open access

Vol 89, No 2 (2018)
Research paper
Published online: 2018-02-28
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Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland

Justyna Dominika Kowalska1, Agnieszka Wroblewska, Piotr Ząbek, Ewa Firląg-Burkacka, Monika Kalinowska, Zofia Byczot, Andrzej Horban
DOI: 10.5603/GP.a2018.0012
·
Pubmed: 29512810
·
Ginekol Pol 2018;89(2):68-73.
Affiliations
  1. HIV Out-Patient Clinic, Hospital for Infectious Diseases in Warsaw, Poland; Department of Adults’ Infectious Diseases, Medical University of Warsaw, Poland, Wolska 37, 01-201 Warsaw, Poland

open access

Vol 89, No 2 (2018)
ORIGINAL PAPERS Gynecology
Published online: 2018-02-28

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 gynaeco­logical visits and 254 cervical cytology tests performed. Seventy-five (51.7%) women were tested for HPV infection. Fac­tors 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.

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 gynaeco­logical visits and 254 cervical cytology tests performed. Seventy-five (51.7%) women were tested for HPV infection. Fac­tors 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.

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Keywords

HIV, cervical cancer, gynaecological care, integrated services, HPV

About this article
Title

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

Journal

Ginekologia Polska

Issue

Vol 89, No 2 (2018)

Article type

Research paper

Pages

68-73

Published online

2018-02-28

DOI

10.5603/GP.a2018.0012

Pubmed

29512810

Bibliographic record

Ginekol Pol 2018;89(2):68-73.

Keywords

HIV
cervical cancer
gynaecological care
integrated services
HPV

Authors

Justyna Dominika Kowalska
Agnieszka Wroblewska
Piotr Ząbek
Ewa Firląg-Burkacka
Monika Kalinowska
Zofia Byczot
Andrzej Horban

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