Determinants of precancerous cervical lesion among HIV positive women on ART in Awi zone public health facilities, Northwest Ethiopia, 2024

Cervical cancer remains a major public health concern among women living with HIV in low‑ and middle‑income countries. Immunosuppression increases susceptibility to persistent human papillomavirus infection and progression to precancerous cervical lesions. Identifying modifiable risk factors is essential to guide prevention and early intervention strategies. The study aimed to identify determinants of precancerous cervical lesions among HIV‑positive women receiving antiretroviral therapy in selected public health facilities of Awi Zone, Northwest Ethiopia, 2024. An institutional‑based unmatched case–control study was conducted from April 2 to June 29, 2024 among 411 women (102 cases and 309 controls). Cases were HIV‑positive women with a positive visual inspection with acetic acid (VIA) result, while controls were HIV‑positive women with a negative VIA result. Data were collected using interviewer‑administered questionnaires and medical record reviews. Data were entered into EpiData 4.6 and analyzed using SPSS version 25. Binary and multivariable logistic regression analyses were performed to identify determinants. Adjusted odds ratios with 95% confidence intervals were used to determine statistical significance at p < 0.05. Early sexual initiation (< 18 years) (AOR = 1.98, 95% CI: 1.15–3.42), history of sexually transmitted infection (AOR = 3.79, 95% CI: 2.26–6.38), duration since HIV diagnosis ≥ 6 years (AOR = 2.91, 95% CI: 1.53–5.53), and baseline viral load ≥ 1000 copies/ml (AOR = 1.89, 95% CI: 1.15–3.12) were significantly associated with precancerous cervical lesions. Behavioral and clinical factors were important predictors of precancerous cervical lesions among HIV‑positive women. Strengthening STI prevention, early screening, and viral load monitoring is recommended to reduce disease burden.