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Gram EJPN, Moseholm E, Nørløv AB, Wilken-Jensen C, Thorsteinsson K, Pedersen BT, Jørgensen SM, Bonde J, Omland LH, Lebech AM, Weis N. Cervical cancer screening integrated in routine clinical care of women with HIV. AIDS 2024; 38:1648-1657. [PMID: 38950190 DOI: 10.1097/qad.0000000000003972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To evaluate if integrated cervical cancer screening (CCS) for women with HIV (WWH) in routine HIV care resulted in increased adherence to screening, and to describe the prevalence of human papillomavirus (HPV)-specific genotypes and the incidence of cellular abnormalities. DESIGN Cohort study. METHODS WWH who accepted the offer of combined CCS and HIV care (group 1), WWH who declined the offer (group 2), and WWH not offered CCS within HIV care (group 3) between 2013 and 2019 were included. Data was collected from The Danish HIV Cohort Study and The Danish Pathology Data Bank. Adherence to the CCS program was defined as fulfilled if WWH were screened annually. RESULTS A total of 804 WWH were included. WWH who accepted CCS within HIV care (group 1; n = 218) had significantly higher adherence to screening in all study years 22-99% compared with the WWH who declined CCS (group 2; n = 232) 10-16% and WWH who were not invited for CCS (group 3; n = 354) 11-25%. There was no significant difference in the prevalence of HPV-specific genotypes and incidence of cellular abnormalities among the three groups. CONCLUSION Integrating CCS for WWH in routine HIV care resulted in higher adherence to the CCS guidelines. Combined services thereby represent an opportunity to engage WWH in HIV care into preventive services.
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Affiliation(s)
- Emma J P N Gram
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
| | - Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Anne B Nørløv
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Hvidovre
| | | | - Kristina Thorsteinsson
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Bispebjerg
| | | | - Sussie M Jørgensen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
| | - Jesper Bonde
- Department of Pathology, Copenhagen University Hospital, Hvidovre
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Okunade KS, Badmos KB, Okoro AC, Ademuyiwa IY, Oshodi YA, Adejimi AA, Awolola NA, Ozonu O, Adelabu H, Olorunfemi G, Akanmu AS, Banjo AA, Anorlu RI, Berek JS. Comparative Assessment of p16/Ki-67 Dual Staining Technology for cervical cancer screening in women living with HIV (COMPASS-DUST)-Study protocol. PLoS One 2023; 18:e0278077. [PMID: 36701329 PMCID: PMC9879465 DOI: 10.1371/journal.pone.0278077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
The risk of progression of low-grade (CIN1) to high-grade cervical intraepithelial neoplasia (CIN2/3) is 3-5 times higher for women living with HIV (WLHIV) than for HIV-negative women. Evidence suggests that the current cervical cancer screening methods perform less effectively in WLHIV. An emerging screening method-p16/Ki-67 dual staining technology (DUST) is a safe and rapid assay that could be used to detect CIN2/3 with higher sensitivity and specificity. The study in this protocol will evaluate the performance of DUST in cervical cancer screening among WLHIV. We will conduct an intra-participant comparative study (Phase 1) to enrol n = 1,123 sexually active WLHIV aged 25-65 years at two accredited adult HIV treatment centres in Lagos, Nigeria to compare the performance of DUST to the currently used screening methods (Pap smear, hr-HPV DNA, or VIA testing) in detecting high-grade CIN and cancer (CIN2+). Subsequently, a prospective cohort study (Phase 2) will be conducted by enrolling all the WLHIV who are diagnosed as having low-grade CIN (CIN1) in Phase 1 for a 6-monthly follow-up for 2 years to detect the persistence and progression of CIN1 to CIN2+. The findings of this study may provide evidence of the existence of a better performance screening method for the primary and triage detection of CIN2+ in WLHIV. It may also demonstrate that this high-performance test can improve the long-term predictive accuracy of screening by extending the intervals between evaluations and thus decrease the overall cost and increase screening uptake and follow-up compliance in WLHIV.
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Affiliation(s)
- Kehinde S. Okunade
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
- Center for Clinical Trial, Research, and Implementation science (CCTRIS), College of Medicine, University of Lagos, Lagos, Nigeria
- * E-mail:
| | - Kabir B. Badmos
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Austin C. Okoro
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iyabo Y. Ademuyiwa
- Department of Nursing Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Yusuf A. Oshodi
- Department of Obstetrics & Gynaecology, Lagos State University College of Medicine, Lagos, Nigeria
| | - Adebola A. Adejimi
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Nicholas A. Awolola
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Oluchi Ozonu
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Hameed Adelabu
- Center for Clinical Trial, Research, and Implementation science (CCTRIS), College of Medicine, University of Lagos, Lagos, Nigeria
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Alani S. Akanmu
- Department of Haematology & Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adekunbiola A. Banjo
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rose I. Anorlu
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Jonathan S. Berek
- Department of Obstetrics & Gynaecology, Stanford University School of Medicine, Stanford, United States of America
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3
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Challenges in Cancer Prevention in HIV. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00532-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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4
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Peprah S, Coleman JS, Rositch AF, Vanden Bussche CJ, Moore R, D'Souza G. Utilization of Pap testing among women living with HIV enrolled in primary care in Baltimore, Maryland: A 10-year longitudinal study, 2005-2014. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2018; 6:52-57. [PMID: 30420338 PMCID: PMC6231054 DOI: 10.1016/j.pvr.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/03/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
Frequent Pap testing is recommended among women living with HIV (WLWH) due to their elevated risk for cervical cancer. However, there are few recent longitudinal evaluations of utilization and determinants of Pap testing among WLWH. Medical and pathology records of WLWH seen at Johns Hopkins Hospital between 2005 and 2014 were assessed using Prentice, Williams, Peterson models. Of 554 WLWH in care for ≥ 18 months, 79% received Pap testing, however only 11% consistently received Pap testing at the recommended interval. Some women (5%) were consistently under-screened (tested at longer intervals) and 21% did not receive any Pap testing at during follow-up. WLWH with decreased likelihood of screening included older women, injection drug users, whites and those who had lived for longer with HIV. In contrast, only women with a prior abnormal Pap result were more likely to receive Pap testing. CD4 cell count and health insurance were not significant determinants. Although many WLWH in care received Pap testing, some WLWH were unscreened or underscreened. Determinants of Pap testing for WLWH include socio-demographic factors and a prior abnormal result; these present potential targets in an urban HIV care setting for closer monitoring and directed interventions to improve utilization among WLWH.
