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Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland
Affiliations- 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
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.
Keywords
HIV, cervical cancer, gynaecological care, integrated services, HPV
About this articleTitle
Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland
Journal
Issue
Article type
Research paper
Pages
68-73
Published online
2018-02-28
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1737
Article views/downloads
1111
DOI
Pubmed
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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