HIV testing in colposcopy and termination of pregnancy services: a missed opportunity?

Abstract

IntroductionThe 2008 National HIV testing guidelines produced jointly by the British Association of Sexual Health and HIV, British HIV Association and British Infection Society recommend HIV testing for patients attending termination of pregnancy (TOP) services and patients diagnosed with cervical intraepithelial neoplasia (CIN) Grade 2 or above. The aim is to reduce the time between acquisition and diagnosis of HIV by encouraging testing in settings where patients present with indicator diseases. Benefits of earlier HIV diagnosis include improved survival, prevention of onward transmission, and optimisation of maternal health when planning pregnancy. There is evidence that HIV reduces the effectiveness of standard treatment for CIN 2/3 and cervical cancer. The experience of antenatal screening indicates that the majority of women accept HIV screening if it is offered as part of a package of care.MethodsThis retrospective case notes review of 60 HIV-positive women, diagnosed between 1 January 2006 and 31 July 2009, collected data on age, ethnicity, length of time in the UK, timing of HIV diagnosis and possible timing of acquisition relative to attendance at colposcopy or TOP services, CD4 count and symptoms at diagnosis and cervical cytology history.ResultsThe authors found that three (5%) women were diagnosed with CIN Grade 2 or above prior to HIV diagnosis; HIV testing at the time of TOP may have resulted in earlier diagnosis for three (5%) women. There was at least one missed opportunity for earlier diagnosis in five (8%) cases.ConclusionsThe authors suggest further work should be undertaken to establish HIV prevalence in TOP and colposcopy services and that HIV testing should become standard practice in the management of CIN 2/3 and cervical cancer.

Routine HIV testing in colposcopy: Table 1

“…The high uptake, especially among women who had never previously had an HIV test, suggests that this approach may target an at-risk population who might not attend for HIV testing in more traditional settings. When combined with the high positivity rate we concur with Bates and Briggs et al's conclusions of promoting more widespread HIV testing in TOP and colposcopy services 1 2…”

“…We read with interest the article by Briggs et al1and associated commentary by Bates2 suggesting a widening of HIV testing venues, to include termination of pregnancy services (TOP) and colposcopy services.…”

HIV testing in termination of pregnancy and colposcopy services: a scoping review

“…36 Regarding missed opportunities, a British case notes review of 60 women diagnosed with HIV between 2006 and 2009 reported that HIV testing at the time of TOP may have resulted in earlier HIV diagnosis in 5% of cases. 37 In Lausanne, Switzerland, among 75 women newly diagnosed with HIV between 2011 and 2015, 34 had presented at least one missed opportunity for earlier HIV diagnosis, of whom 5 (14.7%) had not been tested when seeking TOP (Lhopitallier L, personal communication, 2021). 38…”

Up to the test? Routine HIV testing in everyday clinical practice

“…It has been previously recognised that health care providers in the UK have opportunities to initiate HIV testing in at risk individuals and address the burden of undiagnosed HIV infection (22–24). The majority of people living with HIV seek medical care for a related condition several times in the 6 months prior to their HIV diagnosis, presenting to general medicine and outpatient settings including primary care (21,25).…”