Cervical screening in HIV‐positive women: characteristics of those who default and attitudes towards screening

Abstract

To determine the characteristics of HIV-positive women who undergo cervical screening and to identify negative attitudes and experiences of these women to screening and the factors associated with these. MethodsWe compared the Royal Free Cohort data from 59 newly diagnosed HIV-infected women, 31 of whom did and 28 of whom did not attend for cervical screening in 2001, and from 227 women under active cervical screening follow-up (at least one cervical screen since June 2001) and 88 HIV-infected women lost to follow-up (not screened since January 2001). Attitudes to screening were investigated with the aid of a questionnaire given to all women attending clinic who had had a previous colposcopy. ResultsOf the 59 newly HIV diagnosed women, 31 (53%) underwent cervical screening. These 31 women were more likely to be heterosexual (100 vs 89%, P 5 0.05), to have lower median viral loads (o 50 vs 3210 HIV-1 RNA copies/mL) and to be receiving antiretrovirals (ARVs) (74 vs 54%, P 5 0.1) than those not screened. Of the 315 women who had at least one screen, 72% returned for further follow-up. There were no differences in age or ethnicity between these groups. Those under active follow-up had a higher CD4 count (P 5 0.04) and lower viral load (P 5 0.0001) at their last visit. They were also more likely to be on highly active antiretroviral therapy (HAART) (68 vs 52%, P 5 0.006). A total of 78 of 104 questionnaires (75%) were returned. Women participating in the questionnaire study were mainly of back ethnicity (68%), did not speak English as their first language (59%) and were taking ARVs (76%). Most agreed that regular smears and colposcopy were valuable. Women of white ethnicity, and those speaking English as a first language, were more likely to dislike colposcopy compared with those of nonwhite ethnicity (87 vs 25%, respectively, P 5 0.0007) and not speaking English as a first language (74 vs 26%, respectively, P 5 0.002). Those of white ethnicity were more likely to find smears and colposcopy painful (60 and 73%) compared with those of black ethnicity (46 and 51%, P 5 0.47 and 0.28, respectively). ConclusionsOur results suggest that women on HAART with better disease control, older women, and those of black African ethnicity are more likely to take up cervical screening. Cervical screening experience varies by ethnicity and language.

Adherence to the cervical cancer screening program in women living with HIV in Denmark: comparison with the general population

“…In line with Shah et al [35] we found that an HIV RNA < 500 copies/mL as a proxy for being on HAART and therefore attending the HIV clinics for regular controls and delivery of free HAART was a predictor for screening attendance. This difference was only found to be statistically significant at age 40 years.…”

“…However, if rates of dysplasia are high as reported from other cohorts [1,3,7-11], this yields for new approaches to cervical screening in WLWH. We support the idea of cytology as part of an annual review [15,33] and integration of HIV care and cervical screening in a single clinic setting [14,35,38]. Another measure-inspired by Australian health authorities [15] – could be an opt in automated reminder system with written invitations to women with overdue cervical cytologies.…”

“…Predictors of attendance to screening programs in other studies were a diagnosis of HIV prior to pregnancy [7], previous pregnancies [7], history of abnormal cervical cytology [30], heterosexual transmission [35], screening advice from a gynaecologist rather than an infectious medicine specialist [30], older age [35], Black ethnicity [35] and integration of HIV care and ICC screening in the same setting [14]. …”

Cervical Screening within HIV Care: Findings from an HIV-Positive Cohort in Ukraine

“…An organised screening programme could improve awareness and uptake among the most marginalised women. At an HIV clinic in the United Kingdom, a higher uptake of cervical screening was found among women on HAART compared with those not yet on treatment, probably due to their on-going engagement with HIV care [56]. Regular invitations to attend the HIV/AIDS Centre for screening could help prevent postpartum loss to follow-up among HIV-positive women not on ART.…”

Perception of Cervical Cancer and Cervical Screening, And Uptake of Pap Smear Among Female Employees of the Jos University Teaching Hospital And Its Environs

“…In addition, the HIV epidemic has contributed to the high incidence of cervical cancer in sub-Saharan Africa. 8,9,10 The value of screening for cervical cancer has been proven. Such programmes in developed nations have achieved a decrease in incidence and mortality by 80%.…”