“By the time they run into the hospital, their life is already at stake”: a qualitative study of healthcare professional perceptions on priorities for cervical cancer policy in Uganda

Cervical cancer (CxCa) incidence in Uganda is three times the global average and a leading cause of mortality for women. While there is funding and infrastructure to support HIV control in Uganda, these are not in place for CxCa prevention and control. This study was conducted to explore the knowledge and perceptions of HIV professionals in Uganda to identify perceived barriers and facilitators to CxCa screening and treatment among women living with HIV (WLHIV) as a basis to guide and inform policies and programs for CxCa prevention and control, including service integration. This study used qualitative interviews to obtain primary data from professionals working in the HIV field in Uganda conducted from September 2020 to January 2022. Participants were identified through purposive and snowball sampling and consulted with colleagues at local service and academic agencies in Kampala. Both written and verbal informed consent was obtained. Hour-long interviews were conducted virtually and in person and recorded. Interviews consisted of open-ended questions exploring perspectives on, knowledge about, and practices surrounding HPV and CxCa among WLHIV in Uganda. Transcripts were analyzed and coded via MAXQDA software to identify facilitators and barriers to HPV vaccination, CxCa screening and treatment. Fifty key informant (KI) interviews were conducted. Analysis revealed two themes regarding priorities for cervical cancer policy in Uganda after KIs reflected on improving barriers to CxCa care. These were: (1) decentralization of care through integration of services and (2) leadership on a national level by increasing funding and organizing advocacy initiatives. Practical recommendations identified by KI that derived from these themes included leveraging community institutions and mass media campaigns to target misconceptions surrounding screening, making CxCa screening opt-out and integrated with HIV care, strengthening a centralized database, organizing mass roll-out of self-testing, and organizing training of healthcare workers. Key informants call for solutions that address individual, community, and national barriers of cervical cancer care and emphasize the need for a strong national cervical cancer policy to coordinate currently fragmented services and the political will to adequately fund these.