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Affiliation(s)
- Sally Peprah
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6132B, Baltimore, MD 21205, United States
| | | | - Anne F Rositch
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6132B, Baltimore, MD 21205, United States
| | | | - Richard Moore
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gypsyamber D'Souza
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6132B, Baltimore, MD 21205, United States.
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Musa J, Achenbach CJ, Evans CT, Jordan N, Daru PH, Hou L, Murphy RL, Adewole IF, Simon MA. Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria. BMC Health Serv Res 2018; 18:885. [PMID: 30466437 PMCID: PMC6251217 DOI: 10.1186/s12913-018-3700-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cervical cancer screening (CCS) is an important health service intervention for prevention of morbidity and mortality from invasive cervical cancer. The role of provider recommendation and referral is critical in utilization of this services particularly in settings where screening is largely opportunistic. We sought to understand how patient-reported human immunodeficiency virus (HIV) infection status is associated with provider referral in an opportunistic screening setting. METHODS We performed a cross-sectional analysis of data on a sample of women who had received a CCS at the "Operation Stop" cervical cancer (OSCC) screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used the de-identified records of women who had their first CCS to analyze the association between patient-reported HIV and likelihood of provider-referral at first CCS. We performed descriptive statistics with relevant test of association using Student t-test (t-test) for continuous variables and Pearson chi square or Fisher exact test where applicable for categorical variables. We also used a bivariable and multivariable logistic regression models to estimate the independent association of patient-reported HIV on provider referral. All statistical tests were performed using STATA version 14.1, College Station, Texas, USA. Level of statistical significance was set at 0.05. RESULTS During the 10-year period, 14,088 women had their first CCS. The reported HIV prevalence in the population was 5.0%; 95% CI: 4.6, 5.4 (703/14,088). The median age of women who were screened was 37 years (IQR; 30-45). Women who were HIV infected received more referrals from providers compared to women who were HIV uninfected (68.7% versus 49.2%), p-value < 0.001. Similarly, we found an independent effect of patient-reported HIV infection on the likelihood for provider-referral in the screened sample (aOR = 2.35; 95% CI: 1.95, 2.82). CONCLUSION Our analysis supports the design of health systems that facilitates providers' engagement and provision of necessary counseling for CCS in the course of routine clinical care. The practice of offering recommendation and referrals for CCS to women at high risk of cervical cancer, such as HIV infected women should be supported.
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Affiliation(s)
- Jonah Musa
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA. .,Center for Global Health, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA. .,Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Plateau State, Nigeria.
| | - Chad J Achenbach
- Center for Global Health, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Charlesnika T Evans
- Department of Preventive Medicine, Center for Health Care Studies, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Neil Jordan
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA.,Department of Psychiatry & Behavioral Science, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Plateau State, Nigeria
| | - Lifang Hou
- Center for Global Health, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Robert L Murphy
- Center for Global Health, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Isaac F Adewole
- Federal Ministry of Health, Federal Secretariat Complex, Central Business District, Federal Capital, Abuja, Nigeria
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Mohammed DY, Shukla P, Babayants Y, Sison R, Slim J. Increased proportions of HIV-infected women met cervical cancer screening guideline in 2016. Int J Womens Health 2018; 10:83-87. [PMID: 29497336 PMCID: PMC5818846 DOI: 10.2147/ijwh.s153003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background HIV-infected women are five times more likely to develop invasive cervical cancer. Routine screening can detect early signs of cancer and provide an opportunity for treatment. However, suboptimal screening rates are reported in this population. This retrospective study examined the rates of cervical cancer screening in HIV-positive women, conducted according to the current guidelines, from 2014 to 2016 in an inner-city clinic. Materials and methods We implemented focused scheduling for eligible women by a designated medical assistant. Testing was conducted using Thin Prep™ and Cervista HPV HR™. Chi-square tests and logistic regression models were used to assess predictors of cervical cancer screening in 2016. Results A total of 360 adult HIV-infected women were active in medical care, as of December 31, 2016. Most were African American (77%) and aged 51-60 years (38%). In 2016, 75% of women met the guidelines for cervical cancer screening, compared to 48% in 2014. There was a significant association between receipt of cervical cancer screening in the prior 3 years and screening in 2016. In an adjusted model, those with a prior screening were 6.88 times (95% CI, 3.47-13.67) more likely to be screened in 2016, compared to those who were never previously screened. Conclusion Focused scheduling and implementation of the updated cervical cancer screening guideline extending the period of rescreening, after 3 yearly negative results or negative Papanicolaou/human papilloma virus testing, resulted in an increased proportion of women meeting the current guideline.
