{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:30:03Z","timestamp":1753893003249,"version":"3.41.2"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Women living with HIV (WLHIV) face a significantly elevated risk of invasive cervical cancer, an AIDS-defining malignancy. Integrated cervical cancer screening (CCS) and HIV care are essential for optimal management; however, these services remain largely unintegrated in Ethiopia, resulting in low screening coverage. This study aimed to explore the barriers and facilitators to integrating CCS and preventive treatment services within antiretroviral therapy (ART) follow-up clinics for WLHIV in Northwest Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A phenomenological study was conducted from January to April 2023 among 33 participants across nine purposively selected health facilities in Northwest Ethiopia. Data were collected using focus group discussions and in-depth key informant interviews. Audio-recorded data were transcribed, translated, and coded, followed by thematic analysis using Atlas. Ti 7 software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Key barriers to integration included inadequate facilities, a shortage of dually trained clinicians, low healthcare provider motivation, the absence of integration policies, and a lack of evidence on integration effectiveness. Facilitators included the accessibility of free ART and CCS services, the simplicity of the visual inspection with acetic acid (VIA) screening method, the availability of staff trained in either ART or CCS, and patient familiarity with ART providers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Integrating cervical cancer screening with HIV care in Northwest Ethiopia encounters substantial obstacles, including facility limitations, clinician training deficits, motivational issues, policy gaps, and a lack of evidence. However, accessible services, the VIA method\u2019s simplicity, and existing staff training provide opportunities for successful integration. Addressing these barriers and leveraging facilitators is crucial to improve integrated service delivery and reduce related mortality among WLHIV.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1552524","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T05:30:49Z","timestamp":1750311049000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and facilitators to the integration of cervical cancer screening and treatment service with antiretroviral therapy follow-up clinics for women living with HIV in Northwest Ethiopia: a qualitative study"],"prefix":"10.3389","volume":"13","author":[{"given":"Kelemework Gashinet","family":"Ferede","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Addisu Gasheneit","family":"Ferede","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asiya Mohammed","family":"Abdu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Birhaneslasie Gebeyehu","family":"Yazew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zewdu Bishaw","family":"Aynalem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eneyew Talie","family":"Fenta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Shitu","family":"Mekonnen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berihun","family":"Bantie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gebiyaw Wudie","family":"Tsegaye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"volume-title":"Inside knowledge about gynecologic cancer","year":"2018","key":"ref1"},{"volume-title":"Cervical cancer elimination initiative: from call to action for a global movement","year":"2020","key":"ref2"},{"volume-title":"Overview of cervical cancer, syptom and causes","year":"","key":"ref3"},{"volume-title":"American sexual health association","year":"2022","article-title":"Stages of cervical cancer","key":"ref4"},{"volume-title":"Cervical cancer overview","year":"","key":"ref5"},{"volume-title":"First blobal estimates of cervical cancer attributable to HIV","year":"2022","key":"ref6"},{"volume-title":"The little-known links between cervical cancer and HIV","year":"2019","key":"ref7"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e161","DOI":"10.1016\/S2214-109X(20)30459-9","article-title":"Estimates of the global burden of cervical cancer associated with HIV","volume":"9","author":"Stelzle","year":"2021","journal-title":"Lancet Glob Health."},{"volume-title":"WHO releases new estimates of the global burden of cervical cancer associated with HIV [202]","year":"","key":"ref9"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"505","DOI":"10.3322\/caac.21696","article-title":"Cervical cancer prevention and control in women living with human immunodeficiency virus","volume":"71","author":"Castle","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1002\/ijc.33841","article-title":"Age-specific burden of cervical cancer associated with HIV: a global analysis with a focus on sub-Saharan Africa","volume":"150","author":"Ibrahim Khalil","year":"2022","journal-title":"Int J Cancer"},{"volume-title":"Global strategy to accelerate the elimination of cervical cancer as a public health