Cervical cancer prevention and control strategy in Ethiopia: key informant clinicians’ perspective

Abstract

Cervical cancer is a major public health burden in Ethiopia, ranking second among women and disproportionately affecting HIV-positive individuals. In 2023, an estimated 7445 new cases and 5338 deaths occurred. Such encumbrance escalated as compared with earlier reports, necessitating exploration of challenges and gaps in prevention and control strategies from frontline expert clinicians’ perspectives. A qualitative study design using a descriptive phenomenology strategy was employed to collect data from eight experienced clinicians selected purposively. The study conducted from eight governmental hospitals with a large client flow of HIV patients rendering cervical cancer screening services between September and October 2021 in Ethiopia. Semi-structured interviews were conducted using pre-tested guides, with detailed notes taken and later expanded. The data were translated, coded in Open Code, and analyzed using an inductive thematic analysis approach. Key findings highlighted the implementation of health education and provider training as primary prevention and screening using visual inspection with acetic acid (VIA) and cryotherapy as secondary prevention strategies. Challenges included lack of awareness among women (both HIV-positive and HIV-negative), staff burnout, inconsistent screening algorithms, socio-cultural barriers, and difficulties in follow-up of positive cases, with high loss to follow-up attributed to the asymptomatic nature of cervical cancer and lack of awareness about its severity. Facilitators and recommendations emphasized strengthening awareness through multi-modal approaches, assigning dedicated and trained screening staff, expanding access to screening services, improving follow-up systems, and addressing socio-cultural concerns. Self-sampling was viewed positively as a means to increase screening uptake by reducing fear and privacy-related discomfort, although ensuring specimen quality was considered essential. Evidence from this study identifies a critical need for targeted interventions among women with HIV to overcome current gaps in cervical cancer control. We urge policymakers to leverage these insights to strengthen screening programs and advance the public health goal of eliminating cervical malignancy.