee SJ, Lee YS, Lee HN, et al. Factors associated with participation in cervical cancer screening among young Koreans: a nationwide cross-sectional study. BMJ open. 2017;7(4):e013868.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Assefa AA, Feleke T, SA GT, Degela F, Zenebe A, Abera G. Utilization and associated factors of cervical cancer screening service among eligible women attending maternal health services at Adare General Hospital, Hawassa city, Southern Ethiopia. Sci Rep. 2024;14(1):2774.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Mohamed ZK, Amare YW, Getahun MS, Negussie YM, Gurara AM. Cervical cancer screening service utilization and associated factors among women living with HIV receiving anti-retroviral therapy at Adama Hospital Medical College, Ethiopia. SAGE open Nurs. 2023;9:23779608231152072.

    PubMed  PubMed Central  Google Scholar 

  66. Kim Y-T, Serrano B, Lee J-K, Lee H, Lee S-W, Freeman C et al. Burden of human papillomavirus (HPV)-related disease and potential impact of HPV vaccines in the Republic of Korea. 2019;7:26–42.

  67. Gizaw AT, El-Khatib Z, Wolancho W, Amdissa D, Bamboro S, Boltena MT et al. Uptake of cervical cancer screening and its predictors among women of reproductive age in Gomma district, South West Ethiopia: a community-based cross-sectional study. 2022;17(1):43.

  68. Soneji S, Fukui NJRPSP. Socioeconomic determinants of cervical cancer screening. Latin Am. 2013;33(3):174–82.

    Google Scholar 

  69. Tawiah A, Konney TO, Dassah ET, Visser LE, Amo-Antwi K, Appiah‐Kubi A, et al. Determinants of cervical cancer screening uptake among women with access to free screening: a community‐based study in peri‐urban. Ghana. 2022;159(2):513–21.

    CAS  Google Scholar 

  70. Vigneshwaran E, Goruntla N, Bommireddy BR, Mantargi MJS, Mopuri B, Thammisetty DP et al. Prevalence and predictors of cervical cancer screening among HIV-positive women in rural western Uganda: insights from the health-belief model. 2023;23(1):1216.

  71. Desta M, Getaneh T, Yeserah B, Worku Y, Eshete T, Birhanu MY et al. Cervical cancer screening utilization and predictors among eligible women in Ethiopia: a systematic review and meta-analysis. 2021;16(11):e0259339.

  72. Wanyenze RK, Bwanika JB, Beyeza-Kashesya J, Mugerwa S, Arinaitwe J, Matovu JK, et al. Uptake and correlates of cervical cancer screening among HIV-infected women attending HIV. care Uganda. 2017;10(1):1380361.

    Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the authors who conducted the primary studies, as well as the use of AI software, ChatGPT, which assisted in the preparation and refinement of this text. The AI tool was employed for editing and played a significant role in the completion of this work.

Funding

Have no financial and non-financial support.

Author information

Authors and Affiliations

  1. Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Po.Box 196, Gondar, Ethiopia

    Amlaku Nigusie Yirsaw, Adane Nigusie, Eyob Getachew & Gebeyehu Lakew

  2. Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Muhabaw Shumye Mihret

  3. Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia

    Fantahun Andualem

  4. Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Demis Getachew

  5. Third party monitoring (TPM) at Metema refugee camp, Beza Posterity Development Organization(BPDO), Gondar, Ethiopia

    Abiyu Abadi Tareke

  6. Health Research Development Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia

    Adane Nigusie

Authors
  1. Amlaku Nigusie Yirsaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adane Nigusie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fantahun Andualem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eyob Getachew
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Demis Getachew
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abiyu Abadi Tareke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Muhabaw Shumye Mihret
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gebeyehu Lakew
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ANY, AN, FA, DG, AAT, EG, MSM, GL search and extract the articles, ANY, EG, MSM check the quality of the articles, ANY, AN, GL search and extract the articles, ANY, GL, MGT, FA do the analysis part and write the result, ANY, DG, EG, GL, review the manuscript. ANY, AN, AAT, MSM GL revised the manuscript. Finally, all authors gave approval of the version to be published; agreed on the journal to which the article had been submitted; and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Amlaku Nigusie Yirsaw.

Ethics declarations

Ethics approval and consent to participate

This section is not applicable because this study is a systematic review and Meta-analysis.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yirsaw, A.N., Nigusie, A., Andualem, F. et al. Cervical cancer screening utilization and associated factors among women living with HIV in Ethiopia, 2024: systematic review and meta-analysis. BMC Women's Health 24, 521 (2024). https://doi.org/10.1186/s12905-024-03362-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12905-024-03362-y

Keywords

BMC Women's Health

ISSN: 1472-6874

Contact us