ArticleBMJ open2026
Adherence to follow-up cervical cancer screening and its predictors among women living with HIV in Moshi municipality, Tanzania: a hospital-based retrospective cohort study (2019-2024).
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe effectiveness of cervical cancer screening as a preventive strategy for cervical cancer substantially depends on timely and consistent adherence to recommended follow-up screenings. This study aimed to determine adherence to the recommended follow-up cervical cancer screening, characterise the timing of adherence and determine its associated predictors among women living with HIV (WLHIV) who undertook their first screening between 2019 and 2021 in Moshi Municipality, northern Tanzania.
designWe conducted a retrospective cohort study between 2019 and 2021.
settingHealthcare facilities in Moshi municipality, Kilimanjaro region, northern Tanzania.
participants2030 WLHIV who undertook their first screening in healthcare facilities in Moshi municipality between 2019 and 2021. PRIMARY OUTCOME MEASURES: Adherence to a follow-up cervical cancer screening, defined as the subsequent screening test conducted to detect precancerous development in the cervix carried out after the first screening. For the sub-analysis assessing the timing of adherence to a follow-up screening, this outcome was further categorised into four distinct categories: early adherence, good adherence, poor adherence, extremely poor adherence based on the time elapsed between the first screening and subsequent follow-up screening. Predictors of adherence were assessed using multivariable Poisson regression models with robust SEs and reported as adjusted risk ratios (ARR) with 95% CIs.
resultsAmong 2030 WLHIV who undertook the first screening, only 33.2% adhered to a follow-up screening. Among these, only 21.4% (95% CI 18.4% to 24.7%) demonstrated good adherence, meaning they attended a follow-up within a month after the scheduled date. Also, adherence was higher in private healthcare facilities (ARR=1.57; 95% CI 1.35 to 1.82), lower for WLHIV who had their first screening at outreach facilities (ARR=0.28; 95% CI 0.19 to 0.39) and higher for those who were diagnosed with an abnormal screening outcome in their first screening (ARR=2.62; 95% CI 2.26 to 3.05). Adherence also increased with age and parity.
conclusionAdherence to follow-up cervical cancer screening among WLHIV in Moshi municipality was suboptimal, with only one-third of WLHIV adhering to these screenings. Strengthening recall systems particularly in public and outreach facilities and implementing targeted interventions for younger WLHIV, those with no or fewer children and those who had normal screening outcomes in the first screening is essential to improve adherence to recommended follow-up screening.
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