Breanne Lott

Fellowship Site: Addis Ababa University, Ethiopia

US Institution: University Of Arizona

Project Title: Cervical cancer screening uptake and preferences of Ethiopian women by HIV status: Comparing community- vs. facility-based practices

In Ethiopia, a National Cancer Control Plan was first established in 2015, outlining ambitious activities to reduce cancer burden including rolling out a nationwide cervical cancer screening program using visual inspection with acetic acid (VIA) (Ethiopian Federal Ministry of Health, 2015). In recent years, providers have been trained to provide facility-based VIA cervical screening for all women, including those living with and without HIV, and were equipped with materials such as cryotherapy machines to increase coverage of single-visit “screen-and-treat” cancer prevention services. Still, Ethiopia experiences low uptake of screening, ranging from 0 to 24.8% in various communities (Tilahun, 2019; Aynalem, 2020; Tekle, 2020; Ruddies, 2020; Belete 2015). Provider-reported challenges to screening implementation include low community awareness, environmental barriers, inaccessibility of health services, and the perception that traditional cervical exams are embarrassing or culturally taboo (Gizaw, 2019; Tilahun, 2019; Getachew, 2019; Bayu, 2015). Therefore, there is an increased interest in community-based approaches to screening that increase accessibility of services, allow women to self-sample in the comfort and privacy of their own home, and reduce the burden of screening on patients (Gizaw, 2019). Some concerns exist for women living with HIV who may have client privacy jeopardized during home visits by health workers and who may prefer to access cancer screening services at a health facility, supplemental to regular antiretroviral therapy visits. This mixed method research project will explore women’s perspectives and preferences for screening in community and facility settings, critically assessing appropriateness of various approaches with regard to HIV status, and will culminate in a pilot study of an intervention to improve cervical cancer screening uptake through community-based HPV self-sampling.

GHES Fellow, Breanne Lott, will apply her training in health promotion sciences, global health, and cultural anthropology to assess cervical cancer screening from a health behavior lens. She looks forward to returning to Ethiopia where she has previously lived and worked as a Peace Corps Volunteer and Cervical Cancer Epidemiology Education in Special Populations Fellow. Breanne will collaborate with mentors Professor Damen Hailemariam and Dr. Dawit Worku of Addis Ababa University and Dr. Purnima Madhivanan of University of Arizona.