Determinants of cervical cancer screening among women living with HIV in Lesotho using nationally representative 2023/24 DHS data

Women living with HIV are more prone to develop cervical cancer since they have a compromised immune system; hence, they need to be screened continuously in an attempt to identify and prevent it. Despite Lesotho's high HIV prevalence (25.6%), cervical cancer screening coverage and its determinants among women living with HIV remain insufficiently characterized. This study aimed to quantify the rate and determinants of cervical cancer screening among women living with HIV using the 2023/24 Lesotho DHS data. Cross-sectional analysis was performed using the Lesotho DHS Individual Women's Recode file. A weighted sample of 611 HIV-positive women aged 25 years and older participated in the study, as this age group is eligible for cervical cancer screening. Individual and community-level factors were determined using multilevel mixed-effects logistic regression. The level of significance was determined by the 95% confidence interval and a p value less than 0.05 for associations. The total prevalence of cervical cancer screening among women living with HIV was 85.4%. Women aged 40-44 years (adjusted odds ratio AOR 4.14; 95% confidence interval CI 1.53-11.18) and those who had a clinical breast exam (AOR 5.53; 95% CI 2.54-12.05) were more likely to undergo cervical cancer screening, whereas low parity (AOR 0.19; 95% CI 0.05-0.78) and rural residence (AOR 0.50; 95% CI 0.25-0.99) were associated with lower odds of screening. Adoption of cervical cancer screening among women living with HIV in Lesotho is high, with most screened women receiving normal results. Screening uptake varied by demographics, being higher among older women and those who had breast examinations, while lower among women with low parity and rural residents. Integration of breast and cervical cancer screening, rural outreach targeting, and health education for low-parity women can increase coverage and equity.