Evaluation of cervical cancer prevention program in HIV/AIDS care and treatment clinics in Dar es Salaam, Tanzania

Abstract

Background: Cervical cancer is the most common cancer among women worldwide. According to WHO, globally cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570 000 women were diagnosed with cervical cancer worldwide and about 311 000 women died from the disease(1). It is the most commonly diagnosed cancer in 28 countries and the leading cause of cancer-related deaths in 42 countries, the majority of which are in Sub-Saharan Africa(2). In Dar es salaam, Tanzania there is an ongoing cervical cancer prevention program. The cervical cancer prevention program is on its 3rd year of implementation and an evaluation is needed to document its progress towards achieving the objectives. Therefore, the aim of this study is to evaluate the achievement of the objectives of cervical cancer prevention program in Dar es Salaam, Tanzania Materials and Methods: A cross- sectional study design was used to collect data in Dar es Salaam. Participants were 427 women age of (25-49years) who attended HIV care and treatment clinics. Structured questionnaire was used to gather information and data were analysed using Statistical Package for Social Science (SPSS) version 20 software package. Chi-square test was used to find out the differences between variables and p-value of less than 0.05 was considered significant in this analysis. Results: Two hundred and forty-three (58.6%) of the beneficiaries were found to have utilized cervical cancer screening services among the evaluated 33 health facilities which are implementing CECAP in Dar es Salaam. Majority of clients found in clinics during evaluation were married women 188(45.3%), women who have primary education 181 (43.6%) who are doing their own business 131 (31.6%) and aged between 35-39 years (31.69%) Three hundred and fifty-four women (88.67 %) among the studied population. Awareness of cancer screening services aPR 1.65 95% CI=1.43-1.90 p-Value <0.001, business occupation aPR 1.75 95% CI -1.31-2.33 p-Value <0.001 were significantly associated with utilization of cervical cancer screening services. Barriers to utilization included human resource, infrastructures and cost barriers Conclusion and recommendations: This process evaluation found cervical cancer screening services utilization to be 58.6% among beneficiaries found in the clinics at the evaluation time. This achievement is higher than expected target by PEPFAR COP 20 which requires at least 50% of the eligible to be utilize services. The project is at its middle implementation time (3rd of five years) thus giving the expectations of covering all eligible women at its end. Capacity building to staff and client’s sensitization including involvement of community, improvement of infrastructure and strengthening of referral and linkage services is highly recommended