Utilization of Pap testing among women living with HIV enrolled in primary care in Baltimore, Maryland: A 10-year longitudinal study, 2005-2014

Papillomavirus Res. 2018 Dec:6:52-57. doi: 10.1016/j.pvr.2018.10.002. Epub 2018 Oct 25.


Frequent Pap testing is recommended among women living with HIV (WLWH) due to their elevated risk for cervical cancer. However, there are few recent longitudinal evaluations of utilization and determinants of Pap testing among WLWH. Medical and pathology records of WLWH seen at Johns Hopkins Hospital between 2005 and 2014 were assessed using Prentice, Williams, Peterson models. Of 554 WLWH in care for ≥ 18 months, 79% received Pap testing, however only 11% consistently received Pap testing at the recommended interval. Some women (5%) were consistently under-screened (tested at longer intervals) and 21% did not receive any Pap testing at during follow-up. WLWH with decreased likelihood of screening included older women, injection drug users, whites and those who had lived for longer with HIV. In contrast, only women with a prior abnormal Pap result were more likely to receive Pap testing. CD4 cell count and health insurance were not significant determinants. Although many WLWH in care received Pap testing, some WLWH were unscreened or underscreened. Determinants of Pap testing for WLWH include socio-demographic factors and a prior abnormal result; these present potential targets in an urban HIV care setting for closer monitoring and directed interventions to improve utilization among WLWH.

Keywords: Adherence; Cancer screening; Cervical cancer; HIV; Pap testing; Prentice, William, Peterson models.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Baltimore
  • Female
  • HIV Infections / complications*
  • Health Services Research*
  • Humans
  • Longitudinal Studies
  • Middle Aged
  • Papanicolaou Test / methods*
  • Primary Health Care / methods*
  • Racial Groups
  • Uterine Cervical Neoplasms / diagnosis*
  • Young Adult