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Affiliation(s)
- Debbie Y Mohammed
- Department of Nursing, College of Science and Health, William Paterson University, Wayne, NJ.,Division of Infectious Disease, Department of Medicine, Saint Michael's Medical Center, Newark, NJ
| | - Prerak Shukla
- Division of Infectious Disease, Department of Medicine, Saint Michael's Medical Center, Newark, NJ
| | - Yuriy Babayants
- School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Raymund Sison
- Division of Infectious Disease, Department of Medicine, Saint Michael's Medical Center, Newark, NJ
| | - Jihad Slim
- Division of Infectious Disease, Department of Medicine, Saint Michael's Medical Center, Newark, NJ
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Kennedy CE, Haberlen SA, Narasimhan M. Integration of sexually transmitted infection (STI) services into HIV care and treatment services for women living with HIV: a systematic review. BMJ Open 2017. [PMID: 28637733 PMCID: PMC5734446 DOI: 10.1136/bmjopen-2016-015310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To review and critically appraise the existing evidence on integration of sexually transmitted infection (STI) services into HIV care and treatment services for women living with HIV. DESIGN Systematic review. DATA SOURCES Four electronic databases were searched through 16February 2017 using keywords for HIV, STIs and integration. Reference lists of included articles and other reviews were also screened. REVIEW METHODS We included studies that compared women living with HIV who received STI services integrated into HIV care and treatment services with those who received HIV care and treatment services without integrated STI services or standard of care. RESULTS Of 170 articles identified, 3 studies reported in 4 articles were included. Two studies evaluated comprehensive care for people living with HIV in the UK; in both cases, quality and uptake of STI services seemed to improve following integration. The third study conducted a comparative case study across different models of care in Swaziland: two clinics integrated with sexual and reproductive health services (including STI services), and two stand-alone HIV clinics (without STI services). Coverage for Pap smears among women living with HIV was higher at the fully integrated site, but there was no significant difference in the prevalence of sexual health screening or advice on sexual health. Reported client satisfaction was generally higher at the stand-alone HIV clinic, and a diverse range of factors related to implementation of different care models challenged the notion that integrated services are always superior or desired. CONCLUSION While there is a limited evidence base for integrating STI services into HIV care and treatment services, existing studies indicate that integration is feasible and has the potential for positive outcomes. However, diverse population needs and health system factors must be considered when designing models of care to provide STI services to women living with HIV.
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Affiliation(s)
- Caitlin E Kennedy
- Departments of International Health and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabina A Haberlen
- Departments of International Health and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Landovitz RJ, Desmond KA, Gildner JL, Leibowitz AA. Quality of Care for HIV/AIDS and for Primary Prevention by HIV Specialists and Nonspecialists. AIDS Patient Care STDS 2016; 30:395-408. [PMID: 27610461 DOI: 10.1089/apc.2016.0170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The role of HIV specialists in providing primary care to persons living with HIV/AIDS is evolving, given their increased incidence of comorbidities. Multivariate logit analysis compared compliance with sentinel preventive screening tests and interventions among publicly insured Californians with and without access to HIV specialists in 2010. Quality-of-care indicators [visit frequency, CD4 and viral load (VL) assessments, influenza vaccine, tuberculosis (TB) testing, lipid profile, glucose blood test, and Pap smears for women] were related to patient characteristics and provider HIV caseload. There were 9377 adult Medicare enrollees (71% also had Medicaid coverage) and 2076 enrollees with only Medicaid coverage. Adjusted for patient characteristics, patients seeing providers with greater HIV caseloads (>50 HIV patients) were more likely to meet visit frequency guidelines in both Medicare [98%; confidence interval (CI 97.5-98.2) and Medicaid (97%; CI 96.2-98.0), compared to 60% (CI 57.1-62.3) and 45% (CI 38.3-50.4), respectively, seeing providers without large HIV caseloads (p < 0.001). Patients seeing providers with larger caseloads were significantly more likely to have CD4 (p < 0.001), VL (p < 0.001), and TB testing (p < 0.05). A larger percentage of patients seeing large-volume Medicare providers received influenza vaccinations. Provider caseload was unrelated to lipid or glucose assessments or Pap Smears for women. Patients with access to large-volume providers were more likely to meet clinical guidelines for visits, CD4, VL, tuberculosis testing, and influenza vaccinations, and were not less likely to receive primary preventive care. Substantial insufficiencies remain in both monitoring to assess viral suppression and in preventive care.
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Affiliation(s)
- Raphael J. Landovitz
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, UCLA Center for Clinical AIDS Research and Education, Los Angeles, California
| | - Katherine A. Desmond
- Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Jennifer L. Gildner
- Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Arleen A. Leibowitz
- Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, California
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Ogunwale AN, Coleman MA, Sangi-Haghpeykar H, Valverde I, Montealegre J, Jibaja-Weiss M, Anderson ML. Assessment of factors impacting cervical cancer screening among low-income women living with HIV-AIDS. AIDS Care 2015; 28:491-4. [PMID: 26493859 DOI: 10.1080/09540121.2015.1100703] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Very little is currently known about factors impacting the prevalence of cervical cancer screening among women living with HIV-AIDS (WLHA). To better understand this issue, we surveyed low-income, medically underserved women receiving subsidized gynecologic care through an integrated HIV clinic. A self-administered questionnaire was completed by 209 women who self-identified as HIV positive. A total of 179 subjects (85.7%) reported having had a Pap test in the last three years. The majority of WLHA (95%) knew that the Pap test screens for cervical cancer. However, overall knowledge of cervical cancer risk factors, such as multiple sexual partners or sex with a man with multiple partners, was low (43% and 35%, respectively). Unscreened women were younger and more likely to be single with multiple current sexual partners. In multivariable analyses, the only factors associated with Pap testing were a woman's perception that her partner wants her to receive regular screening (aOR 4.64; 95% CI: 1.15-23.76; p = .04), number of clinic visits during the past year (aOR 1.36, 95% CI: 1.05-1.94; p = .04) and knowledge that the need for a Pap test does not depend on whether or not a woman is experiencing vaginal bleeding (aOR 6.52, 95% CI: 1.04-49.71; p = .05). We conclude that support from male partners in addition to effective contact with the health system and knowledge of cervical cancer risk factors influence Pap utilization among low-income WLHA. Future measures to improve the care for this population should increase knowledge of cervical cancer risk factors and encourage social support for cervical cancer screening among WLHA.