problem","year":"2020","key":"ref12"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1073274818797955","DOI":"10.1177\/1073274818797955","article-title":"Malignancy trends in HIV-infected patients over the past 10 years in a single-center retrospective observational study in the United States","volume":"25","author":"Rihana","year":"2018","journal-title":"Cancer Control"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1002\/ijc.32260","article-title":"Cervical cancer risk in women living with HIV across four continents: a multicohort study","volume":"146","author":"Rohner","year":"2020","journal-title":"Int J Cancer"},{"volume-title":"HIV infection and malignancy: management considerations","year":"2023","key":"ref15"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1177\/0956462413491735","article-title":"Incidence and progression of cervical lesions in women with HIV: a systematic global review","volume":"25","author":"Denslow","year":"2014","journal-title":"Int J STD AIDS"},{"key":"ref17","first-page":"e1224","article-title":"Cervical cancer in women living with HIV: a review of the literature","volume":"6","author":"D\u2019andrea","year":"2019","journal-title":"World Cancer Res J."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"7071925","DOI":"10.1155\/2020\/7071925","article-title":"Cervical cancer screening uptake and associated factors among HIV-positive women in Ethiopia: a systematic review and meta-analysis","volume":"2020","author":"Dessalegn Mekonnen","year":"2020","journal-title":"Adv Prev Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13027-020-00334-3","article-title":"Uptake of cervical cancer screening service and associated factors among age-eligible women in Ethiopia: systematic review and meta-analysis","volume":"15","author":"Ayenew","year":"2020","journal-title":"Infect Agents Cancer"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1089\/jwh.2019.7858","article-title":"Economic and humanistic burden of cervical cancer in the United States: results from a nationally representative survey","volume":"29","author":"Shah","year":"2020","journal-title":"J Women's Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"3749","DOI":"10.1200\/JCO.2016.67.9613","article-title":"HIV infection and survival among women with cervical cancer","volume":"34","author":"Dryden-Peterson","year":"2016","journal-title":"J Clin Oncol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/s40615-020-00751-5","article-title":"Racial\/ethnic disparities in the burden of HIV\/cervical cancer comorbidity and related in-hospital mortality in the USA","volume":"8","author":"Salihu","year":"2021","journal-title":"J Racial Ethn Health Disparities"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.2147\/CMAR.S352389","article-title":"The socioeconomic impact of cervical cancer on patients in Ethiopia: evidence from tikur anbessa specialized hospital","author":"Endale","year":"2022","journal-title":"Cancer Manag Res"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"6668","DOI":"10.3390\/ijerph19116668","article-title":"Psychological and social impact of HIV on women living with HIV and their families in low-and middle-income Asian countries: A systematic search and critical review","volume":"19","author":"Fauk","year":"2022","journal-title":"Int J Environ Res Public Health."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"651","DOI":"10.14423\/smj.0000000000001184","article-title":"Trends in premature deaths among women living with HIV\/AIDS and cervical Cancer","volume":"113","author":"Oduguwa","year":"2020","journal-title":"South Med J"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1159\/000502824","article-title":"A meta-analysis on human papillomavirus type distribution among women with cervical neoplasia in the WHO eastern mediterranean region","volume":"62","author":"Shoja","year":"2019","journal-title":"Intervirology"},{"volume-title":"New World health organization\u2019s recommendations on the screening and treatment to prevent cervical cancer among women living with HIV","year":"2021","key":"ref27"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"176","DOI":"10.4103\/0300-1652.114590","article-title":"Integrating cervical cancer screening with HIV care in a district hospital in Abuja, Nigeria","volume":"54","author":"Odafe","year":"2013","journal-title":"Niger Med J"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e0181156","DOI":"10.1371\/journal.pone.0181156","article-title":"Integrating cervical cancer with HIV healthcare services: a systematic review","volume":"12","author":"Sigfrid","year":"2017","journal-title":"PLoS One"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1002\/ijgo.12025","article-title":"Costs of integrating cervical cancer screening at an HIV clinic in Kenya","volume":"136","author":"Vodicka","year":"2017","journal-title":"Int J Gynecol Obstet"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12905-015-0183-4","article-title":"Integration of HIV and cervical cancer screening perceptions and preferences of communities in Uganda","volume":"15","author":"Kumakech","year":"2015","journal-title":"BMC Womens Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"iv13","DOI":"10.1093\/heapol\/czw149","article-title":"Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review","volume":"32","author":"Watt","year":"2017","journal-title":"Health