Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study

Abstract

BackgroundThe incidence of invasive cervical cancer in HIV-positive women is higher than in the general population. There is evidence that HIV-positive women do not participate sufficiently in cervical cancer screening in Italy, where cervical cancer is more than 10-fold higher in women with AIDS than in the general population. The aim of the present study was to evaluate the history of Pap-smear in HIV-positive women in Italy in recent years. We also examined the sociodemographic, clinical, and organizational factors associated with adherence to cervical cancer screening.MethodsA cross-sectional study was conducted between July 2006 and June 2007 in Emilia-Romagna region (Northern Italy). All HIV-positive women who received a follow-up visit in one of the 10 regional infectivology units were invited to participate. History of Pap-smear, including abnormal smears and subsequent treatment, was investigated through a self-administered anonymous questionnaire. The association between lack of Pap-smear in the year preceding the interview and selected characteristics was assessed by means of odds ratios (OR) and 95% confidence intervals adjusted for study centre and age.ResultsA total of 1,002 HIV-positive women were interviewed. Nine percent reported no history of Pap-smear, and 39% had no Pap-smear in the year prior to the date of questionnaire (last year). The lack of Pap-smear in the last year was significantly associated with age <35 years (OR = 1.4, compared to age ≥45 years), lower education level (OR = 1.3), first HIV-positive test in the last 2 years (OR = 1.4), and CD4 count <200 cells/μl (OR = 1.6). Conversely, when women were advised by a gynecologist rather than other health workers to undergo screening, it significantly increased adherence. Non-significantly higher proportions of lack of Pap-smear in the last year were found in women born in Central-Eastern Europe (OR = 1.8) and Africa (OR = 1.3). No difference in history of Pap-smear emerged by mode of HIV-acquisition or AIDS status.Three hundred five (34%) women reported a previous abnormal Pap-smear, and of the 178 (58%) referred for treatment, 97% complied.ConclusionsIn recent years the self-reported history of Pap-smear in HIV-positive women, in some public clinics in Italy, is higher than previously reported, but further efforts are required to make sure cervical cancer screening is accessible to all HIV-positive women.

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

“…The screening coverage found in the present study is considerably lower than what have been published in previous studies reporting a coverage to the annual ICC HIV screening program between 51% and 81% [13,14,16,30]. These studies are based on self-reported data, and the difference might reflect that women tend to over-report their participation in cervical screening in a given timeframe and therefore these rates are likely upper-end estimates [31].…”

Impact of provider-patient communication on cancer screening adherence: A systematic review

“…A total of 35 articles were considered suitable for inclusion in the review. All but six of the articles were from the United States–other represented countries included Canada (25, 26), Singapore (27), Israel (28), France (29) and Italy (30). Many articles focused on unique populations, including ethnic minorities, rural and urban residents, and veterans.…”

Survival After Cancer in Italian Persons With AIDS, 1986–2005

“…Despite a clear reduction in the survival gap, the 2-fold higher risk of dying after ICC compared with non-PWA provides evidence that participation rates and quality of cervical cancer screening in HIV-infected women in Italy need improvement. 40 The assessment of survival after individual non-AIDSdefining cancers is, as elsewhere, 23 hampered by the small number of cases. Lung cancer was by far the most frequent non-AIDS-defining cancer in Italy.…”