Assessing the uptake of cervical screening amongst HIV-positive women attending an HIV clinic in the UK

NMUH Staff Publications

EMBASE

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<span style="font-size: 10pt;">Background: Women living with HIV (WLWHIV) are at a higher risk of persistent high-risk Human papillomavirus (HR-HPV) infection, the aetiological agent of invasive cervical cancer. The British HIV Association (BHIVA) therefore recommends that WLWHIV have annual cervical screening. Many HIV clinics refer patients to general practitioners (GPs) for screening. Little is known about factors influencing access to cervical screening among WLWHIV in the UK. Methods: The study used mixed-methods (audit and qualitative study) to determine the uptake of cervical screening and factors influencing access to screening amongstwomenattending the HIV clinic at North Middlesex University Hospital Trust. The clinic sends annual reminders to GPs about screening. All women, aged 25-64yrs living in Haringey and Enfield districts were eligible for inclusion. Demographic and clinical data were extracted from electronic records. Cervical screening history and results were ascertained fromthe national cervical screening database. Semi-structured interviews and a focus group discussion were conducted. Transcripts were analysed using thematic analysis. Results: 437/590 women enrolled in care were eligible for inclusion (median age 42yrs, 79% black African, 98% on ART, 74% viral suppression, median CD4 540 cells/ml). In 82% a reminder about annual screening had been sent to the GP within the last year; however only 39% had been screened. 71% of women aged 25-49yrs and 82% aged 50-64yrs had been screened in the last 3 and 5 years, respectively. Eight women were interviewed and 5 took part in a focus group (mean age 43yrs, 100% Black African, 100% on ART, 92% viral suppression, 46% screened in last year). Knowledge about the purpose of screening and causes of cervical cancer were poor; most had never heard of HPV. Lack of knowledge and misinformation about screening, fear of the procedure and of the outcome and cultural norms (e.g. unacceptable to undress in front of male healthcare workers) were key patient-related barriers to uptake. Other barriers included structural barriers (scheduling appointments with GPs) and relationship barriers (low levels of trust in GPs and failure to disclose status). Conclusion: Despite annual reminder to patients and GPs the uptake of annual cervical screening at this clinic was poor. Better understanding of patient- and GP-related barriers to annual screening are needed in order to plan effective strategies for cervical cancer prevention among WLWHIV. (Conference abstract)</span>