Provider attitudes and organizational support for cervical cancer screening implementation across PEPFAR-supported HIV clinics in Kenya.

Abstract

Background: Cervical cancer (CC) is the leading cause of cancer-related mortality in sub-Saharan Africa (SSA), disproportionally affecting women living with HIV. Integration of CC screening and treatment of precancerous lesions into established HIV care systems supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has resulted in screening of millions of women and treatment of tens of thousands of precancerous lesions. Despite these gains, research has largely focused on patient-level barriers to screening, with limited attention to provider attitudes, organizational climate, and leadership support within PEPFAR-supported HIV clinics.

Methods: A cross-sectional survey was conducted with 46 clinic staff at seven affiliated faith-based HIV clinics overseen by the Coptic Hope Center for Infectious Diseases in Nairobi County, Kenya. The Coptic Hope Center is funded by PEPFAR through the Centers for Disease Control and Prevention (CDC). Clinic staff completed three validated implementation science instruments: the Evidence-Based Practice Attitude Scale (EBPAS-36), the Implementation Climate Scale (ICS), and the Implementation Leadership Scale (ILS). Total and subscale scores were computed, and Mann-Whitney U tests were conducted to examine associations between staff and clinic characteristics and total scores.

Results: Clinic staff reported moderate overall EBPAS-36 scores, median (M) = 3.06 on a 0-4 scale, reflecting positive attitudes towards CC screening implementation. The highest ratings were observed for Feedback, Fit, Openness, and Appeal subscales, indicating both the appeal of current screening methods and openness to novel approaches. ICS (M = 2.36) and ILS (M = 3.62 for staff; 2.71 for supervisors) scores indicated moderate to strong organizational and leadership support, though lower scores on Rewards and Selection for EBP subscales suggest limited institutional incentives. No significant differences were observed by clinic type, staff role and years in position.

Conclusions: Staff attitudes, leadership engagement, and organizational climate were broadly supportive of CC screening implementation across PEPFAR-supported clinics in Nairobi, Kenya. As countries in SSA seek to sustain the gains achieved through integrated HIV and CC prevention programs and adapt to evolving donor funding landscapes, preserving positive provider environments is essential to effective service delivery and keeping countries on the path toward CC elimination.