Cervical cancer screening in a population-based sample of Human Immunodeficiency Virus (HIV)-infected women – Virginia, 2008-2009

Background: Infection with human papillomavirus (HPV) is more prevalent in women who are co-infected with HIV, and immunosuppression may increase the risk that an HPV infection will progress to cervical disease. Routine cervical Papanicolaou (Pap) tests are recommended in this population. This report considers cervical cancer screening data from a statewide, population-based HIV surveillance project.

Methods: Medical record abstractions from the Virginia Medical Monitoring Project (MMP) were used to determine how frequently cervical Pap tests were documented in the HIV specialty medical record during the previous year and what factors were related to testing. Supplemental demographic data were pulled from the state HIV surveillance database. Fisher's exact test or chi square tests of independence were used to determine the relationship between demographic variables and documented cervical cancer testing as well as the relationship between the Ryan White Program funding status of patients' care facilities and documented testing.

Results: A cervical Pap test was documented in the previous year for only 34% (73) of the 217 women in the sample. Younger age (p=0.0493) and Hispanic ethnicity (p=0.0064) were determined to be significantly related to having a documented cervical Pap test, as was the Ryan White funding status of the patient's care facility (p=0.0002).

Conclusions: A cervical Pap test was not documented in the majority (66%) of medical records reviewed. Assessment of the cause of missing documentation is necessary to determine if changes in cervical cancer screening practices are needed for HIV-infected women.