title: Risk factors for VIA positivity and determinants of screening attendances in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  Tanzania is among the countries in the world where the cervical cancer incidence is estimated to be highest. Acknowledging an increase in the burden of cervical cancer, VIA was implemented as a regional cervical cancer screening strategy in Tanzania in 2002. With the aim of describing risk factors for VIA positivity and determinants of screening attendances in Tanzania, this paper present the results from a comparative analysis performed among women who are reached and not reached by the screening program".
  
  
  METHODS
  14 107 women aged 25-59 enrolled in a cervical cancer screening program in Dar es Salaam in the period 2002 - 2008. The women underwent VIA examination and took part in a structured questionnaire interview. Socioeconomic characteristics, sexual behavior, HIV status and high-risk (HR) HPV infection were determined in a subpopulation of 890 who participated and 845 who did not participate in the screening.
  
  
  RESULTS
  Being widowed/separated OR=1.41 (95% CI: 1.17-1.66), of high parity OR=3.19 (95% CI: 1.84-5.48) of low education OR= 4.30 (95% CI: 3.50-5.31) and married at a young age OR=2.17 (95% CI: 1.37-3.07) were associated with being VIA positive. Women who participated in the screening were more likely to be HIV positive OR=1.59 (95% CI. 1.14-2.25) in comparison with women who had never attended screening, while no difference was found in the prevalence of HR-HPV infection among women who had attended screening and women who had not attended screening.
  
  
  CONCLUSIONS
  Women who are widowed/separated, of high parity, of low education and married at a young age are more likely to be VIA positive and thus at risk of developing cervical cancer. The study further documents that a referral linkage between the HIV care and treatment program and the cervical cancer screening program is in place in the setting studied, where HIV positive were more likely to participate in the cervical cancer screening program than HIV negative women.
authors.affiliation: Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Crispin
authors.initials: C
authors.lastname: Kahesa
authors.forename: Susanne Kruger
authors.initials: SK
authors.lastname: Kjaer
authors.forename: Twalib
authors.initials: T
authors.lastname: Ngoma
authors.forename: Julius
authors.initials: J
authors.lastname: Mwaiselage
authors.forename: Myassa
authors.initials: M
authors.lastname: Dartell
authors.forename: Thomas
authors.initials: T
authors.lastname: Iftner
authors.forename: Vibeke
authors.initials: V
authors.lastname: Rasch
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections; D036301:Qualitative Research; D012307:Risk Factors; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D013636:Tanzania; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*