Background: Cervical cancer screening is a critical public health intervention that facilitate the early detection and treatment of cervical precancerous lesions before they progress to invasive cancer. The effectiveness of this intervention largely depends on timely and consistent adherence to recommended follow-up screenings. However, in Tanzania, the adherence to follow-up screenings, predictors influencing adherence, the screening outcomes and it's associated factors among Women living with HIV (WLHIV), remain poorly understood.
Objective: To determine the proportion of WLHIV who adhered to a follow-up screening, determine predictors of adherence, and determine the screening outcomes and it's associated factors among WLHIV who have undertaken their first screening between 2019 and 2022 in Moshi Municipality.
Methodology: This retrospective cohort study was conducted among WLHIV who have undertaken their first cervical cancer screening between 2019 and 2022 in Moshi Municipality. Data were analyzed using STATA version 18.0. Descriptive statistics were employed to determine the proportion of adherence to follow-up screening and the corresponding screening outcomes. Multivariable logistic regression analysis was used to estimate the predictors of adherence while log-binomial regression was used to determine factors associated with the screening outcomes.
Results: Among 3,076 WLHIV enrolled into the study, only 33.1% adhered to a follow-up screening. Among these, only 21.4% demonstrated good adherence. Also, adherence was higher in private healthcare facilities [aOR=2.55; 95% CI: 2.02–3.22], lower for WLHIV who had their first screening at an outreach facility [aOR=0.19; 95% CI: 0.12–0.29], higher for those who were diagnosed with abnormal screening outcome in the first screening [aOR=8.19; 95% CI: 4.11–16.34]. It also increases with age, and parity. Additionally, 4.2% of WLHIV were diagnosed with abnormal screening outcome in their follow-up screening. Moreover, WLHIV who had abnormal screening in their first screening were more likely to be diagnosed with abnormal screening outcomes again in their follow-up screening [aRR=12.51, 95% CI: 8.92–37.64].
Conclusion: Adherence to follow-up screening among WLHIV in Moshi Municipality was low. Enhancing follow-up mechanisms, and improving the treatment for precancerous lesions are vital to strengthen adherence and minimize abnormal screening outcomes in a follow-up visit.
Keywords:  Cervical cancer screening, Follow-up, Adherence, Screening outcome, WLHIV.