Risk Factors for Nonadherence with Pap Testing in HIV-Infected Women

Boston University School of Medicine, Section of Infectious Diseases, 850 Harrison Avenue, Boston, MA 02118, USA.
Journal of Women's Health (Impact Factor: 2.05). 08/2011; 20(11):1635-43. DOI: 10.1089/jwh.2010.2465
Source: PubMed


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.
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.
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.
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.

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Available from: Ann Aschengrau, Mar 03, 2015
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    • "The purpose of our study was to use constructs of the HBM to assess Pap test adherence in HIV-infected women receiving health services in a community health setting. Pap test nonadherence rates among women in our study were higher than previously reported rates in HIV-infected women (Baranoski et al., 2011; Oster et al., 2009; Simonsen et al., 2014; Tello et al., 2010). This finding may reflect a lack of awareness of personal susceptibility, barriers to health services, or lack of awareness about cervical cancer, Pap testing, and HPV. "
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    ABSTRACT: The Health Belief Model (HBM) has been widely used as a framework to explain health behaviors in diverse populations, but little HBM research has focused on HIV-infected women and their increased risks for cervical cancer. We used Champion’s Health Belief Model and Self- Efficacy scales to assess relationships between Pap test adherence and constructs of the HBM among 300 HIV-infected women. In addition, we assessed the relationship between HPV and cervical cancer knowledge and key HBM concepts. Participants reported low levels of knowledge regarding risk for cervical cancer and HPV. They perceived lower personal risk for cervical cancer. Women with higher perceived self-efficacy and lower perceived barrier scores reported better Pap test adherence. Findings indicate that HIV-infected women are not aware of the risk for cervical cancer and may not take preventive actions. Further research is needed to identify the full range of factors that impact adherence to cervical cancer screening. Key words: Health Belief Model, HIV, HPV, Pap smear, self-efficacy, susceptibility
    Full-text · Article · May 2015 · The Journal of the Association of Nurses in AIDS Care: JANAC
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    • "In addition, half of HIV-infected women in our study had a CD4 count below 200/mm3. This immune deficiency is associated with an increased risk of cervical dysplasia, but has also been identified as a risk factor for non-adherence to Pap smear program in a US survey [28]. "
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    ABSTRACT: Cervical cancer is the first female cancer in Lao PDR, a low-income country with no national screening and prevention programs for this human papillomavirus (HPV) associated pathology. HIV-infected women have a higher risk of persistent oncogenic HPV infection.The purpose of this study was to determine the knowledge, awareness and attitudes about cervical cancer among Lao women attending or not an HIV treatment center, in order to understand if this attendance had offered an opportunity for information and prevention. A cross-sectional case-control survey was conducted in three provinces of Lao PDR, Vientiane, Luang Prabang and Savannakhet. Cases were 320 women aged 25 to 65, living with HIV and followed in an HIV treatment center. Controls were 320 women matched for age and place of residence, not attending an HIV treatment center. Cases had a greater number of sexual partners and used condoms more often than controls. Only 36.6% of women had consulted a gynecologist (47.5% among cases and 25.6% among controls, p < 0.001) and 3.9% had benefited from at least one Pap smear screening (5.6% cases and 2.2% controls, p = 0.02). The average knowledge score was 3.5 on a 0 to 13 scale, significantly higher in cases than in controls (p < 0.0001). Despite having a lower education level and economic status, the women living with HIV had a better knowledge about cervical cancer and were more aware than the controls of the risk of developing such a cancer (35.9% vs. 8.4%, p = 0.0001). The main source of information was healthcare professionals. The main reasons for not undergoing Pap smear were the absence of symptoms and the default of medical injunction for cases, the lack of information and ignorance of screening usefulness for controls. In Lao PDR, routine consultation in HIV treatment centers is not enough harnessed to inform women of their high risk of developing cervical cancer, and to perform screening testing and treatment of precancerous lesions. Implementing this cost-effective strategy could be the first step toward a national prevention program for cervical cancer.
    Full-text · Article · Mar 2014 · BMC Cancer
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    ABSTRACT: HIV-infected women are at increased risk for cervical dysplasia and require timely follow-up after an abnormal Papanicolaou (Pap) test. This retrospective cohort study assessed the proportion of HIV-infected women with colposcopic evaluation after an abnormal Pap test. Time to colposcopy within 12 months after an abnormal Pap test was assessed with univariate and multivariate Cox proportional hazard modeling in a diverse cohort of HIV-infected women between October 1, 2003, and September 30, 2007. One hundred seventy-seven subjects had an abnormal Pap test: 22 high-grade intraepithelial lesion (HSIL; 12%), 120 low-grade squamous intraepithelial lesion (LSIL; 68%), and 35 atypical squamous cells of undetermined significance, human papillomavirus positive (20%). One hundred twenty (68%) had follow-up colposcopy by 1 year. Decreased time to follow-up was associated with being married (HR 3.5, 95% CI 1.9-6.2), high school graduate or higher education level (HR 1.7, CI 1.2-2.6), HSIL Pap results (HR 2.8, CI 1.3-6.2), Pap testing performed by HIV nurse practitioner versus gynecology clinic (HR 1.7, 1.1-2.7), and CD4 count ≥500 cells/mm(3) (HR 1.8, CI 1.2-2.8), after adjusting for age, race/ethnicity, and LSIL Pap result. Private insurance was associated with decreased time to colposcopy in unadjusted, but not multivariate analysis. Drug use was not associated with time to follow-up colposcopy. Almost one third of HIV-infected women did not have a follow-up colposcopy by 12 months after an abnormal Pap test. Since HIV-infected women are at particularly high risk for cervical cancer, these results are unacceptably poor. Identification of the barriers to appropriate follow-up and targeted interventions are necessary to improve timely follow-up for cytologic abnormalities in this high-risk population.
    Full-text · Article · Dec 2011 · Journal of Women's Health
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