title: Cervical screening within HIV care: findings from an HIV-positive cohort in Ukraine.
abstract: BACKGROUND
  HIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence. Little is known about cervical screening coverage or the prevalence of abnormal cytology among HIV-positive women in Ukraine, which has the most severe HIV epidemic in Europe.
  
  
  METHODS
  Poisson regression models were fitted to data from 1120 women enrolled at three sites of the Ukraine Cohort Study of HIV-infected Childbearing Women to investigate factors associated with receiving cervical screening as part of HIV care. All women had been diagnosed as HIV-positive before or during their most recent pregnancy. Prevalence of cervical abnormalities (high/low grade squamous intraepithelial lesions) among women who had been screened was estimated, and associated factors explored.
  
  
  RESULTS
  Overall, 30% (337/1120) of women had received a cervical screening test as part of HIV care at study enrolment (median 10 months postpartum), a third (115/334) of whom had been tested >12 months previously. In adjusted analyses, women diagnosed as HIV-positive during (vs before) their most recent pregnancy were significantly less likely to have a screening test reported, on adjusting for other potential risk factors (adjusted prevalence ratio (APR) 0.62, 95% CI 0.51-0.75 p<0.01 for 1(st)/2(nd) trimester diagnosis and APR 0.42, 95% CI 0.28-0.63 p<0.01 for 3(rd) trimester/intrapartum diagnosis). Among those with a cervical screening result reported at any time (including follow-up), 21% (68/325) had a finding of cervical abnormality. In adjusted analyses, Herpes simplex virus 2 seropositivity and a recent diagnosis of bacterial vaginosis were associated with an increased risk of abnormal cervical cytology (APR 1.83 95% CI 1.07-3.11 and APR 3.49 95% CI 2.11-5.76 respectively).
  
  
  CONCLUSIONS
  In this high risk population, cervical screening coverage as part of HIV care was low and could be improved by an organised cervical screening programme for HIV-positive women. Bacterial vaginosis testing and treatment may reduce vulnerability to cervical abnormalities.
authors.affiliation: MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Heather
authors.initials: H
authors.lastname: Bailey
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
authors.forename: Igor
authors.initials: I
authors.lastname: Semenenko
authors.forename: Ruslan
authors.initials: R
authors.lastname: Malyuta
authors.forename: Rostislav
authors.initials: R
authors.lastname: Tereschenko
authors.forename: Irina
authors.initials: I
authors.lastname: Adeyanova
authors.forename: Elena
authors.initials: E
authors.lastname: Kulakovskaya
authors.forename: Lyudmila
authors.initials: L
authors.lastname: Ostrovskaya
authors.forename: Liliana
authors.initials: L
authors.lastname: Kvasha
authors.forename: Mario
authors.initials: M
authors.lastname: Cortina-Borja
authors.forename: Claire L
authors.initials: CL
authors.lastname: Townsend
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000382:microbiology / Q000473:pathology* / Q000821:virology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D011247:Pregnancy; D014455:Ukraine / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears; D016585:Vaginosis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult