Knowledge and Perceptions of Cervical Cancer Screening in Nhlambeni, Eswatini: Understanding Facilitators and Barriers for Prevention Interventions.

BACKGROUND: Cervical cancer (CC) is a leading cause of cancer mortality in Eswatini. Preventative programs are readily available at the primary health facilities. Recently, the Human Papilloma Virus (HPV) vaccine has been introduced targeting both in- and out-of-school girls ages between 9 and 14 years old. The government of Eswatini has integrated cervical cancer screening into existing services and health activities, especially in HIV clinics, however, the uptake of screening remains low. AIM: This study explored women's perceptions, knowledge, intervention strategies, facilitators and barriers to scaling up cervical cancer prevention in Nhlambeni community in Eswatini. METHODS: A qualitative approach was utilized for this study and key informant semi-structured interviews were conducted in November 2019. Purposive sampling was undertaken in this study and MAX QDA software was utilized for data analysis. RESULTS: In total, 19 key informants were enrolled, the participants were from public facilities 7(37%), non-governmental organization 9 (47%) and patients 3 (16%). The age range for participants was between 25 - 40 years. Five themes were inductive and deductive which included: current interventions that are targeted for cervical cancer screening, women's source of information about cervical cancer screening activities, what promotion strategies could increase cervical cancer screening, understanding about cervical cancer symptoms/diagnosis of cervical cancer and cultural beliefs and attitudes involved in cervical cancer screening activities. CONCLUSIONS: Despite limited knowledge of cervical cancer and misconceptions about screening, the concept of screening for prevention and providers' influence were motivators for participation in screening. Cervical cancer screen-and-treat programs should consider utilizing language that communicates the need for cervical cancer screening and treatment and utilize prevention concepts that may already be familiar to women living there. In order to enhance cervical cancer prevention initiatives, reduce the stigma associated with the disease, and boost cervical cancer screening rates, it is imperative that there be ongoing community education and engagement on cervical cancer, aimed at both men and women.

CONTEXTE: Le cancer du col de l'utérus (CCU) est une cause majeure de mortalité par cancer en Eswatini. Des programmes préventifs sont facilement disponibles dans les établissements de santé primaires. Récemment, le vaccin contre le virus du papillome humain (VPH) a été introduit, ciblant les filles scolarisées et non scolarisées âgées de 9 à 14 ans. Le gouvernement de l'Eswatini a intégré le dépistage du cancer du col de l'utérus dans les services existants et les activités de santé, notamment dans les cliniques VIH, mais l'adhésion au dépistage reste faible. OBJECTIF: Cette étude a exploré les perceptions des femmes, leurs connaissances, les stratégies d'intervention, les facilitateurs et les obstacles à la mise à l'échelle de la prévention du cancer du col de l'utérus dans la communauté de Nhlambeni en Eswatini. MÉTHODES: Une approche qualitative a été utilisée pour cette étude et des entretiens semi-structurés avec des informateurs clés ont été menés en novembre 2019. Un échantillonnage délibéré a été réalisé dans cette étude et le logiciel MAX QDA a été utilisé pour l'analyse des données. RÉSULTATS: Au total, 19 informateurs clés ont été enrôlés, provenant d'établissements publics (7, 37 %), d'organisations non gouvernementales (9, 47 %) et de patients (3, 16 %). La tranche d'âge des participants se situait entre 25 et 40 ans. Cinq thèmes, à la fois inductifs et déductifs, ont été identifiés, notamment : les interventions actuelles ciblées pour le dépistage du cancer du col de l'utérus, les sources d'information des femmes sur les activités de dépistage du cancer du col de l'utérus, les stratégies de promotion susceptibles d'augmenter le dépistage du cancer du col de l'utérus, la compréhension des symptômes du cancer du col de l'utérus/diagnostic du cancer du col de l'utérus et les croyances culturelles et attitudes impliquées dans les activités de dépistage du cancer du col de l'utérus. CONCLUSIONS: Malgré des connaissances limitées sur le cancer du col de l'utérus et des idées fausses sur le dépistage, le concept de dépistage préventif et l'influence des prestataires ont été des moteurs de la participation au dépistage. Les programmes de dépistage et de traitement du cancer du col de l'utérus devraient envisager d'utiliser un langage qui communique la nécessité du dépistage et du traitement du cancer du col de l'utérus et de mettre en œuvre des concepts de prévention qui peuvent déjà être familiers aux femmes vivant là-bas. Afin d'améliorer les initiatives de prévention du cancer du col de l'utérus, de réduire la stigmatisation associée à la maladie et d'augmenter les taux de dépistage du cancer du col de l'utérus, il est impératif de continuer à sensibiliser et à engager la communauté sur le cancer du col de l'utérus, à destination des hommes et des femmes. MOTS-CLÉS: Cancer du col de l'utérus, Dépistage, Connaissances, Interventions et perception.

