SAMJ: South African Medical Journal
On-line version ISSN 2078-5135
BATRA, Priya; KUHN, Louise and DENNY, Lynette. Utilisation and outcomes of cervical cancer prevention services among HIV-infected women in Cape Town. SAMJ, S. Afr. med. j. [online]. 2010, vol.100, n.1, pp. 39-44. ISSN 2078-5135.
OBJECTIVE: An audit of outcomes of cervical cancer screening and prevention services for HIV-positive women in Cape Town, South Africa. DESIGN: Retrospective review of clinic registers, patient records and pathology databases at three HIV primary health clinics and a tertiary colposcopy referral centre. SUBJECTS: Women recently diagnosed with HIV at three primary health clinics between 2006 and 2008 (N=2 240); new patients seen for colposcopy at a tertiary referral centre between 2006 and 2009 (N=2 031). OUTCOME MEASURES: The proportion of women undergoing cervical cancer screening after HIV diagnosis at primary health clinics, demographic characteristics of women referred for colposcopy at a tertiary centre, and outcomes of therapy for precancerous lesions of the cervix. RESULTS: The proportion of women undergoing at least one Pap smear at HIV primary health clinics after HIV diagnosis was low (13.1%). Women referred for colposcopy tended to be HIV-positive and over the age of 30 years, and in most (70.2%) cytological examination revealed high-grade cervical dysplasia. HIV-positive women treated with excision for precancerous lesions of the cervix were significantly more likely than their HIV-negative counterparts to undergo incomplete excision, experience persistent cervical disease after treatment, and be lost to follow-up. CONCLUSION: Cervical cancer screening efforts must be scaled up for women with HIV. Treatment and surveillance guidelines for cervical intraepithelial neoplasia in HIV-positive women may need to be revised and new interventions developed to reduce incomplete treatment and patient default