Socioeconomic inequalities in cervical cancer screening uptake among women living with HIV in Ethiopia: findings from the Ethiopian population-based HIV impact assessment survey

Abstract

Abstract Background Although cervical cancer is a preventable disease, its burden remains disproportionately high globally, predominantly affecting women in low- and middle-income countries because of inequalities in the uptake of cervical cancer screening. Women living with HIV are at substantially higher risk of developing cervical cancer because of persistent human papillomavirus infection, yet the uptake of cervical screening is very low. In Ethiopia, there is limited evidence on the underlying socioeconomic inequality in screening uptake. Therefore, this study aimed to assess socioeconomic inequalities in the uptake of cervical cancer screening among women living with HIV in Ethiopia. Methods This study was a secondary analysis of data from the Ethiopia Population-based HIV Impact Assessment (EPHIA) survey conducted in 2017–2018. 361 women living with HIV aged 25 to 49 years were included in the analysis. Survey-weighted analyses were performed to account for the complex sampling design. Socioeconomic inequalities were assessed using equiplot, concentration curves, concentration indices, the slope index of inequality (SII), and the relative index of inequality (RII). Fairlie decomposition analysis was performed to quantify the contribution of sociodemographic characteristics to wealth-related inequalities in cervical cancer screening uptake. Results The overall uptake of cervical cancer screening was 15.5% (95% CI: 11.8%–20.1%). Uptake was higher among wealthier women, increasing from 9.6% in the poorest wealth quintile to 20.4% in the middle wealth quintile, an absolute difference of 10.8% points. The concentration index was 0.077, indicating that screening uptake was slightly concentrated among women with higher socioeconomic status. Fairlie decomposition analysis showed that marital status (49.3%) and residence (61.2%) were the largest contributors to wealth-related inequalities. Conclusion This study found significant inequalities in the uptake of cervical cancer screening among Ethiopian women living with HIV, with relatively low uptake overall. Marital status and residence accounted for most of the wealth-based inequalities in service uptake in this group. Efforts to achieve the WHO cervical cancer elimination goals and comply with national policy will require a more purposeful approach. Emphasis should be placed on developing targeted, equality-focused interventions for women, considering their marital status and residence. Further research should consider these issues to ensure equality access to cervical cancer screening services.