Prevalence of Cervical Cancer Screening among HIV+ Women in the United States, 2000 to 2004
Alexandra Oster*1,2, P Sullivan1,3, and J Blair1
1CDC, Atlanta, GA, US; 2Epidemic Intelligence Svc, Atlanta, GA, US; and 3Emory Univ Rollins Sch of Publ Hlth, Atlanta, GA, US
Background: Approximately 250,000 women in the United States are HIV-infected. An estimated 13 to 60% of these women have cervical
cytological abnormalities, which can lead to invasive cervical cancer. HIV
treatment guidelines recommend initial and annual Pap tests for all
HIV-infected women. We assessed screening prevalence and associated factors among
HIV-infected women to determine whether Pap screening is performed as
Methods: We used data collected during 2000 to 2004
in the Supplement to HIV/AIDS Surveillance project, a cross-sectional interview
study of HIV-infected persons aged ≥18 years in 18 states. Variables
included demographic/socioeconomic factors, gynecologic history, HIV care, and
use of medical services. We performed logistic regression to compute adjusted
odds ratios (AOR) and 95% confidence intervals (CI) for the association between
various factors and not having a Pap test.
Results: Among 2417 women, 556 (23.0%) had not had a
Pap test during the past year. Factors associated with not having a Pap test
included increasing age (AOR = 1.3/10 years, CI 1.1 to 1.4) and most recent CD4
cell count of <200 (AOR 1.6, CI 1.1 to 2.1) or unknown (AOR 1.4, CI 1.1 to 1.7).
Compared with women whose most recent pelvic exam was performed at their HIV care
provider’s office, those whose pelvic exam was performed elsewhere had
increased odds of not having a Pap test during the past year (AOR 2.6, CI 2.1
to 3.2). Educational level, household income, drug use, and insurance status
were not significantly associated with Pap screening.
Conclusions: HIV care providers should ensure that
annual Pap tests are performed for women of all ages who have low CD4 cell counts
or receive gynecologic care elsewhere. Integrating HIV and gynecologic care and
educating clinicians about Pap screening recommendations for HIV-infected women
may increase screening among this population.