title: Risk factors for nonadherence with Pap testing in HIV-infected women.
abstract: BACKGROUND
  HIV-infected women are at increased risk for cervical cancer; thus, adherence with Papanicolaou (Pap) testing is of particular importance. The objective of this study was to identify risk factors for inadequate Pap testing in a diverse cohort of HIV-infected women at a large urban safety net HIV clinic.
  
  
  METHODS
  This retrospective cohort study assessed HIV-infected women aged 18?60 years in care between October 1, 2003, and March 31, 2008, for risk factors for inadequate Pap testing. Unadjusted odds ratios (OR) with confidence intervals (CI) and multivariate analyses with generalized estimating equations for correlated data were calculated.
  
  
  RESULTS
  Of 549 women, 293 (53.4%) had a Pap test during each follow-up period. Women who were older, white or Hispanic race/ethnicity, U.S. born, unemployed, drug users, and those with advanced HIV had increased odds of no Pap testing in unadjusted analyses. In multivariate analyses, U.S.-born women who were white or unemployed or had a baseline CD4 count <200 cells/mm(3) had increased odds of no Pap testing (OR 2.0, 95% CI 1.3-3.1; OR 2.3, CI 1.0-5.0; OR 1.7, CI 1.0-2.9, respectively). For non-U.S.-born women, age ?50 years (OR 3.9, CI 1.7-9.0), non-English-speaking status (OR 1.6, CI 1.0-2.4), and drug use (OR 5.8, CI 2.5-13.9) were associated with no Pap testing.
  
  
  CONCLUSIONS
  U.S.-born status and low CD4 count were associated with increased odds of inadequate Pap testing. Further study is needed to identify interventions to improve Pap testing adherence in this high-risk group.
authors: Boston University School of Medicine, Section of Infectious Diseases, 850 Harrison Avenue, Boston, MA 02118, USA. amy.baranoski@bmc.org
authors: Amy S
authors: AS
authors: Baranoski
authors: C Robert
authors: CR
authors: Horsburgh
authors: L Adrienne
authors: LA
authors: Cupples
authors: Ann
authors: A
authors: Aschengrau
authors: Elizabeth A
authors: EA
authors: Stier
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D001900:Boston / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014505:Urban Population; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult