Cervical Cancer Screening Rates in Females Living with HIV at Three Healthcare Settings in the United States, 2010-2019

Abstract

Females living with HIV (FLWHIV) are at greater risk of developing cervical cancer compared to females without HIV. National cervical cancer screening guidelines recommend more frequent screening for FLWHIV to address their increased risk. We sought to examine screening rates among FLWHIV during the most recent decade. This retrospective cohort study was conducted at Kaiser Permanente Washington, Parkland Health, and Mass General Brigham. The study cohort included 18-89-year-old screening-eligible FLWHIV during 2010-2019. Data on sociodemographics, comorbidities, and cervical cancer risk factors and screening tests were extracted from administrative and clinical databases. We reported crude and adjusted screening rates, overall and by test modality. Generalized estimating equation models with Poisson regression were used to estimate screening rate ratios (SRR) and 95% confidence intervals (CI) for the associations between total screening rates and healthcare setting, calendar year, age, race and ethnicity, and comorbidity score. Among 3,556 FLWHIV across the three settings, later calendar years relative to 2010-2013 were associated with lower total screening rates (2014-2016: SRR=0.80, 95% CI= 0.77-0.83; 2017-2019: SRR=0.71, 95% CI=0.68-0.75). Compared to non-Hispanic Black females, non-Hispanic white females had lower total screening rates (SRR=0.89, 95% CI= 0.81-0.98). Older age (SRR=0.82, 95% CI=0.74-0.89 for 50–65-year-olds vs. 18–29-year-olds) and higher comorbidity burden (SRR=0.89, 95% CI=0.82-0.98 for 9+ vs. 0-6 comorbidity score) were also associated with lower screening rates. The screening rate decrease we observed in this large cohort of FLWHIV during 2010-2019 aligns with guideline changes recommending longer screening intervals and implementation of co-testing. Our finding that white FLWHIV and those with greater comorbidity burden have lower screening rates should be confirmed in other US settings, and the age disparity we report warrants further investigation. Given the higher risk of cervical cancer in FLWHIV, it is especially important to address potential screening disparities.