Prevalence and associated factors of persistent precancerous lesions among women treated for cervical lesions in Addis Ababa, Ethiopia

Background Cervical cancer is one of the leading causes of cancer-related deaths among Ethiopian women, despite being largely preventable. Women treated for precancerous cervical lesions remain at elevated risk of developing invasive cancer, yet little is known about the burden and predictors of persistent lesions following treatment in resource-limited settings. Materials and Methods We conducted a cross-sectional study among 242 women who underwent ablative or excisional therapy for precancerous cervical lesions at three clinics in Addis Ababa between November 2022 and December 2023. Data were collected using structured questionnaires and clinical records. Logistic regression analysis was used to identify factors associated with persistent lesions, reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results Of the 242 women treated, 104 (43.0%; 95% CI, 37.2%–49.6%) experienced persistent lesions within 1 year. Persistent lesion rates were highest among women initially screened with Pap smear (97.4%) compared to VIA (21.9%) and HPV DNA testing (14.7%). Independent predictors of persistent lesions included an age of ≥ 50 years (AOR = 5.4; 95% CI, 1.56–18.93), being married (AOR = 2.5; 95% CI, 1.15–5.44), a human immunodeficiency virus (HIV)-positive status (AOR = 5.0; 95% CI, 1.41–20.3), and Pap smear as the initial screening modality (AOR = 4.9; 95% CI, 1.04–23.15). Conclusion Nearly half of the women treated for precancerous cervical lesions experienced persistent disease within 1 year, particularly those who were older, married, HIV-positive, or initially screened by Pap smear. These findings raise concerns about the effectiveness of current treatment and screening strategies. Implications for Practice The high rate of persistent cervical lesions following treatment highlights the need for tailored follow-up protocols, especially for high-risk groups such as women living with HIV and those over the age of 50 years. Expanding access to HPV DNA testing and implementing risk-based follow-up strategies could improve outcomes and reduce persistent lesions, particularly in resource-limited settings where reliance on VIA or Pap smear remains common.