Abstract C177: Increasing cervical cancer screening among women living with HIV (WLWH) in Jamaica
Authors: Beckford Jarrett Sharlene T , Blackwood Sasha-Kaye , Ashing Kimlin Tam , Bryan Kamelia , Ellis Tyrone O , Edwards Jeffrey , McFarland Willi , Skyers Nicola 
Published: September 2024

Abstract
Background: Cervical cancer (CCA) is the third most common cancer and the third leading cause of cancer deaths among women in Jamaica. Although human papilloma virus (HPV), the primary risk factor for CCA, has a prevalence of 54% among sexually active Jamaican women, HPV vaccination uptake is low, and CCA is often diagnosed at advanced stages due to inadequate screening. Women comprise 50% of persons living with HIV in Jamaica and are about six times more likely to develop cervical cancer than women without HIV. However, despite national guidelines requiring annual screenings, a national audit found that fewer than one-third of eligible WLWH underwent a Pap smear in the past year. Objective: We aimed to address gaps in CCA screening among WLWH attending four large HIV treatment sites in Jamaica through programmatic and operational support integrated into HIV care. Method: Working through the UCSF Jamaica Country Programme, funded by PEPFAR, clinical advisors completed site reviews to identify gaps in the CCA screening process. Critical gaps identified at the four sites included insufficient supplies (speculums, slides, cytology brushes, fixative, Pap smear jackets, and bed rolls), limited provider knowledge, delays in sample processing, and the delayed return of results from the national public health lab. From January 2023 to May 2024, our team provided technical assistance and resources for sample collection, private laboratory testing, delivery of samples, and collection and review of results. Results: Cervical cancer modules were integrated into an ongoing clinical management training series that reached 33 clinicians across multiple sessions. With supportive supervision, the sites strengthened patient notification and sample transportation, that facilitated appointment adherence, timely sample delivery, and prompt collection of results. Clinical advisors further supported site teams to identify abnormal results and ensure timely and appropriate follow-up diagnostic tests and treatment referrals. This intervention supported 656 eligible WLWH to complete Pap smears, with 614 timely results returned to the sites by May 2024. Conclusion: Targeted programmatic interventions can increase CCA screening by improving the availability of Pap supplies, clinic workflow, and operational efficiency within HIV care clinics thereby reaching a population at high risk for CCA. Technical and financial support from donors can be expanded to explore clinic-based models for improving and integrating HPV screening and vaccine uptake among vulnerable WLWH. The impact of these interventions can be tested through quality improvement and implementation science frameworks.
Citation Format: Sharlene T Beckford Jarrett, Sasha-Kaye Blackwood, Kimlin Tam Ashing, Kamelia Bryan, Tyrone O Ellis, Jeffrey Edwards, Willi McFarland, Nicola Skyers. Increasing cervical cancer screening among women living with HIV (WLWH) in Jamaica [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C177.