title: Integrating HIV testing into cervical cancer screening in Tanzania: an analysis of routine service delivery statistics.
abstract: BACKGROUND
  While the lifetime risk of developing cervical cancer (CaCx) and acquiring HIV is high for women in Tanzania, most women have not tested for HIV in the past year and most have never been screened for CaCx. Good management of both diseases, which have a synergistic relationship, requires integrated screening, prevention, and treatment services. The aim of this analysis is to assess the acceptability, feasibility and effectiveness of integrating HIV testing into CaCx prevention services in Tanzania, so as to inform scale-up strategies.
  
  
  METHODS
  We analysed 2010-2013 service delivery data from 21 government health facilities in four regions of the country, to examine integration of HIV testing within newly introduced CaCx screening and treatment services, located in the reproductive and child health (RCH) section of the facility. Analysis included the proportion of clients offered and accepting the HIV test, reasons why testing was not offered or was declined, and HIV status of CaCx screening clients.
  
  
  RESULTS
  A total of 24,966 women were screened for CaCx; of these, approximately one-quarter (26%) were referred in from HIV care and treatment clinics. Among the women of unknown HIV status (n = 18,539), 60% were offered an HIV test. The proportion of women offered an HIV test varied over time, but showed a trend of decline as the program expanded. Unavailability of HIV test kits at the facility was the most common reason for a CaCx screening client not to be offered an HIV test (71% of 6,321 cases). Almost all women offered (94%) accepted testing, and 5% of those tested (582 women) learned for the first time that they were HIV-positive.
  
  
  CONCLUSIONS
  Integrating HIV testing into CaCx screening services was highly acceptable to clients and was an effective means of reaching HIV-positive women who did not know their status; effectiveness was limited, however, by shortages of HIV test kits at facilities. Integration of HIV testing into CaCx screening services should be prioritized in HIV-endemic settings, but more work is needed to eliminate logistical barriers. The coverage of CaCx screening among HIV care and treatment-enrolled women in Tanzania may be low and should be examined.
authors.affiliation: Jhpiego, New Bagamoyo Road, P,O, Box 9170, Dar es Salaam, Tanzania. Marya.plotkin@jhpiego.org.
authors.forename: Marya
authors.initials: M
authors.lastname: Plotkin
authors.forename: Giulia V R
authors.initials: GV
authors.lastname: Besana
authors.forename: Safina
authors.initials: S
authors.lastname: Yuma
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Kim
authors.forename: Yusuph
authors.initials: Y
authors.lastname: Kulindwa
authors.forename: Fatma
authors.initials: F
authors.lastname: Kabole
authors.forename: Enriquito
authors.initials: E
authors.lastname: Lu
authors.forename: Mary Rose
authors.initials: MR
authors.lastname: Giattas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D055088:Early Detection of Cancer / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011933:Reagent Kits, Diagnostic / Q000600:supply & distribution; D012189:Retrospective Studies; D013636:Tanzania; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D011933:Reagent Kits, Diagnostic