Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland

Ginekol Pol. 2018;89(2):68-73. doi: 10.5603/GP.a2018.0012.

Abstract

Objectives: HIV-positive women are at increased risk of HPV infection and cervical cancer. European and national guidelines advise yearly screening for cervical cancer, however due to the lack of a central registration of HIV infected persons there is a gap in offering such care through general healthcare services in many countries, including Poland.

Material and methods: In response to the above limitations, integrated gynaecological care (IGC) was established at the HIV Out-Patient Clinic in Warsaw. We analysed data from January 2007 to May 2014. Logistic regression models were used to identify factors associated with not using IGC by patients.

Results: Two hundred and forty women were registered in the observation period:59.6% infected through sexual contact, 18.7% through IDUs, 19.2 % through unknown causes and 2.5% by other (two were vertically infected). The median follow-up time was 2.35 (IQR 0.9-4.5) years and 78.3% were on combination antiretroviral therapy (cART). In total 145 of the women (60.4%) used IGC, from 72.1% of those registered in 2007 to 27.3% registered in 2014. There were in total 1075 gynaeco-logical visits and 254 cervical cytology tests performed. Seventy-five (51.7%) women were tested for HPV infection. Fac-tors decreasing the odds of not using IGC identified by multivariate regression models were being on cART (OR 0.25 [IQR: 0.10-0.59]; p = 0.003) and longer time of observation (0.69 [0.58-0.83]; p = 0.0001).

Conclusions: The utilisation of IGC was very high, but with a delay in commencing the IGC. Women on cART and with longer periods of follow-up had lower odds of not using IGC. A screening approach for women not yet on cART, or newly registered in the clinics, needs special attention.

Keywords: HIV; HPV; cervical cancer; gynaecological care; integrated services.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Delivery of Health Care / methods*
  • Drug Therapy, Combination
  • Early Detection of Cancer / statistics & numerical data*
  • Female
  • HIV Seropositivity* / diagnosis
  • HIV Seropositivity* / drug therapy
  • Humans
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Poland
  • Time Factors
  • Uterine Cervical Neoplasms / diagnosis*

Substances

  • Anti-HIV Agents