# The cervical cancer screening and precancer treatment journey: a qualitative study of experiences among Zambian women living with and without HIV

## TL;DR

This study explores the cervical cancer screening and treatment experiences of Zambian women, including those living with HIV, to identify barriers and solutions for improving care access.

## Contribution

The study provides novel insights into the care-seeking journey and systemic challenges in cervical cancer screening and treatment in Zambia.

## Key findings

- Women's care-seeking journey involved five stages, with fear and logistical barriers affecting timely access.
- Healthcare worker support and social networks facilitated screening, while rural areas faced diagnostic delays.
- Systemic improvements like lab capacity and community engagement are needed for equitable care.

## Abstract

Zambia has the third highest cervical cancer incidence rate globally, and it remains the leading cause of cancer-related death among women. We explored the experiences of Zambian women who accessed cervical cancer screening and precancer treatment services to understand factors influencing care-seeking and access across urban, peri-urban, and rural settings.

In 2020, we conducted eight focus group discussions with women living with and without Human Immunodeficiency Virus (HIV) who underwent cervical cancer screening between 2016 and 2020. To explore their care journey, participants were grouped by screening outcome—those with cervical precancerous lesions and those without. We also conducted 18 in-depth interviews with healthcare workers providing antiretroviral treatment, cervical cancer screening, or precancer treatment at government health facilities. Transcripts were coded and analyzed using thematic analysis.

Care-seeking unfolded across five stages: recognition of need to screen, hesitation and consultation, screening, result interpretation, and treatment. Women were generally knowledgeable about cervical cancer and sought screening promptly, though some delayed due to fear. Social networks and interactions with healthcare workers facilitated screening, while logistical and financial barriers, along with delays in histopathology services particularly in rural areas, hindered access to timely diagnosis and treatment.

Improving cervical cancer screening and precancer treatment in Zambia requires addressing systemic inefficiencies by strengthening laboratory capacity, decentralizing diagnostics, and training healthcare workers to provide respectful, consistent counselling. Expanding community engagement to counter misinformation, leveraging social networks, and providing financial protection are also critical to ensuring timely, equitable, and reassuring care.