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Affiliation(s)
- Abayomi N Ogunwale
- a Departments of Obstetrics & Gynecology , Baylor College of Medicine , Houston , TX 77030 , USA
| | - Maame Aba Coleman
- a Departments of Obstetrics & Gynecology , Baylor College of Medicine , Houston , TX 77030 , USA
| | - Haleh Sangi-Haghpeykar
- a Departments of Obstetrics & Gynecology , Baylor College of Medicine , Houston , TX 77030 , USA
| | - Ivan Valverde
- d Dan L. Duncan Cancer Center , Baylor College of Medicine , Houston , TX 77030 , USA
| | - Jane Montealegre
- b Departments of Pediatrics , Baylor College of Medicine , Houston , TX 77030 , USA
| | - Maria Jibaja-Weiss
- d Dan L. Duncan Cancer Center , Baylor College of Medicine , Houston , TX 77030 , USA
| | - Matthew L Anderson
- a Departments of Obstetrics & Gynecology , Baylor College of Medicine , Houston , TX 77030 , USA.,c Departments of Pathology & Immunology , Baylor College of Medicine , Houston , TX 77030 , USA.,d Dan L. Duncan Cancer Center , Baylor College of Medicine , Houston , TX 77030 , USA.,e Center for Reproductive Medicine , Baylor College of Medicine , Houston , TX 77030 , USA
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10
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Adherence to the cervical cancer screening program in women living with HIV in Denmark: comparison with the general population. BMC Infect Dis 2014; 14:256. [PMID: 24885577 PMCID: PMC4025560 DOI: 10.1186/1471-2334-14-256] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/30/2014] [Indexed: 11/10/2022] Open
Abstract
Background Women living with HIV (WLWH) are at increased risk of invasive cervical cancer (ICC). International HIV guidelines suggest cervical screening twice the first year after HIV diagnosis and thereafter annually. Adherence to the HIV cervical screening program in Denmark is unknown. Methods We studied women from a population-based, nationwide HIV cohort in Denmark and a cohort of age-matched females from the general population. Screening behaviour was assessed from 1999–2010. Adjusted odds ratios (OR’s) for screening attendance in the two cohorts and potential predictors of attendance to guidelines were estimated. Pathology specimens were identified from The Danish Pathology Data Bank. Results We followed 1143 WLWH and 17,145 controls with no prior history of ICC for 9,509 and 157,362 person-years. The first year after HIV diagnosis 2.6% of WLWH obtained the recommended two cervical cytologies. During the different calendar intervals throughout the study period between 29-46% of WLWH followed the HIV cervical screening guidelines. Adjusted OR’s of attendance to the general population screening program for WLWH aged 30, 40 and 50 years, compared to controls, were 0.69 (95% CI: 0.56-0.87), 0.67 (0.55-0.80) and 0.84 (0.61-1.15). Predictors of attendance to the HIV cervical screening program were a CD4 count > 350 cells/μL and HIV RNA < 500 copies/mL. Calendar period after 2002 and HIV RNA < 500 copies/mL predicted attendance to the general population cervical screening program. Conclusions The majority of WLWH do not follow the HIV guidelines for cervical screening. We support the idea of cytology as part of an annual review and integration of HIV care and cervical screening in a single clinic setting.
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Cross SL, Suharwardy SH, Bodavula P, Schechtman K, Overton ET, Onen NF, Lane MA. Improving cervical cancer screening rates in an urban HIV clinic. AIDS Care 2014; 26:1186-93. [PMID: 24625234 PMCID: PMC4065211 DOI: 10.1080/09540121.2014.894610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Human immunodeficiency virus (HIV)-infected women are at increased risk of invasive cervical cancer; however, screening rates remain low. The objectives of this study were to analyze a quality improvement intervention to increase cervical cancer screening rates in an urban academic HIV clinic and to identify factors associated with inadequate screening. Barriers to screening were identified by a multidisciplinary quality improvement committee at the Washington University Infectious Diseases clinic. Several strategies were developed to address these barriers. The years pre- and post-implementation were analyzed to examine the clinical impact of the intervention. A total of 422 women were seen in both the pre-implementation and post-implementation periods. In the pre-implementation period, 222 women (53%) underwent cervical cancer screening in the form of Papanicolaou (Pap) testing. In the post-implementation period, 318 women (75.3%) underwent cervical cancer screening (p < 0.01). Factors associated with lack of screening included fewer visits attended (pre: 4.2 ± 1.5; post: 3.4 ± 1.4; p < 0.01). A multidisciplinary quality improvement intervention was successful in overcoming barriers and increasing cervical cancer screening rates in an urban academic HIV clinic.
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Affiliation(s)
- Sara L Cross
- a Division of Infectious Diseases , Washington University School of Medicine , St. Louis , MO , USA
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Fletcher FE, Vidrine DJ, Tami-Maury I, Danysh HE, King RM, Buchberg M, Arduino RC, Gritz ER. Cervical cancer screening adherence among HIV-positive female smokers from a comprehensive HIV clinic. AIDS Behav 2014; 18:544-54. [PMID: 23605155 DOI: 10.1007/s10461-013-0480-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV-positive women are at elevated risk for developing cervical cancer. While emerging research suggests that gynecologic health care is underutilized by HIV-positive women, factors associated with adherence to Pap testing, especially among HIV-positive female smokers are not well known. We utilized baseline data from a smoking cessation trial and electronic medical records to assess Pap smear screening prevalence and the associated characteristics among the HIV-positive female participants (n = 138). 46 % of the women had at least 1 Pap test in the year following study enrollment. Multiple logistic regression analysis indicated that younger age, African American race, hazardous drinking, increased number of cigarettes smoked per day, and smoking risk perception were associated with non-adherence to Pap smear screening. Cervical cancer screening was severely underutilized by women in this study. Findings underscore the importance of identifying predictors of non-adherence and addressing multiple risk factors and behavioral patterns among HIV-positive women who smoke.
