Precancerous cervical lesions and associated factors among HIV-positive women in Southern and Eastern African countries: A systematic review and meta-analysis
Gebrie Getu Alemu, Astewil Moges Bazezew, Amlaku Nigusie Yirsaw, Wubet Tazeb Wondie, Berihun Agegn Mengistie, Tenagnework Eseyneh Dagnaw, Mekuriaw Nibret Aweke, Nebebe Demis Baykemagn, Gebeyehu Lakew, Bisrat Tewelde GebretsadkanBackground
Women living with HIV (WLHIV) face a sixfold increased risk of cervical cancer compared to HIV-negative women. Most WLHIV residing in the Southern and Eastern African regions have a substantial HIV-related cervical cancer burden. Studies on precancerous cervical lesions (PCCL) and associated factors in WLHIV from these regions have inconsistent and inconclusive findings. Therefore, we aimed to synthesize the pooled prevalence of PCCL and associated factors among WLHIV in Southern and Eastern Africa.
Methods
This study was registered under PROSPERO (CRD420251123583) and conducted in accordance with PRISMA 2020 standards. Primary studies published from inception to 2025 in Southern and Eastern Africa were included. The methodological quality of studies was assessed using the Newcastle-Ottawa scale. Data extraction and statistical analyses were done in Microsoft Excel and STATA 17, respectively. Pooled prevalence, publication bias, subgroup, and sensitivity analysis were conducted. Associations were expressed as odds ratios (OR), and a p-value of less than 0.05 was considered statistically significant.
Results
44 studies met the inclusion criteria, with a sample size of 47,009. The pooled prevalence of PCCL was 22.25% (95% CI: 19.57, 24.93). Age at first sexual intercourse (< 18 years) (OR = 2.99, (2.34, 3.82)), multiparity (OR = 4.97, (3.21, 7.69)), having multiple sexual partners (OR = 3.06 (2.45, 3.83)), having a history of sexually transmitted infections (STI) (OR = 3.93 (3.23, 4.78)), smoking (OR = 7.01, (3.39, 14.49)), ever taking oral contraceptive pills (OR = 2.69, (1.85, 3.90)), low CD4 count (OR = 1.79, (1.56, 2.05)), and having not initiated antiretroviral therapy (ART) (OR = 2.02, (1.56, 2.62)) were significantly associated with an increased risk of PCCL.
Conclusion and recommendations
The pooled prevalence of PCCL was high. Additionally, early first sexual intercourse, parity, STIs, multiple sexual partners, smoking, oral contraceptive use, CD4 count, and ART were positively associated with the occurrence of PCCL. Therefore, stakeholders shall implement interventions to avert future incidents of PCCL and address the identified factors.