Preventive Medicine
Volume 107, 2018, Pages 14-20

Cervical cancer screening uptake among HIV-positive women in Ontario, Canada: A population-based retrospective cohort study (Article) (Open Access)

Burchell A.N.* , Kendall C.E. , Cheng S.Y. , Lofters A. , Cotterchio M. , Bayoumi A.M. , Glazier R.H. , Antoniou T. , Raboud J. , Yudin M.H. , Loutfy M.
  • a Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  • b Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
  • c Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  • d Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  • e Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
  • f Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • g Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  • h Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  • i Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
  • j Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  • k Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Department of Medicine, University of Toronto, Toronto, Ontario, Canada, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada

Abstract

Cervical cancer caused by oncogenic types of the human papillomavirus (HPV) is of concern among HIV-positive women due to impairment of immune responses required to control HPV infection. Our objectives were to describe patterns of cervical cancer screening using Pap cytology testing among HIV-positive women in Ontario, Canada from 2008 to 2013 and to identify factors associated with adequate screening. We conducted a retrospective, population-based cohort study among screen-eligible HIV-positive women using provincial administrative health data. We estimated annual proportions tested and reported these with 95% confidence intervals (CI). Next, using person-years as the unit of analysis, we identified factors associated with annual Pap testing using log-binomial regression. A total of 2271 women were followed over 10,697 person-years. In 2008, 34.0% (95%CI 31.1–37.0%) had a Pap test. By 2013, the proportion of HIV-positive women tested was 25.9% (95%CI 23.6–28.2%). Women who were most likely to undergo testing were younger, were immigrants from countries with generalized HIV epidemics, lived in the highest income neighbourhoods, had a female primary care physician, had two or more encounters per year with an infectious disease or internal medicine specialist, and had greater comorbidity. Nearly three in four HIV-positive women were under-screened despite all having universal insurance for medically-necessary services. Annual Pap testing decreased following the 2011–2013 release of new guidelines for a lengthened screen interval for average risk women and a billing disincentive. Clinic-based intervention such as physician alerts or reminders may be needed to improve screening coverage among HIV-positive women. © 2017 The Authors

Author Keywords

Women Cervical cancer screening HIV HPV Mass screening

Index Keywords

immigrant HIV Infections Human immunodeficiency virus infection mass screening health insurance human comorbidity statistics and numerical data priority journal early cancer diagnosis Aged cancer screening Early Detection of Cancer procedures Humans migrant Emigrants and Immigrants female female physician population research isolation and purification Article Retrospective Studies Ontario major clinical study adult uterine cervix cancer Papillomavirus Infections Uterine Cervical Neoplasms Papillomaviridae uterine cervix tumor papillomavirus infection medical specialist cohort analysis Papanicolaou Test Cervical Intraepithelial Neoplasia uterine cervix carcinoma in situ retrospective study highest income group
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85038918024&doi=10.1016%2fj.ypmed.2017.11.023&partnerID=40&md5=c71397008bf599d05a8f902334523ad7
DOI: 10.1016/j.ypmed.2017.11.023
ISSN: 00917435
Original Language: English