Arti Barnes1, Andrea C Betts2,3,4, Eric K Borton2, Joanne M Sanders2, Sandi L Pruitt2,3, Claudia Werner5,6, Andres Bran1,6,7, Carolee D Estelle1,6, Bijal A Balasubramanian3,8, Stephen J Inrig2,9, Ethan A Halm1,2,3, Celette Sugg Skinner2,3, Jasmin A Tiro2,3. 1. Department of Internal Medicine. 2. Department of Clinical Sciences. 3. Harold C. Simmons Comprehensive Cancer Center. 4. Department of Health Promotion and Behavioral Sciences. 5. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas. 6. Parkland Health and Hospital System. 7. Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA. 8. Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health School of Public Health in Dallas, Texas. 9. Mount Saint Mary's University, Los Angeles, California.
Abstract
OBJECTIVE: Little is known about cervical cancer screening and results patterns among HIV-infected (HIV+) women in real-world healthcare settings. We characterized two periods of screening opportunity. DESIGN: Retrospective cohort. SETTING: US safety-net healthcare system in Dallas County, Texas. PARTICIPANTS: We analyzed data from electronic medical records (EMR) of 1490 HIV+ women receiving care 2010-2014. MAIN OUTCOME MEASURES: At baseline, we categorized a woman's Pap status 15 months prior to index date as under-screened (vs. screened), and cytology result (normal vs. abnormal). Then, we examined screening completion and results, and colposcopy uptake and results after an abnormal screen, in the subsequent 15-month period. RESULTS: More than half of women (56%) had no evidence of a Pap test (i.e. under-screened) at baseline. Under-screened women were more likely to be older (50-64 years), have diabetes, and unknown viral load; they were less likely to be Black, Hispanic, have Medicaid, recently pregnant, have a HIV clinic visit, or a CD4 cell count at least 200 cells/μl. Nearly half of under-screened women (46%, n = 383) remained under-screened in the subsequent 15 months. Among women under-screened at baseline who later completed screening and follow-up during the study period, 21 high-grade dysplasia and three cancers were diagnosed. Overall, 40% of women did not receive colposcopy when needed, with most failures to follow-up occurring in women who were under-screened at baseline. CONCLUSION: Most HIV+ women receiving care in a safety-net system did not receive sufficient screening for cervical cancer and remained at exceptionally high risk of developing high-grade dysplasia.
OBJECTIVE: Little is known about cervical cancer screening and results patterns among HIV-infected (HIV+) women in real-world healthcare settings. We characterized two periods of screening opportunity. DESIGN: Retrospective cohort. SETTING: US safety-net healthcare system in Dallas County, Texas. PARTICIPANTS: We analyzed data from electronic medical records (EMR) of 1490 HIV+ women receiving care 2010-2014. MAIN OUTCOME MEASURES: At baseline, we categorized a woman's Pap status 15 months prior to index date as under-screened (vs. screened), and cytology result (normal vs. abnormal). Then, we examined screening completion and results, and colposcopy uptake and results after an abnormal screen, in the subsequent 15-month period. RESULTS: More than half of women (56%) had no evidence of a Pap test (i.e. under-screened) at baseline. Under-screened women were more likely to be older (50-64 years), have diabetes, and unknown viral load; they were less likely to be Black, Hispanic, have Medicaid, recently pregnant, have a HIV clinic visit, or a CD4 cell count at least 200 cells/μl. Nearly half of under-screened women (46%, n = 383) remained under-screened in the subsequent 15 months. Among women under-screened at baseline who later completed screening and follow-up during the study period, 21 high-grade dysplasia and three cancers were diagnosed. Overall, 40% of women did not receive colposcopy when needed, with most failures to follow-up occurring in women who were under-screened at baseline. CONCLUSION: Most HIV+ women receiving care in a safety-net system did not receive sufficient screening for cervical cancer and remained at exceptionally high risk of developing high-grade dysplasia.
Authors: Emma L Frazier; Madeline Y Sutton; Yunfeng Tie; A D McNaghten; Janet M Blair; Jacek Skarbinski Journal: J Womens Health (Larchmt) Date: 2015-10-08 Impact factor: 2.681
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