Cervical cancer screening in rural South Africa among HIV-infected migrant farm workers and sex workers

Abstract

At an HIV clinic in the Limpopo province of South Africa, chart reviews revealed long delays in addressing abnormal Pap smears, difficulty in referrals, poor quality and lost results, and increasing cases of cervical cancer. To address these barriers, a “see and treat” approach to screening was proposed. The objective was to integrate this method into current HIV care offered by local providers and to obtain demographic and risk factor data for use in future educational and intervention programs in the region.A cross sectional study of HIV farm workers and at-risk sex workers attending an HIV clinic was performed with visual inspection with acetic acid (VIA). Those with positive screens were offered cryotherapy. Clinic charts were reviewed retrospectively for Pap smear results for the previous year at the time of program initiation and at 12 and 18 months post-program.A total of 403 participants consented and underwent screening with VIA (306 Farm workers and 97 sex workers participated). 83.9% of participants (32.9% sex workers and 100% farm workers) were HIV +. VIA was positive in 30.5% of participants, necessitating cryotherapy. There was no significant difference in VIA positivity between HIV + farm workers and sex workers. There was a positive correlation between Pap smears and VIAs results.We demonstrate successful integration of cervical cancer screening using VIA for HIV + farm workers and sex workers into an existing HIV treatment and prevention clinic in rural South Africa, addressing and treating abnormal results promptly.

Abnormal cervical cytology amongst women infected with human immunodeficiency virus in Limpopo province, South Africa

“… 8 Afzal and co-authors in a study conducted in LP found that 26.7% of the HIV-positive migrant farm and sex workers had abnormal cytology. 11 The reasons for various prevalence rates reported in these studies are unclear; however, it could be because of various methods used for CC screening 20 , 21 , 22 , 23 and sexual practices of women, 7 , 8 , 12 , 24 , 25 which is explained by higher burden of HPV infection. 26 , 27 , 28 , 29 …”

“… 10 In Limpopo province (LP), 26.7% of the HIV-positive migrant farm workers and sex workers had abnormal cervical cytology tests. 11 Not surprisingly, studies report significantly higher burdens of abnormal cervical cytology in HIV-positive women, compared with HIV-negative women. 12 , 13 The national guidelines in SA clearly state that women aged 30 years or older should be offered three free lifetime Pap smears, 14 with recommendations to screen HIV-positive women annually.…”

HIV/AIDS Acceptance and Access to Health Care Services on Female Sex Workers

“…There is a known association that those with HIV are more susceptible to human papilloma virus (HPV). HPV prevalence rates in the HIV infected population is upward of 36%, also leading to more frequent occurrence of high-grade cervical lesions [10].…”

Perceptions of Midwives on Pap Smear Tests during Pregnancy

“…Findings such as health professionals' attitudes, patients' inadequate knowledge, and lack of resources have been reported as contributions to the low-uptake of Pap smear test among women globally (Afzal et al, 2017;Godfrey et al, 2019;Manikkam 2016;Phaswana-Mafuya and Peltzer, 2017;DoH, 2017). When women are empowered with the knowledge they will probably take responsibility of their own health and seek for Pap smear test whenever it is due (DoH, 2017;Mingo et al, 2012).…”