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Affiliation(s)
- Faith E Fletcher
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, PO Box 301439, Unit 1330, Houston, TX, 77030-1439, USA,
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Tello MA, Jenckes M, Gaver J, Anderson JR, Moore RD, Chander G. Barriers to recommended gynecologic care in an urban United States HIV clinic. J Womens Health (Larchmt) 2012; 19:1511-8. [PMID: 20629573 DOI: 10.1089/jwh.2009.1670] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite an increased risk for cervical cytologic abnormalities, HIV-infected women frequently miss their gynecology appointments. We examined barriers to adherence with gynecologic care in an urban HIV clinic. METHODS We conducted a cross-sectional survey of 200 women receiving gynecologic services in an urban HIV clinic, followed by focus groups. Primary outcomes included (1) missed gynecology appointments and (2) receipt of a Pap smear in the previous year. Independent variables included sociodemographic characteristics, child care responsibilities, substance use, depressive symptoms, social support, interpersonal violence, CD4 count, and HIV-1 RNA. We conducted multivariable logistic regression to examine associations between independent variables and outcomes. We then held two focus groups designed to gather opinions on and increase our understanding of the key findings from the survey. RESULTS Of 200 women, 69% missed at least one gynecology appointment, and 22% had no Pap smear in the past year. In logistic regression, moderate (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.4-6.7) and severe (OR 3.1, 95% CI 1.3-7.5) depressive symptoms and past-month substance use (OR 2.3, 95% CI 1.0-5.3) were associated with missing an appointment in the prior year. An education level of less than high school (OR 0.3, 95% CI 0.1-0.6) compared with high school diploma or greater was associated with not having a Pap smear in the previous year. When analyses were limited to women with a cervix (n = 166), moderate (OR 2.5, 95% CI 1.1-5.7) and severe (OR 2.5, 95% CI 1.0-6.3) depressive systems remained significantly associated with missing a gynecology appointment in the previous year and age >50 (OR 0.3, 95% CI 0.1-0.9), an HIV-1 RNA > 50 (OR 0.4, 95% CI 0.2-0.9), and education level less than high school (OR 0.2, 95% CI 0.1-0.5) were associated with not having a Pap smear in the past 12 months. Qualitative analysis of the focus group data suggested that fear, inclement weather, and forgetting appointments may contribute to missed gynecology appointments. CONCLUSION Gynecologic healthcare is underused among HIV-infected women. We found that depressive symptoms, substance use, fear of the gynecologic examination, and simply forgetting about the appointment may be barriers to gynecologic care. Interventions targeting these barriers may improve use of gynecologic care among this population.
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Affiliation(s)
- Monique A Tello
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Setse R, Siberry GK, Moss WJ, Gravitt P, Wheeling T, Bohannon B, Dominguez K. Cervical pap screening cytological abnormalities among HIV-infected adolescents in the LEGACY cohort. J Pediatr Adolesc Gynecol 2012; 25:27-34. [PMID: 22088311 PMCID: PMC4152823 DOI: 10.1016/j.jpag.2011.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/02/2011] [Accepted: 09/10/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the prevalence of cervical Pap screening (CPAP-S), identify factors associated with CPAP-S, and explore risk factors for abnormal cervical cytology in female adolescents with perinatally and behaviorally acquired HIV infection. DESIGN Cross-sectional. SETTING LEGACY is a national observational cohort chart review study of 1478 HIV-infected persons (<age 24 years) managed in 22 HIV specialty clinics in the United States. PARTICIPANTS Sexually active females aged 13-24 years in the LEGACY cohort. MAIN OUTCOME MEASURES CPAP-S and abnormal cervical cytology. RESULTS Of 231 sexually active female LEGACY participants 13-24 years of age 49% had documentation of CPAP-S between 2001 and 2006. Fifty-eight percent of 113 cervical tests were abnormal (2% high-grade). In multivariable analysis, perinatal HIV infection and black race were associated with decreased likelihood of CPAP-S (adjusted prevalence ratio [APR] 0.66, 95% CI 0.45-0.96 and APR 0.74, 95% CI 0.56-0.96, respectively). Presence of any sexually transmitted infection (STI) was independently associated with increased likelihood of CPAP-S (APR 1.56, 95% CI 1.21, 2.02). CD4+ T-lymphocyte count <200 cells/mL and previous STI diagnosis were independently associated with increased likelihood of abnormal cervical cytology (APR 2.19, 95% CI 1.26-3.78 and APR 1.94, 95% CI 1.29-2.92, respectively). CONCLUSIONS Among sexually active HIV-infected adolescent females, prevalence of CPAP-S was low and cytology was abnormal in more than half of Pap smears. Perinatally HIV-infected, sexually active females were less likely to undergo CPAP-S than their behaviorally HIV-infected counterparts. Interventions targeted at HIV-infected adolescents and care providers are needed to improve CPAP-S in HIV-infected young women, especially those with perinatally acquired HIV infection.
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Affiliation(s)
- Rosanna Setse
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Baranoski AS, Horsburgh CR, Cupples LA, Aschengrau A, Stier EA. Risk factors for nonadherence with Pap testing in HIV-infected women. J Womens Health (Larchmt) 2011; 20:1635-43. [PMID: 21879883 DOI: 10.1089/jwh.2010.2465] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND HIV-infected women are at increased risk for cervical cancer; thus, adherence with Papanicolaou (Pap) testing is of particular importance. The objective of this study was to identify risk factors for inadequate Pap testing in a diverse cohort of HIV-infected women at a large urban safety net HIV clinic. METHODS This retrospective cohort study assessed HIV-infected women aged 18?60 years in care between October 1, 2003, and March 31, 2008, for risk factors for inadequate Pap testing. Unadjusted odds ratios (OR) with confidence intervals (CI) and multivariate analyses with generalized estimating equations for correlated data were calculated. RESULTS Of 549 women, 293 (53.4%) had a Pap test during each follow-up period. Women who were older, white or Hispanic race/ethnicity, U.S. born, unemployed, drug users, and those with advanced HIV had increased odds of no Pap testing in unadjusted analyses. In multivariate analyses, U.S.-born women who were white or unemployed or had a baseline CD4 count <200 cells/mm(3) had increased odds of no Pap testing (OR 2.0, 95% CI 1.3-3.1; OR 2.3, CI 1.0-5.0; OR 1.7, CI 1.0-2.9, respectively). For non-U.S.-born women, age ?50 years (OR 3.9, CI 1.7-9.0), non-English-speaking status (OR 1.6, CI 1.0-2.4), and drug use (OR 5.8, CI 2.5-13.9) were associated with no Pap testing. CONCLUSIONS U.S.-born status and low CD4 count were associated with increased odds of inadequate Pap testing. Further study is needed to identify interventions to improve Pap testing adherence in this high-risk group.
