title: Barriers to Follow-Up for Abnormal Papanicolaou Smears among Female Sex Workers in Lima, Peru.
abstract: BACKGROUND
  Cervical cancer is the most prevalent cancer among Peruvian women. Female sex workers (FSW) in Peru are at elevated risk for HPV infection, and receive annual Papanicolaou screening. The objective of this study was to identify barriers to follow-up for abnormal Pap smears among FSW in Peru.
  
  
  METHODS
  97 FSW attending the Alberto Barton Health Center in Lima were surveyed regarding their STI screening history. 17 women with a history of an abnormal Pap smear were interviewed about their experiences regarding follow-up care.
  
  
  RESULTS
  Of the 27 HPV-positive women, only 8 (30%) received follow-up treatment. Of the 19 women who did not receive follow-up, 7 (37%) had not been informed of their abnormal result. Qualitative interviews revealed that the major barrier to follow-up was lack of knowledge about HPV and potential health consequences of an abnormal Pap smear.
  
  
  CONCLUSIONS
  HPV infection is highly prevalent in Peruvian FSW, yet only 30% of FSW with abnormal Pap smears receive follow-up care. The predominant barriers to follow-up were lack of standardization in recording and communicating results and insufficient FSW knowledge regarding health consequences of HPV infection. Standardization of record-keeping and distribution of educational pamphlets have been implemented to improve follow-up for HPV.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Devora
authors.initials: D
authors.lastname: Aharon
authors.affiliation: Centro de Salud Alberto Barton del Callao, Callao, Lima, Peru.
authors.forename: Martha
authors.initials: M
authors.lastname: Calderon
authors.affiliation: Centro de Salud Alberto Barton del Callao, Callao, Lima, Peru.
authors.forename: Vicky
authors.initials: V
authors.lastname: Solari
authors.affiliation: Pontificia Universidad Catolica del Peru, Callao, Lima, Peru.
authors.forename: Patricia
authors.initials: P
authors.lastname: Alarcon
authors.affiliation: University of Washington, Seattle, WA, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zunt
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D010568:Peru / Q000453:epidemiology; D062486:Public Health Surveillance; D012307:Risk Factors; D060386:Sex Workers; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014626:Vaginal Smears; D055815:Young Adult