Abstract C84: Utilization of cervical cancer screening services by women living with HIV enrolled in primary care at the Moore Clinic of Johns Hopkins Hospital: A 10-year retrospective cohort study
Authors: Peprah Sally , Coleman Jenell , Rositch Anne , VandenBussche Christopher , Moore Richard , D'Souza Amber 
Published: March 2017

Background: Due to their compromised immune function, which elevates their risk of disease, women living with HIV (WLWH) represent an important high-risk subgroup for cervical precancer and cancer. However, there is limited information on cervical cancer screening utilization by WLWH in the current antiretroviral treatment era. This retrospective cohort study explores frequency of screening, screening intervals, and the risk factors associated with utilization of cervical cancer screening services by 544 WLWH enrolled in clinical care for at least 18 months at Johns Hopkins between 2005-2014. Understanding utilization and the significant factors associated with underscreening of WLWH, can inform interventions to improve screening adherence in this high-risk group.

Methods: Pap tests, clinical and socio-demographic covariates were obtained by merging a pathology database with a clinical cohort database. The primary outcome of interest was the receipt of Pap testing in the study period. Frequency of screening and screening intervals were described from study entry (defined as first clinic visit after January 1, 2005) to exit (December 31, 2014 or last time seen at Johns Hopkins).

Results: The cohort was primarily black (79%), median age of 41 years (IQR: 34-48) and median follow-up of 5.7 years (IQR: 3.7-7.9). At entry, median CD4 count and HIV viral load were 307 cells/ul (IQR: 510-127), and 7712 copies/ml (IQR: 400-53693) respectively. Current smoking (57%), injection drug use (26%) and obesity or overweight (48.5%) were all common at entry. A substantial proportion of these women (21%) were never screened during the study, despite being in care. Median follow-up among these never-screened women was 4.7 years (IQR: 3.2-6.3). Among the 79% of women who were screened at least once, there was variation in frequency of screening. Some of these women received only one (21%), or two (18%) Pap tests, while others had three (15%), four (13%) and five or more (32%) Pap tests. Among this group of ever-screened participants, the median interval between Pap tests was 11.3 months (IQR: 6.2-17.2). Women who only had one Pap during the study had a much longer average time from entry to Pap (49.5 months, IQR: 18.4-62.4), than the time between Pap tests for women who had 2,3, 4, and 5 or more Pap tests (17.6, 14.8, 12.4, 10.1 months, respectively), p&lt;0.001. Clinical and socio-demographic factors associated with Pap test utilization are currently being explored, and will be included in the meeting presentation.

Conclusion: These findings enhance our knowledge of cervical cancer screening utilization among a high-risk group of HIV-infected, primarily minority, women. They demonstrate that in spite of the recommendation for annual cervical cancer screening of WLWH, even when enrolled in clinical care, some WLWH are not screened.

Citation Format: Sally Peprah, Jenell Coleman, Anne Rositch, Christopher VandenBussche, Richard Moore, Amber D'Souza. Utilization of cervical cancer screening services by women living with HIV enrolled in primary care at the Moore Clinic of Johns Hopkins Hospital: A 10-year retrospective cohort study. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C84.