HIV / STI
Predictors of guideline-adherent screening for cervical cancer among women living with HIV in the Bronx, New York Danya Birnbaum* Danya Birnbaum Jenny Shen Chloe Teasdale Breanne Lott Jessica Atrio Howard Strickler Heidi E. Jones
Background: Cervical cancer screening is essential care. Using the Einstein-Rockefeller-CUNY Center for AIDS Research (ERC CFAR) Clinical Cohort database, we examined factors associated with screening among women living with HIV (WLH) receiving care in the Montefiore Health System (MHS), the largest provider of HIV care in the Bronx, New York.
Methods: WLH aged 21-65 years receiving HIV care (2+ lab tests) within 18 months at MHS between 2014-2019 were included. Those who received cervical cancer screening ≤18 months from their date of entry were coded as screening-adherent, based on annual screening guidelines for WLH. Potential predictors of screening explored included: age, race/ethnicity, socio-economic status, CDC-defined HIV acquisition group, hepatitis C virus status, insurance type, pregnancy and hormonal contraceptive use during observation period, and HIV viral load (VL; using test closest to entry date). We ran multivariable logistic regression of screening using stepwise modeling, keeping variables with p≤0.15 in the final model.
Results: Of 2,553 WLH, 1,794 (70.3%) were screened for cervical cancer within the first 18 months of observed person time. WLH who had acquired HIV through injection drug use (IDU) [aOR: 0.67; 95% CI: 0.49, 0.92] vs. non-IDU and those with detectable HIV (VL >10,000 [aOR: 0.67; 95% CI: 0.53, 0.85], VL 100-10,000 [aOR: 0.56; 95% CI: 0.43, 0.73] vs. <100 copies/ml) were less likely to receive cervical cancer screening. WLH who used any hormonal contraception had 3.22 times [95% CI: 2.34, 4.41] the odds of screening as those not using hormonal contraception.
Conclusions: Nearly one-third of WLH receiving HIV care in the Bronx did not receive cervical cancer screening within 18 months of care. WLH with uncontrolled viral load and those who acquired HIV via IDU were more likely to not have been screened, indicating the importance of targeted outreach and alternative screening modalities, such as self-sampling and mobile clinics.