DOI: 10.1200/go-26-26000 ISSN: 2687-8941

Structural and Socioeconomic Barriers to Cervical Cancer Screening Uptake Among Women Living With HIV in Nigeria

Nzube Ekpunobi, Ngozi Idemili-Aronu, John Olawepo, Gregory Aarons, Echezona Ezeanolue
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PURPOSE

Women living with HIV (WLHIV) in Nigeria face an elevated risk of cervical malignancy, and despite the availability of screening services, screening remains suboptimal. This study aims to quantify screening uptake and identify the primary structural and socioeconomic barriers to access in a multicenter cohort.

METHODS

A cross-sectional analysis was conducted using REDCap-collected data from WLHIV across 12 facilities in Nigeria. We utilized descriptive statistics to measure uptake and logistic regression to assess the association between socio-economic factors and screening history.

RESULTS

A total of 4,613 WLHIV were included. Overall, 35.3% (n = 1,628) reported ever undergoing cervical cancer screening, while 64.7% (n = 2,985) had never been screened. Most participants were within the reproductive age group, with a large proportion having primary or no formal education, and many reporting low household income. Contrary to expectations, screening uptake did not differ significantly by educational attainment or income level. While tertiary education was significantly associated with higher disease knowledge, it did not significantly increase the odds of actual screening uptake in this cohort (AOR = 0.99; 95% CI: 0.85 to 1.15; P = .924). Among those unscreened, several structural barriers were evident, including the cost of screening (5.8%), distance to screening centers, and lack of provider recommendation. However, the dominant structural barrier was the absence of a physician’s recommendation, cited by 44.0% of respondents. These barriers were frequently reported among women who had never been screened. Additionally, variability in screening uptake across facilities suggests differences in service availability and implementation strength.

CONCLUSION

Cervical cancer screening uptake among WLHIV in Nigeria remains suboptimal, with nearly two-thirds never screened and largely dependent on provider initiation rather than patient education alone. Socioeconomic disadvantage and structural barriers, such as cost and access, significantly limit uptake. To improve outcomes, health systems must transition to provider-initiated screening models and integrate low-cost cervical cancer services into routine HIV care.

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