Cervical cancer is the leading malignancy among women in Uganda, with HIV infection increasing risk six-fold. We explored the acceptability of implementing integrated cervical screening in HIV care and a modified referral protocol among health workers in Kampala, Uganda. Key informant interviews were conducted with health workers at least 6 months after the introduction of cervical screening and a modified referral protocol in HIV clinics. During data analysis, we applied the theoretical framework of acceptability, with its seven constructs becoming the thematic areas: affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, self-efficacy and intervention coherence.
A total of 23 key informant interviews were conducted with representatives from each category of health workers in the HIV clinics. They all reported strong support for the intervention but identified barriers that must be addressed to increase the acceptability of its implementation. Under the thematic areas of affective attitude, ethicality and perceived effectiveness of implementing the intervention, it was highly accepted. Regarding intervention coherence, prospective acceptability was high among the doctors and nurses/midwives, low among laboratory technicians, medical records officers and counsellors; however, it improved retrospectively. Under burden, opportunity costs and self-efficacy, increased workload, inadequate knowledge and skills and compromising the quality of HIV care were identified as key barriers limiting the intervention’s acceptability. Health workers recommended scaling up the intervention while prioritising the mitigation of identified barriers in all HIV clinics for widespread acceptance.
Integrating cervical screening in routine HIV care and modifying the usual-care referral protocol to improve access to referral services for screen-positive women are strongly supported by health workers. However, increasing acceptability and ensuring successful implementation require addressing barriers of staff shortages, limited knowledge and skills and potential compromises to existing HIV care among others. Implementation strategies should include context-specific implementation research, ensuring adequate staffing, targeted training and effective referral protocols.
