Investigator
University Of Bern
Factors associated with uptake of gynaecological care and cervical cancer screening among women in the Swiss HIV Cohort Study
Abstract Objectives We assessed factors associated with attendance at gynaecological visits and cervical cancer screening, and estimated the incidence of cervical dysplasia and cancer among women with HIV (WWH) in Switzerland over two decades. Methods We used self‐reported gynaecological information, collected biannually, in the Swiss HIV Cohort Study between April 2001 and June 2022. We used mixed‐effects logistic regression to examine factors associated with attending yearly gynaecological visits and having cervical smears performed. We estimated cervical dysplasia and cancer incidence rates per 100 000 person‐years and used Cox regression to assess factors associated with incident dysplasia and cancer. Results Among 4052 included WWH, cervical smears were collected in 83% of 33 097 pregnancy‐unrelated visits. Gynaecological visits were less common among older women, among those with lower education, or with a history of intravenous drug use. If a gynaecological visit occurred, cervical smears were less common among women of Black than White ethnicity. Among 3970 women included in the incidence analysis, 218 cervical dysplasias (crude rate: 466/100 000 person‐years) and 14 cervical cancers (crude rate: 28/100 000 person‐years) were recorded. Women who had cervical smears documented in a higher proportion of time periods were more likely to have a cervical dysplasia diagnosis but less likely to have a cervical cancer diagnosis documented. Conclusions We found substantial disparities in the uptake of gynaecological visits and cervical smears by age, education level, ethnicity and intravenous drug use. Implementing more targeted and integrated cervical cancer screening and gynaecological care models may help reduce these disparities and improve prevention of cervical cancer among WWH in Switzerland.
Screening and prevention of HPV‐related anogenital cancers in women living with HIV in Europe: Results from a systematic review
AbstractBackgroundWomen living with HIV (WLWH) are at increased risk of human papillomavirus (HPV)‐related cancers. Throughout Europe, there is great heterogeneity among guidelines for screening programmes, access to HPV testing and HPV vaccination. The aim of this systematic review is to summarize available data on screening and prevention measures for HPV‐related anogenital cancers in WLWH across the WHO European Region (WER).MethodsThe systematic review followed the PRISMA guidelines and was registered on Prospero. PubMed, Embase and Web of Science databases were searched to identify available studies, written in English and published between 2011 and 2022. A metanalysis was conducted using random‐effects models to calculate pooled prevalence of HPV. Subgroup analyses were conducted according to country and HPV testing.ResultsThirty‐four articles involving 10 336 WLWH met the inclusion criteria. Studies were heterogenous in their methodology and presentation of results: 73.5% of studies focused on cervical cancer prevention, and only 4.4% on anal cancer; 76.5% of studies conducted HPV testing as a routine part of screening. The prevalence of high‐risk HPV was 30.5–33.9% depending on the detection method used. A total of 77% of WLWH had cervical cytology results reported. Six studies reported the positive association of CD4 cell count <200 cells/μL with HPV prevalence and cervical abnormalities. Anal HPV testing was conducted in <8% of participants. HPV vaccination was completed in 5.6% of women (106/1902) with known vaccination status. There was no information about the vaccination status of the majority of women in the analysed studies (8434/10336).ConclusionData about screening of HPV‐related anogenital cancer in WLWH in Europe are heterogenous and lacking, especially in relation to anal cancer. HPV DNA testing is not routinely done as part of screening for HPV‐related cancer; guidelines should include indications for when to use this test. Low CD4 count is a risk factor for HPV infection and cytological abnormalities. HPV vaccination data are poor and, when available, vaccination rates are very low among WLWH in Europe. This review concludes that significant improvements are required for data and also consistency on guidelines for HPV screening, prevention and vaccination in WLWH.