Eswatini Women´s Knowledge about Cervical Cancer, Data from a Prevention and Awareness Campaign 2021: A Community Based Cross-sectional Campaign.

INTRODUCTION: The increased risk of cervical cancer among HIV+ women is higher compared to HIV - women. A majority of HIV+ care programs offer integrated cervical cancer screening. In Eswatini, the health care system has incorporated two screening modalities, visual acetic acid test and pap smear, into HIV programs. This was a significant strategy to identify women at greater risk for developing cervical cancer. Additionally, leveraging on the trained staff on cervical cancer screening, infrastructure and referral systems for existing services. OBJECTIVE: The aim is to scientifically accompany prevention and awareness campaigns in Eswatini in its real-world settings to obtain (1) a better understanding of cervical cancer knowledge among female participants and (2) to determine the prevalence of screening among women undergoing cervical cancer screening (VIA and Pap smear). METHODS: Community cross-sectional survey among attendees in four regions in Eswatini. Two data collection tools were used: Questionnaires and clinical data from VIA screening. Data were collected from June - October 2021. Age, education and marital status at entry and exit points were assessed to measure the women's awareness of cervical cancer at both points. RESULTS: A total of 450 attendees were interviewed and a total of 414 attendees were screened - 212 through VIA and 202 through pap smear. There was a significant understanding of cervical cancer regardless of education level. A significant variation of more than 90% was observed at the exit point. CONCLUSION: These findings will inform aspects of implementation, including community outreach messaging, health promotion, screening sites and emphasis on accessibility and efficiency of preventative behaviour for women who attend to cervical cancer screening sites.

INTRODUCTION: Le risque accru de cancer du col de l'utérus chez les femmes séropositives est plus élevé par rapport aux femmes séronégatives. La majorité des programmes de soins pour les séropositives offrent un dépistage intégré du cancer du col de l'utérus. Au Swaziland, le système de santé a incorporé deux modalités de dépistage, le test d'acide acétique visuel et le frottis, dans les programmes VIH. Il s'agissait d'une stratégie significative pour identifier les femmes présentant un risque accru de développer un cancer du col de l'utérus. De plus, en tirant parti du personnel formé au dépistage du cancer du col de l'utérus, de l'infrastructure et des systèmes de référence pour les services existants. OBJECTIF: L'objectif est d'accompagner scientifiquement les campagnes de prévention et de sensibilisation au Swaziland dans leur contexte réel pour obtenir (1) une meilleure compréhension des connaissances sur le cancer du col de l'utérus parmi les participantes et (2) déterminer la prévalence du dépistage chez les femmes se soumettant à un dépistage du cancer du col de l'utérus (TAV et frottis). MÉTHODES: Enquête transversale communautaire auprès des participants dans quatre régions du Swaziland. Deux outils de collecte de données ont été utilisés : des questionnaires et des données cliniques du dépistage par TAV. Les données ont été collectées de juin à octobre 2021. L'âge, l'éducation et l'état matrimonial à l'entrée et à la sortie ont été évalués pour mesurer la sensibilisation des femmes au cancer du col de l'utérus aux deux points. RÉSULTATS: Un total de 450 participants ont été interviewés et un total de 414 participants ont été dépistés, 212 par TAV et 202 par frottis. Une compréhension significative du cancer du col de l'utérus a été observée, quel que soit le niveau d'éducation. Une variation significative de plus de 90 % a été observée à la sortie. CONCLUSION: Ces résultats informeront des aspects de la mise en œuvre, notamment la messagerie de sensibilisation communautaire, la promotion de la santé, les sites de dépistage et l'accent mis sur l'accessibilité et l'efficacité des comportements préventifs pour les femmes fréquentant les sites de dépistage du cancer du col de l'utérus. MOTS-CLÉS: Cancer du col de l'utérus, Sensibilisation, Dépistage, Swaziland.

Mandrax use, sexual risk, and opportunities for pre-exposure prophylaxis among out-of-school adolescent girls and young women in Cape Town, South Africa.

