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Cervical screening and HIV: A review of women attending three sexual health clinics in Sydney

Cervical screening and HIV: A review of women attending three sexual health clinics in Sydney

Cervical cytology abnormalities are more common in women with HIV.Australian guidelines recommend annual Papanicolau (Pap) tests and colposcopy for all screen detected abnormalities for immunocompromised women.
Methods: Retrospective case note review of women with HIV who attended three publicly funded sexual health clinics in metropolitan Sydney January 2009 to December 2011. Correlates of screen detected abnormalities were assessed using logistic regression.
Results: In the three-year study period 156 women, median age 40 (range 21-73 years), attended for HIV care. Nearly two-thirds, 112 (72.7%) were born overseas and one-third, 51 (33.8%) spoke a language other than English. Pap tests were performed on 108 (69.2%) women, of whom 13 (12.6%) were screened annually. Pap Test Register information was documented for 130 women, with 77 (59.2%) included on the register. Of the 48 (30.8%) women who did not
have a Pap test at a sexual health centre over the study period, only 7 (14.6%) had documented attendance at another service. Cervical screening results were available for 103 women, 30 (29.1%) had an abnormality detected. Correlates with an abnormal result were younger age (p=0.027), being born in Sub-Saharan Africa (p=0.004), more recent arrival in Australia (p= 0.02), CD4 count <350mm3 (p< 0.001), having a detectable viral load (p=0.049), shorter duration
on antiretroviral therapy (p<0.001) and more recent diagnosis of HIV (p=0.01). There was no correlation with CD4 nadir or regular attendance for HIV care.
Conclusion: As far as we are aware this is the largest study to examine cervical screening uptake and outcomes of women with HIV in Australia. Our participants have low documented uptake of screening. Screen detected abnormalities were associated with a combination of social and HIV related factors. Targeted education to address barriers and innovative recruitment strategies may improve screening rates.
Speakers: Donna Tilley
Conference: ASHM 2013
Areas of Interest / Categories: Australian Society for HIV 2013

Australian Society for HIV 2013

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