Positive impact of initiative to improve cervical cancer screening rates among PLWH

Positive impact of initiative to improve cervical cancer screening rates among PLWH | Image Credit: © Queenmoonlite Studio - © Queenmoonlite Studio - stock.adobe.com.

Cervical cancer screening rates are increased among people living with HIV (PLWH) by a directed initiative, according to a recent study presented at the Infectious Disease Society for Obstetrics and Gynecology 2024 Annual Meeting.¹

The risk of developing cervical cancer is increased among PLWH vs the general population, indicating a need for a quality initiative to increase cervical cancer screening rates for these patients. Investigators evaluated a focused intervention at a clinic receiving Ryan White funds for identifying PLWH without age-appropriate cervical cancer screening.

PWLH enrolled in care and with indicated cervical cancer screening were identified through searches of electronic medical records. A nurse contacted PLWH without screening through phone calls or a letter if the patient could not be reached over the phone.

Overdue PLWH received a Pap smear at 1 of 13 special clinics created during cervical cancer awareness screening month. When clinically indicated, patients were offered breast exams and mammograms at their visits.

Additionally, awareness materials and documents were provided to PLWH during their scheduled appointments. Participants could also schedule appointments during different special clinic days if they missed an appointment.

Multiple steps were taken to ensure patients could receive the necessary screening. Calls were made up to 3 different days at different times, and a care manager was notified for patients requiring transportation.

Cervical cancer screening before the intervention was reported in 54% of PLWH, compared to the goal of 70% set by the National Institute of Health. An overdue Pap smear was reported in 104 patients, 24% of whom received a Pap smear outside of the institution’s health care system with no available results.

Sixteen percent of overdue patients declined screening while 19% could not be reached. A Pap smear was scheduled for 35 PLWH, with 16 attending the appointment. An appointment pending with other providers or hysterectomy not recorded in a medical chart was reported in 10% of patients.

These results indicated an increase in cervical cancer screening rates following the directed initiative being offered in combination with routing HIV care, from 54% to 75%. However, the data was limited by a lack of ability to collect data about patients’ reasons for declining screening and the potential impact of bad weather on screening sessions.

Investigators recommended further analysis about social and clinical factors such as HIV viral load. Additionally, research is necessary to determine correlating factors for PLWH with abnormal Pap smear results.

These conclusions support guidelines for cervical cancer screening in high-income countries recently released by the Advancing Cervical CancEr ScreeningS (ACCESS) Consensus Group.² The guidelines support the development of national plans for cervical cancer elimination using framework from the World Health Organization.

The ACCESS guidelines recommend efforts to improve cervical cancer screening in underscreened populations using targeted and culturally relative communication approaches. Elimination programs should implement targeted education, improve screening accessibility, and ensure screening is covered by health insurance.

ACCESS highlighted the benefits of a health care professional as the preferred option for performing screening in the majority of women. Self-sampling was recommended in underscreened women who rarely attend screening appointments.

Reference

1. Harris L, Rose S, Stivers T, Mansoor A. Focused intervention for cervical cancer screening improved screening rates at a Ryan White funded clinic. Presented at: The Infectious Disease Society for Obstetrics and Gynecology 2024 Annual Meeting. Portland, OR. August 1-3, 2024.
2. Krewson C. Guidelines released to boost cervical cancer screening in high-income countries. June 12, 2024. Accessed August 7, 2024. https://www.contemporaryobgyn.net/view/guidelines-released-to-boost-cervical-cancer-screening-in-high-income-countries