OBJECTIVES: The purpose of this five year study was twofold: to offer a cervical cancer screening program which incorporated a "see and treat" model for the treatment of cervical intraepithelial neoplasia (CIN) in HIV-positive women, and; to measure appointment and treatment adherance in a community based one-stop-shop model which integrates colposcopy and treatment.
METHODS: Seventy-five HIV+ women underwent screening cervical cytology and colposcopy regardless of previous cytology results. Women found to have CIN by colposcopic impression were offered treatment using the loop electrical excisional procedure (LEEP) during the same visit. Histopathology of the LEEP specimens was used to evaluate adequacy of colposcopy and cervical cytology. Features of this see and treat one-stop-shop community based model include: childcare, drug and alcohol counseling, peer counseling, legal counseling, case management and psychological services.
RESULTS: Sixty percent of 72 women kept follow-up appointments. A comparative population seen at a colposcopy clinic in a tertiary institution had an adherence follow-up rate of 31.5. Twenty-four women underwent LEEP. The sensitivity of abnormal cytology and colposcopic impression for detection of CIN was 0.62 and 0.87. Benign cytology was associated with CIN in 37.5 % of cases. Colposcopic impression detected CIN in all cases where cytology was benign. Abnormal cytology predicted CIN in 3 (12.5 %) cases where colposcopic was considered normal.
CONCLUSION: Colposcopy with"see and treat" intent is sensitive method for the detection of CIN. We recommend that cervical cytology with colposcopy be integrated with innovative models that utilize support services which enhance access to care and follow-up adherence for women with HIV disease.
Learning Objectives: Learner will be able to analyze the benefit of providing a one-stop-shop "see and treat" model of care in the primary care setting. The learner will be able to discuss the impact of accessibility on health care adherance patterns in high risk HIV infected women. Participants will be able to discuss the contribution of traditional cervical cancer risk factors to the development of cervical disease in HIV-infected women. Particiapants will be able to discuss the sensitibvity of the PAP smear and colposcopy in detecting cervical dysplasia in HIV-infected women
Keywords: Community-Based Health Care, Cervical Cancer
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.