Cervical Cancer Care Seeking Journey: A Qualitative Study of Care-seeking Experiences Among Zambian Women Living With and Without HIV

Abstract

Background Zambia has the third highest cervical cancer incidence rate globally, which remains the leading cause of cancer related death among women. We explored the experiences of Zambian women who accessed cervical cancer services to understand care seeking behavior and factors influencing access to care in urban, peri-urban and rural settlements in Zambia. Materials and Methods We conducted eight focus group discussions with women living with and without Human Immunodeficiency Virus (HIV) who had been screened for cervical cancer, and eighteen in-depth interviews with healthcare workers providing antiretroviral treatment (ART) or cervical cancer screening and treatment services at government health facilities in 2020. We coded and analyzed transcripts using thematic analysis. Results The majority of women were knowledgeable about cervical cancer and sought care promptly upon recognizing the need for screening, except for a few women who delayed seeking care until they overcame their fear through encouragement from their social networks. Despite a few reported challenges such as distance to the facility, transport costs, and waiting time, screening experiences were largely positive as women were received well and guided through the screening process by healthcare workers. However, for women who needed histopathology services, laboratory inefficiencies and financial constraints particularly in the rural areas delayed diagnosis and prevented timely access to treatment. Conclusion To improve uptake and access to cervical pre-cancer services, interventions should intensify cervical cancer sensitization, capitalize on the positive influence of social networks and healthcare workers, address health system inefficiencies, and allocate resources to counter structural barriers.