Risk factors associated with cervical cancer diagnosis among women living with HIV: a modified poisson regression analysis

Abstract

Cervical cancer is a leading cancer among women, with approximately 570,000 new cases and 311,000 deaths annually. Women living with HIV face a sixfold higher risk of developing cervical cancer than those without HIV. However, the specific risk factors in this population remain underexplored in Uganda. The main objective was to examine factors associated with cervical cancer among women living with HIV in Kampala, Uganda. Secondary data of 307 records at the Centre registry on cervical cancer among women living with HIV, screened for cervical cancer between 1st January 2021 to 31st July 2022 were retrieved. A modified Poisson regression model was fitted to examine factors associated with cervical cancer among women living with HIV in Kampala, Uganda. The findings are reported as adjusted Risk Ratios (aRR) with the 95% Confidence Intervals (CI). The overall positivity rate for cervical cancer in this study was 11.4%. The results indicate that women living with HIV who had multiple sexual partners had a significantly higher likelihood of testing positive for cervical cancer (aRR = 1.03; 95% CI: 1.01 - 1.15) compared to those with one or no sexual partner. Similarly, women with a history of STIs other than HIV had an increased risk (aRR = 1.07; 95% CI: 1.01 - 1.13) compared to those without such a history. Notably, an interaction between multiple sexual partners and history of STIs other than HIV revealed that women with both risk factors had an even higher likelihood of screening positive (aRR = 1.16; 95% CI: 1.06 - 1.28), suggesting a compounded risk. Conversely, the risk of cervical cancer was significantly lower among women with a history of contraceptive use (aRR = 0.91; 95% CI: 0.85 - 0.98) and those with a CD4 count of at least 200 cells/mm³ (aRR = 0.92; 95% CI: 0.87 - 0.98) compared to their respective counterparts. This study underscores the role of behavioral and clinical factors in cervical cancer risk among women living with HIV in Uganda. Raising awareness about risky sexual behaviors, such as having multiple sexual partners, is essential. Integrating safe sex education and routine STI screening into HIV/AIDS care services is recommended. Future studies with larger sample sizes are needed to enhance statistical power and reliability. Additionally, further research should explore the interaction between HIV/AIDS, CD4 count, and different contraceptive methods in relation to cervical cancer risk.