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. 2017 Jan 6;12(1):e0169327.
doi: 10.1371/journal.pone.0169327. eCollection 2017.

Barriers to Follow-Up for Abnormal Papanicolaou Smears Among Female Sex Workers in Lima, Peru

Free PMC article

Barriers to Follow-Up for Abnormal Papanicolaou Smears Among Female Sex Workers in Lima, Peru

Devora Aharon et al. PLoS One. .
Free PMC article


Background: Cervical cancer is the most prevalent cancer among Peruvian women. Female sex workers (FSW) in Peru are at elevated risk for HPV infection, and receive annual Papanicolaou screening. The objective of this study was to identify barriers to follow-up for abnormal Pap smears among FSW in Peru.

Methods: 97 FSW attending the Alberto Barton Health Center in Lima were surveyed regarding their STI screening history. 17 women with a history of an abnormal Pap smear were interviewed about their experiences regarding follow-up care.

Results: Of the 27 HPV-positive women, only 8 (30%) received follow-up treatment. Of the 19 women who did not receive follow-up, 7 (37%) had not been informed of their abnormal result. Qualitative interviews revealed that the major barrier to follow-up was lack of knowledge about HPV and potential health consequences of an abnormal Pap smear.

Conclusion: HPV infection is highly prevalent in Peruvian FSW, yet only 30% of FSW with abnormal Pap smears receive follow-up care. The predominant barriers to follow-up were lack of standardization in recording and communicating results and insufficient FSW knowledge regarding health consequences of HPV infection. Standardization of record-keeping and distribution of educational pamphlets have been implemented to improve follow-up for HPV.

Conflict of interest statement

The authors have declared that no competing interests exist.

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Grant support

This project was supported by the NIH Research Training Grant #R25TW009345 awarded to the Northern Pacific Global Health Fellows Program by the Fogarty International Center, as well as by the Arnhold Global Health Institute at the Icahn School of Medicine at Mount Sinai. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.