Cervical Screening within HIV Care: Findings from an HIV-Positive Cohort in UkraineReport as inadecuate




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Introduction

HIV-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.

Methods

Poisson 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.

Results

Overall, 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.

Conclusions

In 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.



Author: Heather Bailey, Claire Thorne , Igor Semenenko, Ruslan Malyuta, Rostislav Tereschenko, Irina Adeyanova, Elena Kulakovskaya, Lyudm

Source: http://plos.srce.hr/



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