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

Abstract

IntroductionHIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence. Little is known about cervical screening coverage or the prevalence of abnormal cytology among HIV-positive women in Ukraine, which has the most severe HIV epidemic in Europe.MethodsPoisson regression models were fitted to data from 1120 women enrolled at three sites of the Ukraine Cohort Study of HIV-infected Childbearing Women to investigate factors associated with receiving cervical screening as part of HIV care. All women had been diagnosed as HIV-positive before or during their most recent pregnancy. Prevalence of cervical abnormalities (high/low grade squamous intraepithelial lesions) among women who had been screened was estimated, and associated factors explored.ResultsOverall, 30% (337/1120) of women had received a cervical screening test as part of HIV care at study enrolment (median 10 months postpartum), a third (115/334) of whom had been tested >12 months previously. In adjusted analyses, women diagnosed as HIV-positive during (vs before) their most recent pregnancy were significantly less likely to have a screening test reported, on adjusting for other potential risk factors (adjusted prevalence ratio (APR) 0.62, 95% CI 0.51–0.75 p<0.01 for 1st/2nd trimester diagnosis and APR 0.42, 95% CI 0.28–0.63 p<0.01 for 3rd trimester/intrapartum diagnosis). Among those with a cervical screening result reported at any time (including follow-up), 21% (68/325) had a finding of cervical abnormality. In adjusted analyses, Herpes simplex virus 2 seropositivity and a recent diagnosis of bacterial vaginosis were associated with an increased risk of abnormal cervical cytology (APR 1.83 95% CI 1.07–3.11 and APR 3.49 95% CI 2.11–5.76 respectively).ConclusionsIn this high risk population, cervical screening coverage as part of HIV care was low and could be improved by an organised cervical screening programme for HIV-positive women. Bacterial vaginosis testing and treatment may reduce vulnerability to cervical abnormalities.

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

“…ART access for children has been prioritized in EE and currently ART coverage is >90% in Ukraine and 75% in Russia [10,23,27] vs. around 50% and 34% among adults, respectively [23,64]. Access to some aspects of HIV care such as ARV resistance testing is poor or uneven [61] and young people and their families may face additional barriers including illegal charging of users fees for non-HIV-specific services [65][66][67][68] and poor access to sexual and mental health services [69,70].…”

Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine

“…the reduction of future MTCT risk and the avoidance of repeated exposure to short-course ART for PMTCT 9 ) may be more apparent in areas with higher rates of fertility than in Ukraine, where the overall fertility rate is just 1.5 children per woman. 4 However, nearly one third of HIV-positive childbearing women in Ukraine have HIV-negative partners, 34 a fact that highlights the potential benefit of Option B+ in preventing onward sexual transmissions. 35 Questions regarding Option B+ -including the risk-benefit ratio for the long-term treatment of ART-ineligible individuals and how to achieve equitable and sustainable ART access and improve retention in HIV care -are currently being addressed in other settings.…”

Rates and Correlates of Self-Reported Pap Testing in African-Caribbean-Black HIV-Positive Women in Ontario, Canada

“…A total of 126 HIV-positive women completed the questionnaire. Median age was 40 years (IQR [34][35][36][37][38][39][40][41][42][43][44][45][46].The majority of women reported heterosexual contact as the route of HIV acquisition. Fifty-three percent of respondents were born in East Africa, while 14.3% were from Southern Africa, 8.7% from West Africa and 16.7% from the Caribbean.…”

“…On the other hand, women with HIV also have frequent contact with health care providers, a factor which has been shown to increase adherence to regular Pap screening [24][25]. There have been several studies examining Pap testing in the HIV-positive community and rates of screening range from 30% to 88% [26][27][28][29][30][31][32][33][34]. Factors associated with regular screening include access to a primary care physician [30] or gynecologist [27][28][29], while the lack of regular screening is predicted by older [28,35,36] or younger [29] age, lower education level [29,35], intravenous drug use [26,35,36] and having a CD4+ count <200 cells/mm [3,29,36].…”