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Affiliation(s)
- Amy S Baranoski
- Boston University School of Medicine, Section of Infectious Diseases, 850 Harrison Avenue, Boston, MA 02118, USA.
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Parham GP, Mwanahamuntu MH, Sahasrabuddhe VV, Westfall AO, King KE, Chibwesha C, Pfaendler KS, Mkumba G, Mudenda V, Kapambwe S, Vermund SH, Hicks ML, Stringer JS, Chi BH. Implementation of cervical cancer prevention services for HIV-infected women in Zambia: measuring program effectiveness. ACTA ACUST UNITED AC 2010; 4:703-722. [PMID: 25419240 DOI: 10.2217/hiv.10.52] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cervical cancer kills more women in low-income nations than any other malignancy. A variety of research and demonstration efforts have proven the efficacy and effectiveness of low-cost cervical cancer prevention methods but none in routine program implementation settings of the developing world, particularly in HIV-infected women. METHODS In our public sector cervical cancer prevention program in Zambia, nurses conduct screening using visual inspection with acetic acid aided by digital cervicography. Women with visible lesions are offered same-visit cryotherapy or referred for histologic evaluation and clinical management. We analyzed clinical outcomes and modeled program effectiveness among HIV-infected women by estimating the total number of cervical cancer deaths prevented through screening and treatment. RESULTS Between 2006 and 2008, 6572 HIV-infected women were screened, 53.6% (3523) had visible lesions, 58.5% (2062) were eligible for cryotherapy and 41.5% (1461) were referred for histologic evaluation. A total of 75% (1095 out of 1462) of patients who were referred for evaluation complied. Pathology results from 65% (715 out of 1095) of women revealed benign abnormalities in 21% (151), cervical intraepithelial neoplasia (CIN) I in 30% (214), CIN 2/3 in 33% (235) and invasive cervical cancer in 16.1% (115, of which 69% were early stage). Using a conditional probability model, we estimated that our program prevented 142 cervical cancer deaths (high/low range: 238-96) among the 6572 HIV-infected women screened, or one cervical cancer death prevented per 46 (corresponding range: 28-68) HIV-infected women screened. CONCLUSION Our prevention efforts using setting-appropriate human resources and technology have reduced morbidity and mortality from cervical cancer among HIV-infected women in Zambia. Financial support for implementing cervical cancer prevention programs integrated within HIV/AIDS care programs is warranted. Our prevention model can serve as the implementation platform for future low-cost HPV-based screening methods, and our results may provide the basis for comparison of programmatic effectiveness of future prevention efforts.
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Affiliation(s)
- Groesbeck P Parham
- University of Alabama at Birmingham, AL, USA ; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ; University Teaching Hospital, Lusaka, Zambia
| | - Mulindi H Mwanahamuntu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ; University Teaching Hospital, Lusaka, Zambia
| | | | | | | | - Carla Chibwesha
- University of Alabama at Birmingham, AL, USA ; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Gracilia Mkumba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ; University Teaching Hospital, Lusaka, Zambia
| | | | - Sharon Kapambwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ; University Teaching Hospital, Lusaka, Zambia
| | | | | | - Jeffrey Sa Stringer
- University of Alabama at Birmingham, AL, USA ; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Benjamin H Chi
- University of Alabama at Birmingham, AL, USA ; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Logan JL, Khambaty MQ, D'Souza KM, Menezes LJ. Cervical cancer screening among HIV-infected women in a health department setting. AIDS Patient Care STDS 2010; 24:471-5. [PMID: 20653483 DOI: 10.1089/apc.2009.0295] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-infected women are at increased risk of developing invasive cervical cancer and present for care at a later stage of disease. Because of this susceptibility, the US Preventive Services Task Force and Centers for Disease Control and Prevention recommend that HIV-infected women receive two Pap smears during their first year after diagnosis, then annually thereafter. The aim of this study was to determine adherence to these screening guidelines and associations between demographic factors and receipt of Pap smears at a local health department in Florida. Demographic and Pap smear data were extracted from randomly selected medical records of 200 HIV-infected women receiving care between January 2000 and May 2006. Descriptive statistics and chi(2) associations were determined. Overall, 83% of women received at least one Pap smear in their first year after enrollment; 24.5% received the recommended two Pap smears. The women were predominantly minorities (57.4% African Americans; 22.8% Hispanics) and economically disadvantaged (mean income $8,180). First year Pap smear rate was significantly associated with type of insurance (p = 0.0185) and Pap smear facility (p < 0.0001), with a trend toward association with HIV risk behavior (p = 0.0593). First-year Pap smear rate was not associated with age, income, ethnicity, or incarceration history. Although this health department provided similar cervical cancer screening levels to those reported elsewhere, rates fall short of evidence-based guidelines. Future research must address low second Pap smear rates in the context of patient and provider barriers to improve early detection and prevention of cervical cancer in HIV-infected women.
