2 - (OP6) Bridging Gaps in Care: Exploring Patient and Provider Perspectives on Retention in the Cervical Cancer Prevention and Treatment Cascade Among Women with HIV in Durban, South Africa

Introduction: Women with HIV (WWH) are disproportionately affected by high-risk human papillomavirus (HPV), which can progress to precancerous lesions and cervical cancer. Public health efforts have increased cervical cancer screening rates from 18-25% to over 50% in South Africa (SA). However, only 25% of WWH with a high-risk abnormal Pap smear result receive timely follow-up care. This study explored barriers and facilitators to follow-up care among WWH with a recent abnormal Pap result to inform the development of an intervention to increase retention in care across the cervical cancer prevention cascade among WWH.

Methods: Participants were recruited from a community reproductive health clinic in Durban, SA. Eligible participants were > 18 years, persons with a cervix, living with HIV, and had a high-risk abnormal cervical cytology screening test within the last six months. Healthcare providers (professional nurses) were also recruited from the same clinic. Qualitative data were analyzed via rapid analysis.

Results: Participants (N=15) were Black South Africans with a median age of 36 years (range: 22-45) and a median HIV diagnosis age of 29 years (range: 21-39). Of the 15, 12 participants had scheduled and three attended their follow up appointment, and most had heard about cervical cancer from their doctor/nurse or a family member. Fear and shock were the most common emotional responses to receiving abnormal Pap smear results, primarily fear of cervical cancer and fear of dying. For some women, fear functioned as a facilitator, motivating them to attend follow up care out of a desire for early detection and a sense of responsibility to themselves and their children. At the same time, insufficient information from providers emerged as a barrier; some women felt rushed, left with unanswered questions, and were increasingly distressed, which then heightened fear and undermined follow-up engagement. Both participants and healthcare providers (N=3) emphasized a need for an intervention that addresses barriers by integrating cervical cancer education, debunking myths (e.g., that hysterectomy is inevitable), and reducing fear surrounding abnormal results through counseling. Healthcare providers requested additional training on Pap smear education, interpretation and communication of results to patients, and strategies to improve quality of care beyond meeting screening quotas.

Discussion: In this sample, fear of cervical cancer, particularly fear of dying, emerged as a powerful driver of women’s engagement in follow-up care. Fear was often intensified by inconsistent and insufficient information from providers, underscoring a critical gap in the cervical cancer care cascade. These findings point to the need for a multi-level intervention, which may include: a patient component to improve understanding of cervical cancer prevention and treatment pathways and reduce fear around abnormal Pap smear results and a provider component focused on strengthening patient-provider communication around abnormal results and improving quality of care. Addressing these barriers has the potential to reduce loss to follow-up, late-stage cervical cancer diagnoses, and mortality in this population.