Precancerous cervical lesions and associated factors among HIV-positive women in Southern and Eastern African countries: A systematic review and meta-analysis
9 affiliations
- 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 2Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 3Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 4Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
- 5Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 6Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
- 7Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 8Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 9Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Medicine and Health Sciences, Mekelle University, Mekelle, Ethiopia.
Abstract
Background: Women living with HIV (WLHIV) face a sixfold increased risk of cervical cancer compared to HIV-negative women. Most WLHIV residing in the Southern and Eastern African regions have a substantial HIV-related cervical cancer burden. Studies on precancerous cervical lesions (PCCL) and associated factors in WLHIV from these regions have inconsistent and inconclusive findings. Therefore, we aimed to synthesize the pooled prevalence of PCCL and associated factors among WLHIV in Southern and Eastern Africa. Methods: This study was registered under PROSPERO (CRD420251123583) and conducted in accordance with PRISMA 2020 standards. Primary studies published from inception to 2025 in Southern and Eastern Africa were included. The methodological quality of studies was assessed using the Newcastle-Ottawa scale. Data extraction and statistical analyses were done in Microsoft Excel and STATA 17, respectively. Pooled prevalence, publication bias, subgroup, and sensitivity analysis were conducted. Associations were expressed as odds ratios (OR), and a p-value of less than 0.05 was considered statistically significant. Results: 44 studies met the inclusion criteria, with a sample size of 47,009. The pooled prevalence of PCCL was 22.25% (95% CI: 19.57, 24.93). Age at first sexual intercourse (< 18 years) (OR = 2.99, (2.34, 3.82)), multiparity (OR = 4.97, (3.21, 7.69)), having multiple sexual partners (OR = 3.06 (2.45, 3.83)), having a history of sexually transmitted infections (STI) (OR = 3.93 (3.23, 4.78)), smoking (OR = 7.01, (3.39, 14.49)), ever taking oral contraceptive pills (OR = 2.69, (1.85, 3.90)), low CD4 count (OR = 1.79, (1.56, 2.05)), and having not initiated antiretroviral therapy (ART) (OR = 2.02, (1.56, 2.62)) were significantly associated with an increased risk of PCCL. Conclusion and recommendations: The pooled prevalence of PCCL was high. Additionally, early first sexual intercourse, parity, STIs, multiple sexual partners, smoking, oral contraceptive use, CD4 count, and ART were positively associated with the occurrence of PCCL. Therefore, stakeholders shall implement interventions to avert future incidents of PCCL and address the identified factors.
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BibTeX
@article{alemu2026precancerous,
title = {{Precancerous cervical lesions and associated factors among HIV-positive women in Southern and Eastern African countries: A systematic review and meta-analysis}},
author = {Gebrie Getu Alemu and Astewil Moges Bazezew and Amlaku Nigusie Yirsaw and Wubet Tazeb Wondie and Berihun Agegn Mengistie and Tenagnework Eseyneh Dagnaw and Mekuriaw Nibret Aweke and Nebebe Demis Baykemagn and Gebeyehu Lakew and Bisrat Tewelde Gebretsadkan},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0361185},
url = {https://doi.org/10.1371/journal.pone.0361185},
note = {CC BY},
}
RIS
TY - JOUR
TI - Precancerous cervical lesions and associated factors among HIV-positive women in Southern and Eastern African countries: A systematic review and meta-analysis
AU - Gebrie Getu Alemu
AU - Astewil Moges Bazezew
AU - Amlaku Nigusie Yirsaw
AU - Wubet Tazeb Wondie
AU - Berihun Agegn Mengistie
AU - Tenagnework Eseyneh Dagnaw
AU - Mekuriaw Nibret Aweke
AU - Nebebe Demis Baykemagn
AU - Gebeyehu Lakew
AU - Bisrat Tewelde Gebretsadkan
PY - 2026
DA - 2026/10/23
JO - PLOS One
DO - 10.1371/journal.pone.0361185
UR - https://doi.org/10.1371/journal.pone.0361185
AB - Background: Women living with HIV (WLHIV) face a sixfold increased risk of cervical cancer compared to HIV-negative women. Most WLHIV residing in the Southern and Eastern African regions have a substantial HIV-related cervical cancer burden. Studies on precancerous cervical lesions (PCCL) and associated factors in WLHIV from these regions have inconsistent and inconclusive findings. Therefore, we aimed to synthesize the pooled prevalence of PCCL and associated factors among WLHIV in Southern and Eastern Africa. Methods: This study was registered under PROSPERO (CRD420251123583) and conducted in accordance with PRISMA 2020 standards. Primary studies published from inception to 2025 in Southern and Eastern Africa were included. The methodological quality of studies was assessed using the Newcastle-Ottawa scale. Data extraction and statistical analyses were done in Microsoft Excel and STATA 17, respectively. Pooled prevalence, publication bias, subgroup, and sensitivity analysis were conducted. Associations were expressed as odds ratios (OR), and a p-value of less than 0.05 was considered statistically significant. Results: 44 studies met the inclusion criteria, with a sample size of 47,009. The pooled prevalence of PCCL was 22.25% (95% CI: 19.57, 24.93). Age at first sexual intercourse (< 18 years) (OR = 2.99, (2.34, 3.82)), multiparity (OR = 4.97, (3.21, 7.69)), having multiple sexual partners (OR = 3.06 (2.45, 3.83)), having a history of sexually transmitted infections (STI) (OR = 3.93 (3.23, 4.78)), smoking (OR = 7.01, (3.39, 14.49)), ever taking oral contraceptive pills (OR = 2.69, (1.85, 3.90)), low CD4 count (OR = 1.79, (1.56, 2.05)), and having not initiated antiretroviral therapy (ART) (OR = 2.02, (1.56, 2.62)) were significantly associated with an increased risk of PCCL. Conclusion and recommendations: The pooled prevalence of PCCL was high. Additionally, early first sexual intercourse, parity, STIs, multiple sexual partners, smoking, oral contraceptive use, CD4 count, and ART were positively associated with the occurrence of PCCL. Therefore, stakeholders shall implement interventions to avert future incidents of PCCL and address the identified factors.
SN - 1932-6203
ER -