Utilisation and outcomes of cervical cancer prevention services among HIV-infected women in Cape Town

S Afr Med J. 2010 Jan;100(1):39-44.

Abstract

Objective: An audit of outcomes of cervical cancer screening and prevention services for HIV-positive women in Cape Town, South Africa.

Design: Retrospective review of clinic registers, patient records and pathology databases at three HIV primary health clinics and a tertiary colposcopy referral centre.

Subjects: Women recently diagnosed with HIV at three primary health clinics between 2006 and 2008 (N=2 240); new patients seen for colposcopy at a tertiary referral centre between 2006 and 2009 (N=2 031).

Outcome measures: The proportion of women undergoing cervical cancer screening after HIV diagnosis at primary health clinics, demographic characteristics of women referred for colposcopy at a tertiary centre, and outcomes of therapy for precancerous lesions of the cervix.

Results: The proportion of women undergoing at least one Pap smear at HIV primary health clinics after HIV diagnosis was low (13.1%). Women referred for colposcopy tended to be HIV-positive and over the age of 30 years, and in most (70.2%) cytological examination revealed high-grade cervical dysplasia. HIV-positive women treated with excision for precancerous lesions of the cervix were significantly more likely than their HIV-negative counterparts to undergo incomplete excision, experience persistent cervical disease after treatment, and be lost to follow-up.

Conclusion: Cervical cancer screening efforts must be scaled up for women with HIV. Treatment and surveillance guidelines for cervical intraepithelial neoplasia in HIV-positive women may need to be revised and new interventions developed to reduce incomplete treatment and patient default.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Colposcopy / statistics & numerical data
  • Female
  • HIV Infections / pathology
  • HIV Infections / prevention & control
  • HIV Infections / psychology*
  • Humans
  • Middle Aged
  • Papanicolaou Test
  • Patient Acceptance of Health Care*
  • Preventive Health Services / statistics & numerical data*
  • Retrospective Studies
  • South Africa
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / virology
  • Vaginal Smears / statistics & numerical data
  • Women's Health Services / statistics & numerical data*
  • Young Adult