Utilisation and outcomes of cervical cancer prevention services among HIV-infected women in Cape Town.
OBJECTIVE
An audit of outcomes of cervical cancer screening and prevention services for HIV-positive women in Cape Town, South Africa.


METHODS
Retrospective review of clinic registers, patient records and pathology databases at three HIV primary health clinics and a tertiary colposcopy referral centre.


METHODS
Women recently diagnosed with HIV at three primary health clinics between 2006 and 2008 (N=2 240); new patients seen for colposcopy at a tertiary referral centre between 2006 and 2009 (N=2 031).


METHODS
The proportion of women undergoing cervical cancer screening after HIV diagnosis at primary health clinics, demographic characteristics of women referred for colposcopy at a tertiary centre, and outcomes of therapy for precancerous lesions of the cervix.


RESULTS
The proportion of women undergoing at least one Pap smear at HIV primary health clinics after HIV diagnosis was low (13.1%). Women referred for colposcopy tended to be HIV-positive and over the age of 30 years, and in most (70.2%) cytological examination revealed high-grade cervical dysplasia. HIV-positive women treated with excision for precancerous lesions of the cervix were significantly more likely than their HIV-negative counterparts to undergo incomplete excision, experience persistent cervical disease after treatment, and be lost to follow-up.


CONCLUSIONS
Cervical cancer screening efforts must be scaled up for women with HIV. Treatment and surveillance guidelines for cervical intraepithelial neoplasia in HIV-positive women may need to be revised and new interventions developed to reduce incomplete treatment and patient default.
Batra
Priya
P
College of Physicians and Surgeons, Columbia University, New York, NY, USA. priya.batra@gmail.com
Kuhn
Louise
L
Denny
Lynette
L
D000328:Adult; D015331:Cohort Studies; D003127:Colposcopy / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000473:pathology / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013019:South Africa; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears / Q000706:statistics & numerical data; D014932:Women's Health Services / Q000706:statistics & numerical data*; D055815:Young Adult