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Affiliation(s)
- Jennifer L. Logan
- University of South Florida, Division of Infectious Disease and International Medicine, Tampa, Florida
| | - Maria Q. Khambaty
- University of South Florida, Division of Infectious Disease and International Medicine, Tampa, Florida
| | - Karina M. D'Souza
- University of South Florida, Division of Infectious Disease and International Medicine, Tampa, Florida
| | - Lynette J. Menezes
- University of South Florida, Division of Infectious Disease and International Medicine, Tampa, Florida
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Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study. BMC Cancer 2010; 10:310. [PMID: 20565935 PMCID: PMC2904281 DOI: 10.1186/1471-2407-10-310] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 06/21/2010] [Indexed: 11/23/2022] Open
Abstract
Background The 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. Methods A 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. Results A 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. Conclusions In 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.
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Rahangdale L, Sarnquist C, Yavari A, Blumenthal P, Israelski D. Frequency of cervical cancer and breast cancer screening in HIV-infected women in a county-based HIV clinic in the Western United States. J Womens Health (Larchmt) 2010; 19:709-12. [PMID: 20201703 PMCID: PMC2867552 DOI: 10.1089/jwh.2009.1412] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women's primary-care services are frequently dispensed to HIV-infected women through HIV specialty clinics. Our objective was to evaluate cervical cancer and breast cancer screening practices in a county-based HIV clinic in San Mateo, California. METHODS This was a retrospective cohort study of medical records of HIV-infected women obtaining HIV care at this site. RESULTS Between January 1, 2002 and December 31, 2006, 69 women were documented to have at least 12 months of medical care at the clinic. Median followup time was 51 months. Over 253 person-years of followup, there were 656 pap smears performed per 1,000 person-years; 77.9% of women had at least one Pap smear during the study time period. A total of 59.5% (47/79) of normal pap smears had a followup pap smear within 18 months; 62.0% of abnormal pap smears had a followup pap smear within 12 months. A CD4 count of less than 200 cells/mm(3) was associated with not receiving a pap smear in multivariable analysis. Mammogram screening was performed on 64.7% of women aged 40 or older. CONCLUSIONS Based on the results of this study, the majority of HIV-infected women at this clinic received cervical and breast cancer screening at some point during their care. Only two-thirds of abnormal pap smear results had followup pap smear screening within a year. With the increased risk of cervical cancer in HIV-infected women, efforts should be made to promote cervical cancer screening, particularly in high-risk women.
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Affiliation(s)
- Lisa Rahangdale
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA.
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20
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Phillips AA, Justman JE. Screening HIV-infected patients for non-AIDS-defining malignancies. Curr HIV/AIDS Rep 2009; 6:83-92. [PMID: 19358779 DOI: 10.1007/s11904-009-0013-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The use of antiretroviral therapy has reduced mortality and shifted the spectrum of malignancies affecting people living with HIV/AIDS (PLWH). We review guidelines and evidence for screening PLWH for non-AIDS-defining malignancies as compared with the general population. Cervical cancer screening clearly differs for HIV-seropositive women, with two Pap tests 6 months apart in the first year and then annually if normal. The role of cervical human papillomavirus screening has not yet been defined in HIV-seropositive women. Anal cancer screening consists of an annual digital rectal examination, and some (but not all) guidelines also recommend annual anal Pap tests. Screening for breast and colorectal cancer should follow standard, age-appropriate screening recommendations that apply to the general population. Screening HIV-infected men for prostate cancer, as with the general population, lacks a clear benefit. Despite increasing rates of hepatocellular carcinoma and lung cancers among PLWH, there is insufficient evidence to support routine screening.
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Affiliation(s)
- Adrienne A Phillips
- Department of Medicine, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, 506 Lenox Avenue, MLK Building 13-101, New York, NY 10037, USA.
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Tello MA, Yeh HC, Keller JM, Beach MC, Anderson JR, Moore RD. HIV women's health: a study of gynecological healthcare service utilization in a U.S. urban clinic population. J Womens Health (Larchmt) 2009; 17:1609-14. [PMID: 19049355 DOI: 10.1089/jwh.2008.0881] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women infected with HIV have a high rate of many gynecological problems. Adherence to recommended gynecological care among women enrolled in our urban HIV clinics was hypothesized to be low. METHODS We conducted an analysis of data from the Johns Hopkins HIV Clinical Cohort Database examining demographic and clinical predictors of clinic visit adherence by women in the HIV primary care and HIV gynecological clinics. RESULTS Between January 2002 and April 2006, 1,086 women had 26,401 scheduled appointments to the two clinics, of which 21,959 were to HIV primary care and 4,442 were to HIV gynecological care. There were 12,097 (55%) completed primary care visits and 1,609 (36.2%) completed HIV gynecological visits (p < 0.001, accounting for clustering). By multivariate analysis, age <40 years (OR 0.81, 95% CI 0.70-0.94) and substance abuse (OR 0.67, 95% CI 0.61-0.73) were associated with a decreased likelihood of attending an HIV primary care appointment. African American race (OR 0.63, 95% CI 0.45-0.90), CD4 count <200 cells/mm(3) (OR 0.73, 95% CI 0.56-0.95), and substance abuse (OR 0.57, 95% CI 0.45-0.71) were associated with a decreased likelihood of attending an HIV gynecological appointment. CONCLUSIONS This analysis determined that the rate of clinic visit adherence is significantly lower for HIV gynecological care than for HIV primary care in the same population of women. Factors associated with HIV gynecological clinic visit noncompliance included African American race/ethnicity, substance use, and more advanced immunosuppression. We have planned additional quantitative and qualitative studies to examine the associations with and barriers to HIV gynecological care, with the goal of creating appropriate interventions toward improving gynecological healthcare utilization among women enrolled in urban HIV clinics.
