title: Preventive health care among HIV positive women in a Utah HIV/AIDS clinic: a retrospective cohort study.
abstract: BACKGROUND
  Despite evidence that HIV positive women may suffer higher rates of heart disease, diabetes, human papillomavirus infection, and some types of cancer, the provision of preventive health services to HIV positive women is unknown. Preventive health services recommended for such women include breast, colorectal and cervical cancer screening, sexually transmitted infection (STI) testing, vaccinations, and patient counseling on a number of issues including sexual behaviors.
  
  
  METHODS
  This retrospective cohort study utilized medical record reviews of 192 HIV positive women who were patients at the University of Utah Infectious Diseases Clinic in 2009. Medical records were reviewed for all encounters during 2009 using a standardized data collection form; data were collected on patient demographics and a variety of preventive health services. Chi squared tests were used to assess receipt of preventive health services by demographic factors, and multivariable logistic regression was used to determine predictors of receiving select services.
  
  
  RESULTS
  The most commonly recorded preventive services included blood pressure screening, screening for Hepatitis A and B, Tetanus-Diphtheria-Pertussis vaccination, Pneumococcal pneumonia vaccination, substance abuse screening, and mental health screening. STI testing and safe sex counseling were documented in the medical records of only 37% and 33.9% of women, respectively. Documentation of cancer screening was also low, with cervical cancer screening documented for 56.8% of women, mammography for 65% (N = 26/40) of women, and colorectal cancer screening for 10% (N = 4/40) of women, where indicated. In multivariable models, women with private health insurance were less likely to have documented STI testing (OR 0.20; 95% CI 0.08 - 0.52), and, Hispanic women were less likely to have documented safe-sex counseling (OR 0.26; 95% CI 0.07 - 0.94).
  
  
  CONCLUSIONS
  HIV/AIDS providers should focus on the needs of all women for preventive care services, including those with fewer socio-demographic risk factors (i.e., insured, stable housing etc.). In addition, failure to provide STI testing, cancer screening, or safe sex counseling to all patients represents a missed opportunity for provision of services that are important from both a clinical and public health perspective.
authors.affiliation: Department of Family and Preventive Medicine, Division of Public Health, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA. sara.simonsen@utah.edu.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Simonsen
authors.forename: Deanna
authors.initials: D
authors.lastname: Kepka
authors.forename: Joan
authors.initials: J
authors.lastname: Thompson
authors.forename: Echo L
authors.initials: EL
authors.lastname: Warner
authors.forename: Maggie
authors.initials: M
authors.lastname: Snyder
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Ries
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D037001:Directive Counseling / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006506:Hepatitis A / Q000175:diagnosis; D006509:Hepatitis B / Q000175:diagnosis; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D007348:Insurance, Health; D001523:Mental Disorders / Q000175:diagnosis; D008875:Middle Aged; D022242:Pneumococcal Vaccines; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011859:Radiography; D012189:Retrospective Studies; D021841:Safe Sex; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000517:prevention & control; D019966:Substance-Related Disorders / Q000175:diagnosis; D014589:Utah; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D022242:Pneumococcal Vaccines