Number of Primary Care Visits Associated with Screening for Cervical Dysplasia among Women with HIV Infection in Harris County, Texas, United States of America.

Abstract

Studies indicate that women with HIV infection in the United States are inadequately screened for cervical dysplasia. However, few of these studies have included women in the southern United States, where HIV incidence is now concentrated. We performed a retrospective chart review of women with HIV infection in two HIV clinics in a large southern metropolitan area. To describe screening rates among women in care, only women with ≥2 primary care clinic visits during 2007 were included. We used log-binomial regression to estimate prevalence ratios and 95% confidence intervals of screening and to identify demographic, behavioral, and care-related factors associated with screening. Only 52% (258/498) of women in our study were screened during the year; only 29% (8/28) of women with ≤50 CD4 cells/mm³. Factors associated with increased screening in unadjusted analyses included increased number of primary care visits (p<0.001), higher CD4 cell count (p<0.001), younger age (p=0.006) and Hispanic compared to non-Hispanic ethnicity (p<0.001). In adjusted analyses, women with ≥4 primary care visits were 21% more likely to be screened than women with <4 visits (adjusted prevalence ratio = 1.21; 95% confidence interval: 1.02-1.44). Women with CD4 cell counts <200 cells/mm³ were less likely to be screened than women with CD4 counts ≥350 cells/mm³ (adjusted prevalence ratio: 0.77; 95% confidence interval: 0.59- 1.00). Rates of screening for cervical dysplasia were lower than those seen in similar care settings in other geographic areas in the United States. The number of HIV primary care visits, which has been associated with retention in care, was associated with screening prevalence. Interventions designed to improve retention in care may improve screening rates for cervical dysplasia as well.