Assessing Knowledge, Uptake, and Factors Associated with Cervical Cancer Screening Among Women Aged 25-49 Years Receiving HIV Testing Services in Wakiso District, Uganda: A Population-Based Study

Background and Purpose: Achieving Uganda’s national targets for cervical cancer elimination (briefly, 70% of women screened, 90% vaccinated, 70% with precancerous legions treated by 2030) requires scaling targeted high-impact interventions to increase cervical cancer screening uptake. The limited data on women’s knowledge and screening uptake at population level in Uganda hampers progress towards achieving these targets. We examined knowledge, uptake, and factors associated with cervical cancer screening among women receiving HIV testing in Wakiso district, Uganda, to inform the design of high-impact targeted community-based prevention interventions.

Methods: A cross-sectional study was conducted in April 2024 among 504 eligible women in Wakiso district, Uganda. Data were collected through face-to-face interviews. Cervical cancer screening uptake was measured dichotomously (past three years, yes/no), while knowledge was assessed using a Likert scale of ten (10) questions adapted from existing literature. The main predictors investigated included HIV, partner involvement, knowledge of cervical cancer screening and residence, and controlled-for sociodemographic characteristics. Univariate, bivariate, and multivariable modified Poisson regression models with robust variance were performed using Stata software version 17.

Results: The median age of participants was 30 years (IQR=26-37), with 51.2% living in semi-urban areas. The mean knowledge score for cervical cancer screening was 6.8 (SD=3.2), and 50.8% had high levels of knowledge. One-third (32%) of women had undergone cervical cancer screening, with significantly higher uptake among women living with HIV compared to those without (75.7% vs 28.9%, p<0.001). In adjusted models, cervical cancer screening was higher among women living with HIV (aPR= 1.8, 95% CI: 1.3-2.4). Additional factors associated with higher screening rates included partner involvement (aPR=2.8, 95% CI: 2.2-3.5), high knowledge about cervical cancer screening (aPR=3.6, 95% CI: 2.5-5.0), and residence in an urban area (aPR=1.4, 95% CI: 1.0-1.9).

Conclusion and Implications: Women living with HIV are at increased risk of cervical cancer and remain a priority population for routine screening. While this group shows higher screening rates, overall coverage remains inadequate. Efforts should focus on enhancing cervical cancer screening literacy and integrating screening into community-based HIV testing programs. Strengthening these initiatives can improve screening uptake and contribute to cervical cancer prevention in low-resource settings.