Non-clearance of cervical precancerous lesions and associated factors among women living with HIV in Uganda, 2020-2023.

Objectives

We assessed the proportion of women living with HIV (WLHIV) with non-clearance of cervical precancerous lesions following a positive visual inspection with acetic acid (VIA) test, and treatment in Uganda from October 2020 to September 2023, and examined associated factors.

Methods

Cervical precancerous lesions were defined by a positive VIA result. Non-clearance was defined as a positive VIA result one year after screening and treatment. Treatment modalities included thermocoagulation, loop electrosurgical excision procedure (LEEP), and cryotherapy. We used a two-stage stratified cluster sample design and applied sampling weights to account for differential selection probabilities. All reported percentages and statistical estimates are weighted unless otherwise specified. Factors associated with non-clearance were assessed using modified Poisson regression, with adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Treatment type was analyzed descriptively due to small numbers of women receiving cryotherapy and LEEP.

Results

Mean age was 36.3 years (standard deviation [SD]=7.6), and mean duration on antiretroviral therapy (ART) was 7.5 (SD=4.9) years. Most participants 807 (95.5%) were on first-line ART, and 770 (91.1%) were virally suppressed. Non-clearance was 17.1% (95% CI:10.3%-27.01%). Non-clearance was associated with second line ART (aRR=3.54, 95% CI: 2.40-5.23), p<0.01) and urban residence (aRR=1.68, 95% CI:1.00-2.83, p=0.049).

Conclusion

Non-clearance occurred in 17.1% of WLHIV, a proportion consistent with rates reported in comparable studies among women living with HIV. Second-line ART was significantly associated with non-clearance, and urban residence showed a borderline association. These findings highlight the need to further explore these factors in order to optimize treatment outcomes in this population.