Cervical cancer screening patterns among HIV-positive women in Estonia: a population-based retrospective cohort study

Abstract

Background The World Health Organisation (WHO) calls for the elimination of cervical cancer (CC) as a public health issue. To achieve elimination, efforts must be aligned and accelerated. Women living with HIV (WLWH) have excess risk for developing, and dying from, CC over the general population. Estimates of cervical cancer screening programme coverage in Eastern European countries that have experienced HIV epidemics since the early 2000’s are scarce. Method This population-based retrospective study uses a healthcare administrative database and follows cohorts of all WLWH in a ratio of 1:3 randomly matched (age, region) HIV negative women from 2009 to 2018. Annual and longitudinal (over the whole study period) coverage for cervical cancer screening (opportunistic, organised, HIV specific) and adjusted odds ratios (AORs) for longitudinal screening coverage predictors were estimated from 2009 to 2018. Results Among WLWH and HIV-negative women, the mean annual coverage with opportunistic screening was 61.45 and 65.59%; and organised screening was 20.4 and 28.7%, respectively (both: p < 0.00001). 19.01% (95% CI 18.05–19.97) HIV-negative and 13.9% (95% CI 12.35–15.45) WLWH were longitudinally covered with organised cervical cancer screening. Among WLWH, the mean annual HIV-specific cervical cancer screening coverage was 49.4, and 24.3% were longitudinally covered. Longitudinal coverage with HIV-specific cervical cancer screening was inversely associated with age, hepatitis C virus (HCV) co-infection (AOR 0.754, 95% CI 0.619, 0.916), not having insurance (AOR 0.331, 95% CI 0.264, 0.412), drug abuse (AOR 0.459, 95% CI 0.336, 0.618) and higher among those retained in HIV care (AOR 1.972, 95% CI 1.615, 2.410). Among HIV-negative women, longitudinal coverage with organised cervical cancer screening was inversely associated with residence in the region and higher among older women. Conclusions Our results highlight unacceptably low coverage of cervical cancer screening of WLWH in Estonia. There is need for dedicated cervical cancer screening efforts for WLWH considering the high cancer risk and rate in the study population.

Barriers Associated with Adherence to Cervical Cancer Screening Among Women Living with HIV in Nkhatabay District, Malawi: A Mixed-Methods Study

“…Although this study focused on VIA, which is the most common screening method in Malawi, other studies that focused on other screening methods, such as Pap smears, have reported similar results as common barriers to adherence to CCS among WLHI. [27][28][29][30] This finding can be explained by the qualitative results of this study.…”

Bacterial Vaginosis Decreases the Risk of Cervical Cytological Abnormalities

“…Menopause is associated with estrogen loss, which affects CMV metabolism, immune balance, a shift between Th1/Th2 immune adaptive responses, vaginal atrophy, reduced abundance of lactobacilli, and increased abundance of other bacterial species ( 16, 17 ). However, in addition to the effect of age on the CVM leading to GTIs, other confounding factors affect the risk of GTIs such as frequency of intercourse, douching, pessaries, and smoking status ( 18 ).…”

A systematic review of the cost-effectiveness of interventions to increase cervical cancer screening among underserved women in Europe

“…In Europe, rates vary between 25 and 80% and, even in countries such as the UK with historically high screening rates, uptake has been falling in recent years to 71% in 2019, despite previously being over 80% [ 9 ]. This is a concern because there is now considerable evidence that those women who have not been vaccinated against HPV are less likely to be screened, leading to widening inequalities [ 10 – 13 ].…”