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One Third of HIV+ South Carolina Women Not Getting Regular Pap Test
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2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland
Mark Mascolini
Slightly more than one third of HIV-positive South Carolina women on Medicaid did not have at least one Pap test from 2005 through 2009, though guidelines call for at least annual Pap testing in women with HIV [1]. Two thirds of the women without a Pap test got diagnosed with HIV before 2005.
Because of immune suppression, HIV-positive people run a higher risk of human papillomavirus (HPV) infection, which can cause cervical, anal, and other cancers. Detecting high-risk HPV genotypes is critical to preventing cervical dysplasia (abnormal cell development) and cervical cancer, which is an AIDS-defining cancer.
US guidelines call for two Pap tests in the first year after HIV diagnosis and, if those tests are negative, for annual Pap testing in subsequent years [2]. To determine whether health centers in South Carolina follow those guidelines, researchers at the University of South Carolina and other institutions planned this study of HIV-positive women on Medicaid (public insurance for the poor) for at least 9 of 12 months in years from 2005 to 2009.
To identify the study population, the investigators linked databases from South Carolina Medicaid and the state HIV/AIDS reporting system. That approach identified 1543 women from 18 to 64 years old. More than three quarters of women were black (78.3%) and single (75.7%). Half of the women (52%) were 25 to 55 years old, while 44% were 45 to 64. Only 12% were 18 to 24. All women were alive throughout the 2005-2009 study period.
The researchers found that 563 women (36.5%) had no Pap test from January 1, 2005 through December 31, 2009. Of these 563 women, 364 (64.7%) got diagnosed with HIV before 2005, so some of these HIV-positive women had no Pap test for 5 or more years. The remaining women got diagnosed between 2005 and 2009.
A county-level analysis showed that, among countries with at least 5 women in the study group, only 1 county met the Healthy People 2020 baseline of 84.5% adherence to cervical cancer screening recommendations. Only 5 counties met a more relaxed 76% adherence rate.
The researchers suggested that poor retention in care probably contributes to inconsistent Pap testing in South Carolina. They did not have data on how many clinicians recommended Pap testing according to guidelines. And they plan additional analyses to determine what role provider characteristics--such as gender and race--play in poor adherence to screening guidelines.
The investigators called for "multi-level cancer prevention and control efforts . . . that target both patients and providers."
References
1. Wigfall LT, Brandt HM, Duffus WA, et al. HPV and cervical cancer prevention and control among financial disadvantaged women living with HIV/AIDS in South Carolina. 2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland. Abstract O_07.
2. US Department of Health and Human Services, Health Resources and Services Administration. Guide for HIV/AIDS clinical care. January 2011. http://hab.hrsa.gov/deliverhivaidscare/clinicalguide11/
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