Abstract Background: Delays in screening and timely diagnosis contribute significantly to global disparities in cervical cancer mortality in Botswana and other low- and middle-income countries, particularly those with high rates of HIV. Little is known about the modifiable factors shaping these delays from the perspectives of women themselves. Methods: From March-May 2019, we conducted a concurrent, mixed methods study of patients receiving cervical cancer care in Botswana. Structured questionnaires captured beliefs and knowledge related to cervical cancer screening and HIV. Clinical data were abstracted from medical records and confirmed by participants. Semi-structured interviews examined patients’ understanding of and experiences with cervical cancer screening. Quantitative data were analyzed using descriptive and bivariate statistics. Qualitative data were analyzed using deductive and inductive content analysis and triangulated with quantitative data to identify areas of convergence and divergence. Results: Forty-two women were interviewed, 64% of whom were living with HIV. Median age was 45 years in women living with HIV (LWH) and 64 years in those without HIV. Overall screening rates prior to symptomatic disease were low (24%). Median time from most proximal screening to diagnosis was 52 median days (IQR: 15-176), with no significant differences by HIV status. General screening knowledge was higher among women living with HIV versus those without (100% vs 73%), but knowledge about specific risk factors including HPV was low in both groups. In interviews, participants expressed limited awareness of needing to be screened prior to symptoms. Additionally, participants reported significant delays in receipt of screening results and in obtaining referrals for follow-up care. However, participants also described myriad sources of social and tangible support that helped them to overcome some of these challenges. Conclusion: Interventions focused on increasing routine screening and supporting timely awareness and access to care are needed to reduce global disparities in cervical cancer.

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