Policy Plan"},{"volume-title":"Guideline for cervical cancer prevention and control in Ethiopia","year":"2015","key":"ref33"},{"volume-title":"National guidelines for comprehensive HIV prevention, care and treatment","year":"2022","key":"ref34"},{"volume-title":"Annual report of Awi Zone health department","year":"2022","key":"ref35"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"160","DOI":"10.3389\/fonc.2016.00160","article-title":"Challenges in prevention and care delivery for women with cervical cancer in sub-Saharan Africa","volume":"6","author":"Randall","year":"2016","journal-title":"Front Oncol"},{"key":"ref37","doi-asserted-by":"crossref","DOI":"10.1136\/sextrans-2015-052270.593","volume-title":"Barriers and facilitators to uptake of cervical cancer screening among clients attending integrated HIV\/sexual and reproductive health clinics in Zimbabwe","author":"Sibanda","year":"2015"},{"volume-title":"Exploring effective approaches of integrating cervical screening services into the normal routine care within HIV clinics: a qualitative study in a Ugandan community health facility","year":"2021","author":"Auma","key":"ref38"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"5","DOI":"10.5334\/ijic.3068","article-title":"Barriers to the integration of care in inter-organisational settings: a literature review","volume":"18","author":"Auschra","year":"2018","journal-title":"Int J Integr Care"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e0003183","DOI":"10.1371\/journal.pgph.0003183","article-title":"Integration of cervical cancer screening into healthcare facilities in low-and middle-income countries: a scoping review","volume":"4","author":"Kassa","year":"2024","journal-title":"PLoS Glob Public Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"S29","DOI":"10.1016\/j.ijgo.2013.02.002","article-title":"Sexual and reproductive health and HIV services: integrating HIV\/AIDS and cervical cancer prevention and control","volume":"121","author":"Belhadj","year":"2013","journal-title":"Int J Gynecol Obstet"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1186\/s12905-021-01331-3","article-title":"Health workers\u2019 perspectives on barriers and facilitators to implementing a new national cervical cancer screening program in Ethiopia","volume":"21","author":"Lott","year":"2021","journal-title":"BMC Womens Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"S21","DOI":"10.1097\/QAD.0000000000001885","article-title":"Opportunities and challenges for evidence-informed HIV-noncommunicable disease integrated care policies and programs: lessons from Malawi, South Africa, Swaziland and Kenya","volume":"32","author":"Mwagomba","year":"2018","journal-title":"AIDS"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1247121","DOI":"10.3389\/fpubh.2023.1247121","article-title":"Facilitators and barriers to integration of noncommunicable diseases with HIV care at primary health care in Ethiopia: a qualitative analysis using CFIR","volume":"11","author":"Badacho","year":"2023","journal-title":"Front Public Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1080\/09540121.2014.894617","article-title":"Perceptions of barriers and facilitators to cervical cancer screening among low-income, HIV-infected women from an integrated HIV clinic","volume":"26","author":"Fletcher","year":"2014","journal-title":"AIDS Care"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e0217331","DOI":"10.1371\/journal.pone.0217331","article-title":"Estimating the costs of HIV clinic integrated versus non-integrated treatment of pre-cancerous cervical lesions and costs of cervical cancer treatment in Kenya","volume":"14","author":"Vodicka","year":"2019","journal-title":"PLoS One"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1186\/s12913-023-09326-6","article-title":"Acceptability of integration of cervical cancer screening into routine HIV care, associated factors and perceptions among HIV-infected women: a mixed methods study at Mbarara regional referral hospital, Uganda","volume":"23","author":"Ninsiima","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"A228.3","DOI":"10.1136\/sextrans-2015-052270.593","article-title":"P17. 15 barriers and facilitators to uptake of cervical cancer screening among clients attending integrated hiv\/sexual and reproductive health clinics in Zimbabwe","volume":"91","author":"Sibanda","year":"2015","journal-title":"BMJ"},{"volume-title":"The role of health services integration in healthcare system performance: a case of HIV\/AIDS and NCD services in Nakuru County, Kenya","year":"2024","author":"Njuguna","key":"ref49"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1552524\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T05:30:55Z","timestamp":1750311055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1552524\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":49,"alternative-id":["10.3389\/fpubh.2025.1552524"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1552524","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2025,6,19]]},"article-number":"1552524"}}