title: Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study.
abstract: BACKGROUND
  The incidence of invasive cervical cancer in HIV-positive women is higher than in the general population. There is evidence that HIV-positive women do not participate sufficiently in cervical cancer screening in Italy, where cervical cancer is more than 10-fold higher in women with AIDS than in the general population. The aim of the present study was to evaluate the history of Pap-smear in HIV-positive women in Italy in recent years. We also examined the sociodemographic, clinical, and organizational factors associated with adherence to cervical cancer screening.
  
  
  METHODS
  A cross-sectional study was conducted between July 2006 and June 2007 in Emilia-Romagna region (Northern Italy). All HIV-positive women who received a follow-up visit in one of the 10 regional infectivology units were invited to participate. History of Pap-smear, including abnormal smears and subsequent treatment, was investigated through a self-administered anonymous questionnaire. The association between lack of Pap-smear in the year preceding the interview and selected characteristics was assessed by means of odds ratios (OR) and 95% confidence intervals adjusted for study centre and age.
  
  
  RESULTS
  A total of 1,002 HIV-positive women were interviewed. Nine percent reported no history of Pap-smear, and 39% had no Pap-smear in the year prior to the date of questionnaire (last year). The lack of Pap-smear in the last year was significantly associated with age <35 years (OR = 1.4, compared to age > or =45 years), lower education level (OR = 1.3), first HIV-positive test in the last 2 years (OR = 1.4), and CD4 count <200 cells/microl (OR = 1.6). Conversely, when women were advised by a gynecologist rather than other health workers to undergo screening, it significantly increased adherence. Non-significantly higher proportions of lack of Pap-smear in the last year were found in women born in Central-Eastern Europe (OR = 1.8) and Africa (OR = 1.3). No difference in history of Pap-smear emerged by mode of HIV-acquisition or AIDS status.Three hundred five (34%) women reported a previous abnormal Pap-smear, and of the 178 (58%) referred for treatment, 97% complied.
  
  
  CONCLUSIONS
  In recent years the self-reported history of Pap-smear in HIV-positive women, in some public clinics in Italy, is higher than previously reported, but further efforts are required to make sure cervical cancer screening is accessible to all HIV-positive women.
authors.affiliation: Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico - IRCCS, Via Gallini 2, 33081 Aviano (PN), Italy. dalmaso@cro.it
authors.forename: Luigino
authors.initials: L
authors.lastname: Dal Maso
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
authors.forename: Mauro
authors.initials: M
authors.lastname: Lise
authors.forename: Priscilla Sassoli
authors.initials: PS
authors.lastname: De' Bianchi
authors.forename: Jerry
authors.initials: J
authors.lastname: Polesel
authors.forename: Florio
authors.initials: F
authors.lastname: Ghinelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Falcini
authors.forename: Alba C
authors.initials: AC
authors.lastname: Finarelli
mesh_terms: D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D065006:Papanicolaou Test; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health