Objective
Women living with HIV experience higher risk of cervical cancer, but screening rates in the U.S. are lower than recommended. The purpose of this study was to examine whether an intervention using self-sampling of cervico-vaginal cells for human papillomavirus (HPV) with results counseling would increase cervical cytology ("Pap") testing among women with HIV.
Methods
This was a randomized controlled trial to test the effectiveness of an intervention of self-sampling for HPV and results counseling. Participants were 94 women over age 18, with HIV infection, attending an HIV Clinic for a primary care visit, whose last cervical cancer screening was 18 months or more before baseline. Women were assigned to the intervention or information-only group. The primary outcome was completion of cervical cytology testing within 6 months of baseline. The secondary outcome was the women's perceived threat of developing cervical cancer.
Results
A total of 94 women were enrolled and analyzed in the study. The cytology completion rate overall was 35% by 6 months from baseline. There were no differences comparing HPV positive with HPV negative women, nor comparing them with the information-only group. In the intervention group, a positive HPV test increased perceived threat of cervical cancer.
Conclusions
The intervention did not improve cytology test attendance, though education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average 3.6 years prior to the baseline appointment. Self-sampling for HPV testing was feasible.
This article outlines some recent advances in both obstetrics and gynaecology. In obstetrics, the new screening tests for Down's syndrome and the introduction of computer analysis of the fetal ECG are discussed. Cervical screening and the role of human papilloma virus detection is examined and advances in the non-surgical management of menorrhaghia and improvements in the management of urinary stress incontinence are also reviewed.
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