Prior Cervical Cancer Screening, Social Determinants of Health, and HIV Status Among Patients at the Cancer Disease...

Cervical cancer screening uptake remains very low in sub-Saharan Africa, particularly in Zambia, where limited access results in high cervical cancer mortality. Social determinants of health (SDOH) are among the factors influencing low screening rates. Women living with HIV (WLHIV) are especially vulnerable due to additional risk factors. Although Zambia has expanded screening programs into HIV clinics, the impact of SDOH on screening uptake is not well understood. This study investigated the relationship between prior cervical cancer screening, SDOH, and HIV amongst diagnosed cervical cancer patients at the Cancer Disease Hospital (CDH) in Zambia.

Newly diagnosed, untreated patients aged ≥ 18 years who presented to CDH for treatment for histologically confirmed cervical cancer between 2022 and 2026 were enrolled in a prospective, IRB-approved cohort and responded to a health-related social needs questionnaire. We constructed an SDOH score using the 5 Healthy People 2030 domains: economic stability, education, health/substance use, neighborhood and built environment, and social and community context. The association between prior cervical cancer screening and SDOH score was analyzed using logistic regression models overall and stratified by HIV status.

A total of 464 patients were enrolled (median age 50 y [IQR:43-57]). Of these patients, 215 (46.3%) reported having undergone prior screening, 178 (46.4%) had advanced-stage cancer (stage III/IV), and 251 (54.1%) were WLHIV. Early cancer stage (stage I/II) was associated with having undergone prior screening (p = 0.017). A higher proportion of screened individuals were 50-59 years of age (p = 0.001) compared to other age groups. Having education about and knowledge of cervical cancer was associated on unadjusted analysis with prior screening. On adjusted analysis for HIV status and age, patients with lower SDOH scores (indicating less disadvantage) had 2.21 times higher odds of having undergone prior screening than women with higher SDOH scores (p < 0.001). Additionally, WLHIV had 2.72 times higher odds of having undergone prior screening compared to women without HIV (p < 0.001).

Age, SDOH, and HIV status were associated with having undergone prior cervical cancer screening. Further research is warranted to understand barriers to screening and to explore the acceptance of screening among women without HIV in Zambia.