BACKGROUND: In South Africa (SA), adolescent girls and young women (AGYW) aged 15 - 24 years account for nearly 25% of all new HIV infections in the country. The intersection of substance use and sexual risk continues to drive the HIV epidemic among AGYW. For example, methaqualone, also known as Mandrax, has sedative effects that may affect women's ability to negotiate condom use during sex, refuse sex without a condom, or consent to sex, thereby increasing their risk for HIV. Consequently, it is critical to understand how Mandrax use affects HIV risk among AGYW and to assess awareness of and willingness to use biomedical HIV prevention methods, such as pre-exposure prophylaxis (PrEP), among AGYW who use Mandrax. OBJECTIVES: To examine the role of Mandrax use in sexual behaviours and investigate the extent to which AGYW who use Mandrax are aware of and willing to initiate PrEP. METHODS: Data for this report were derived from baseline and 6-month follow-up data provided by 500 AGYW participating in a cluster-randomised trial assessing the efficacy of a young woman-focused intervention to reduce substance use and HIV risk. AGYW who self-identified as black African or coloured, reported using substances, reported condomless sex in the past 3 months, and had discontinued school early were recruited from 24 community clusters across Cape Town, SA. Following consent/assent, participants provided biological specimens to test for recent drug use (including Mandrax) and completed the self-report questionnaire. RESULTS: Logistic regression analysis revealed that the AGYW who had a positive test result for Mandrax use were less likely to use a condom with their main partner (p=0.01), and almost three times more likely to use alcohol and/or other drugs before or during their last act of sexual intercourse (p<0.001), compared with the AGYW who had a negative Mandrax test result. Mandrax use was not significantly related to PrEP awareness (p>0.10) or willingness to use PrEP (p>0.10), but 70% of AGYW who used Mandrax were willing to initiate PrEP. CONCLUSION: The study findings highlight how Mandrax use may contribute to HIV risk among SA AGYW. Key decision-makers should consider incorporating substance use prevention efforts into existing HIV reduction programmes and equip youth-friendly clinics with the resources to identify AGYW who use Mandrax and offer them PrEP.

Substance use and depressive and anxiety symptoms among out-of-school adolescent girls and young women in Cape Town, South Africa.

BACKGROUND: There is a high prevalence of substance use among youth in South Africa (SA), and adolescent girls and young women (AGYW) experience high rates of depression and anxiety. Substance use behaviours and mental health are associated with other public health problems among AGYW such as HIV and unintended pregnancy. Therefore, understanding the relationship between substance use and mental health is imperative to improve AGYW's health. OBJECTIVES: To examine the association between heavy drinking, marijuana, methamphetamine and methaqualone (Mandrax) use and depressive and anxiety symptoms among AGYW aged 16 - 19 years who have dropped out of school in Cape Town, SA. METHODS: Data for this report come from the baseline data of 500 participants of an ongoing cluster-randomised trial assessing the efficacy of a young woman-focused intervention to reduce substance use and HIV risk. After AGYW consented/assented to participate, they completed a urine drug screen and a baseline questionnaire. RESULTS: Logistic and negative binomial regressions, controlling for clustering at the neighbourhood level, revealed that frequency of depressive symptoms was significantly and positively related to a positive drug screen for Mandrax (ß=0.07; p=0.03). All other associations between the frequency of depressive symptoms and substance use were not statistically significant (ps>0.05). The associations between frequency of anxiety symptoms and substance use were not statistically significant (ps>0.05). CONCLUSIONS: Our findings highlight the need to address substance use, especially Mandrax use and its associated risk, and depression in an integrated, youth-friendly setting.

Use of mid-upper arm circumference for determining overweight and overfatness in children and adolescents.

OBJECTIVE: To assess the use of mid-upper arm circumference (MUAC) for identification of overweight and overfatness in rural South African children and adolescents. METHODS: Anthropometric data (weight, height, MUAC and % body fat) from a cross-sectional sample of 978 black South African 5-14-year-olds were analysed. Receiver operating characteristic (ROC) curve analysis determined the validity of MUAC as a proxy for determining overweight and overfatness. FINDINGS: Area under the curve (AUC) results were generally high. Boys and girls aged 10-14 years had ROC-AUC for overfatness classed as 'excellent', 0.97 and 0.98 respectively. Cut-points in the MUAC distribution which optimised the ROC-AUC for identification of overfatness and obesity were determined for boys and girls aged 5-9 and 10-14 years, and had high sensitivity and specificity. CONCLUSIONS: MUAC may have potential for clinical and surveillance applications as an accurate yet simple and widely available indicator of overweight and overfatness in children and adolescents in resource-poor settings.

Successful paediatric HIV treatment in rural primary care in Africa.

OBJECTIVE: Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme. DESIGN: Clinical cohort. SETTING: KwaZulu-Natal, South Africa. PATIENTS: HIV-infected children aged 60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1). CONCLUSIONS: Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.