RESUMO
OBJECTIVE: To map the cervical cancer screening cascade among women living with HIV attending a public-sector cytology screening program in Johannesburg, South Africa. METHODS: We conducted a retrospective cohort study of routinely collected clinical data captured in an electronic medical record system. Women (≥18 years) living with HIV with an abnormal Pap result between January 2013 and May 2018 were included. The proportion of women who received follow-up consistent with extant clinical guidelines, stratified by their initial Pap smear result, was examined. RESULTS: The study included 2072 women: 1384 (66.8%) with a low-risk Pap result, 681 (32.9%) with a high-risk Pap result, and 7 (0.3%) with suspected cancer. Only 174 (25.6%) women with a high-risk Pap result underwent guideline-indicated management within 18 months. Among women with a low-risk Pap result, 375 (27.1%) received follow-up within 1 year; the cumulative incidence of follow-up increased to 63.1% at 3 years. All women with suspected cancer either received a colposcopic biopsy or were referred for further treatment. CONCLUSION: Attrition among South African women living with HIV who attended cervical screening in an urban public-sector program was high. Developing tailored interventions to address bottlenecks in the care cascade and improve cervical screening outcomes will be central to eliminating cervical cancer.
Assuntos
Infecções por HIV , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Registros Eletrônicos de Saúde , Feminino , Humanos , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Teste de Papanicolaou , Infecções por Papillomavirus/prevenção & controle , Estudos Retrospectivos , África do Sul/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem , Displasia do Colo do Útero/prevenção & controleRESUMO
OBJECTIVE: To determine preferences for HPV-based cervical cancer screening among South African women. METHODS: A discrete choice experiment survey was conducted among 298 women who attended two public-sector clinics in South Africa from February 1 to May 31, 2018. Participants chose between hypothetical screening scenarios: method of swab collection (self or provider); timing of treatment (same day or return visit); type of clinic (static or mobile); cost of services (US $0 or US $4); and time spent at the clinic (30, 60, or 120 minutes). A logistic regression model was generated to evaluate the importance of each attribute. A market simulation analysis was performed to determine potential uptake of the various screening strategies. RESULTS: The participants expressed strong preferences for free services (ß=0.50; P<0.001) and same-day HPV testing and treatment (ß=0.40; P<0.001). The market simulation indicated that 83.8% of women would be willing to undergo screening if services were free; the swab was collected by the provider; and treatment was offered at a return visit. Including same-day testing and treatment in the model increased uptake to 96.4%. CONCLUSION: Offering same-day HPV testing and treatment could substantially improve uptake of cervical cancer screening in the South African public healthcare sector.