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Affiliation(s)
- Monique A Tello
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Koethe JR, Moore RD, Wagner KR. Physician specialization and women's primary care services in an urban HIV clinic. AIDS Patient Care STDS 2008; 22:373-80. [PMID: 18373414 DOI: 10.1089/apc.2007.0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To compare adherence to published primary care guidelines by general internal medicine and infectious diseases (ID) specialist physicians treating HIV-positive women we conducted a retrospective patient record review of 148 female HIV-positive patients seen at the Nathan Smith Clinic in New Haven, Connecticut, in 2001 and 2002. Four quality measures were defined to evaluate physician practices: annual cervical cancer screening, influenza vaccination and hyperlipidemia screening, and biennial mammography. Main outcome was the frequency of meeting each measure by generalist and ID-specialist physicians, and the two physician types were compared after controlling for patient clustering, age, and CD4 cell count. Among all measures, the rates of cervical cancer screening in 2001 were lowest among generalists (55%) and ID-specialists (47%) but not significantly different (odds ratio [OR] 1.26, 95% confidence interval [CI] 0.78 to 1.90), and the rates of hyperlipidemia screening in 2002 were highest for both generalists (98%) and ID-specialists (93%), but again not significant (OR 2.86, CI 0.30 to 27.6). No statistically significant differences were found between physician types for any quality measure, nor were significant differences found in the CD4 cell counts of patients of each physician type who received each service. Our results show potential for improvements in care among both generalist and ID-specialist physicians treating HIV-positive women.
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Affiliation(s)
- John R. Koethe
- Vandervilt University School of Medicine, Nashville, Tennessee
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Franceschi S, Jaffe H. Cervical Cancer Screening of Women Living with HIV Infection: A Must in the Era of Antiretroviral Therapy. Clin Infect Dis 2007; 45:510-3. [PMID: 17638204 DOI: 10.1086/520022] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 04/06/2007] [Indexed: 11/03/2022] Open
Abstract
Women living with human immunodeficiency virus (HIV) infection have a much higher risk of human papillomavirus infection and cervical cancer than do HIV-uninfected women. Before the introduction of antiretroviral therapy, the lack of cervical cancer screening among HIV-infected women probably had little influence on their life expectancies because of the high competing mortality associated with other causes, but the situation is changing rapidly everywhere. In sub-Saharan Africa, for instance, approximately 400,000 HIV-infected women were receiving antiretroviral therapy in 2005. Funds given to antiretroviral therapy programs in low-resource countries not only support the purchase of drugs, but they also support the development of clinical infrastructures and laboratories. Because women who receive antiretroviral therapy are observed regularly, they can also receive the continuity of care needed for cervical screening. Therefore, the real opportunity to prevent cervical cancer in HIV-infected women in low-resource countries should not be missed, especially as new, inexpensive screening methods (e.g., rapid human papillomavirus tests) are under evaluation.
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Murri R, Franceschi S, Ravizza M, Fiore S, Bini T, Mussini C, Fasolo M, Liuzzi G, Ippolito G, D'Arminio Monforte A. Access to gynecological services and Papanicolau tests in HIV-infected Italian women: a questionnaire survey. AIDS Care 2006; 18:376-8. [PMID: 16809116 DOI: 10.1080/09540120500409267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of the study was to evaluate the access to Papanicolau (Pap) tests of HIV-infected women in Italy. A cross-sectional survey on a cohort of HIV-infected women seen at 27 HIV clinics was performed. At each clinic a female physician involved in the care of HIV-infected women was asked questions on clinic and patients' characteristics and on access to Pap tests. The outcome of the study was to find the percentage of women who had not had a Pap test before coming to the HIV clinic and the percentage having had a Pap test in 2001. In the survey, 7,600 HIV-infected women were represented. Women who came to the clinic without having ever had a Pap test were 62+/-22%, while women who had had a Pap test in 2001 were 43+/-36%. Women who reported never having had a Pap test before coming to the HIV clinic were more often from the south than the north of Italy (17.9+/-49% from the north, 18+/-53% from the center and 9.3+/-83.9% from the south; p<0.001). This a difference disappeared when comparing the women who had had a Pap test in 2001 (28+/-39.6% from the north, 31.6+/-44.2% from the center and 25.6+/-45.7% from the south; p=0.88). Despite the published guidelines in Italy, only 38% of women had ever had a Pap test before coming to the HIV clinic and only 43% had had a Pap test in 2001. Strategies aimed to improve these proportions should be rapidly implemented at all levels of care organization.
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Affiliation(s)
- R Murri
- Depatrment of Infectious Diseases, Catholic University of Rome, Italy.
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Hirschhorn LR, McInnes K, Landon BE, Wilson IB, Ding L, Marsden PV, Malitz F, Cleary PD. Gender differences in quality of HIV care in Ryan White CARE Act-funded clinics. Womens Health Issues 2006; 16:104-12. [PMID: 16765286 DOI: 10.1016/j.whi.2006.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 02/07/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women with HIV infection have lagged behind men in receipt of critical health care, but it is not known if those disparities are due in part to where women receive care. We examined differences in care received by HIV-infected women and men in a national sample of Ryan White CARE Act-funded clinics and explored the influence of clinic characteristics on care quality. METHODS Record review was done on a sample of 9,015 patients who received care at 69 CARE Act-funded HIV primary care clinics that participated in a quality improvement study. Outcome measures studied were highly active antiretroviral therapy (HAART) use, HIV viral suppression, Pneumocystis jiroveci pneumonia (PCP) prophylaxis, screening, and other disease prevention efforts. RESULTS Women were less likely than men to receive HAART (78% versus 82%, p < .001), receive PCP prophylaxis (65% versus 75%, p < .0001), or have their hepatitis C virus status known (87% versus 88%, p = .02) despite being seen more regularly (69% versus 66%, p = .04). Sites serving high percentages of women delivered similar or better care for both men and women than other sites. Although sites serving a higher percent of women had more support services such as case management and onsite obstetrician-gynecologists and provided Pap smears at higher rates, women at such sites remained less likely than men to receive important HIV care including HAART and PCP prophylaxis. CONCLUSIONS The gap in the quality of care provided to HIV-infected men and women in critical areas persists, and is not explained by the types of sites where men and women receive care.
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Affiliation(s)
- Lisa R Hirschhorn
- Harvard Medical School Division of AIDS, The Landmark Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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