Evaluating the trend of time to colposcopy follow-up among women with a positive primary human papillomavirus screening result at Kaiser Permanente Southern California
Timeliness of colposcopy follow-up after primary human papillomavirus screening has not been well examined. We evaluated time to colposcopy follow-up among women with an abnormal primary human papillomavirus screening result overall and by human papillomavirus genotype, triage cytology results, race/ethnicity, and neighborhood deprivation index. Women aged 30 to 65 years who received primary human papillomavirus screening at Kaiser Permanente Southern California from July 15, 2020, to December 31, 2021 and had screening results that required colposcopy follow-up were identified. All data were collected from Kaiser Permanente Southern California's electronic medical records. Multivariable modified Poisson models were used to evaluate the associations between human papillomavirus type and triage cytology results, race/ethnicity, neighborhood deprivation index, and receiving a colposcopy within 3 months and 6 months of screening results. A total of 5833 women were included. The mean age was 42.9 years; 11.4%, 9.8%, 48.7%, and 24.4% were of Asian/Pacific Islander, non-Hispanic Black, Hispanic, and non-Hispanic White race/ethnicity. Overall, 71% and 78% received colposcopy within 3 and 6 months of screening, respectively. Compared with women with non-16/18, other high-risk human papillomavirus types and low-grade cytology results, women with HPV 16/18 with normal low-grade or high-grade cytology results and women with other high-risk human papillomavirus and high-grade cytology results were more likely to have colposcopy within 3 months of screening results [risk ratio ranged from 1.21 (95% confidence interval, 1.16-1.25) to 1.34 (95% confidence interval, 1.25, 1.42)]. Non-Hispanic Black women (vs non-Hispanic White, risk ratio=0.93 [0.87, 1.00]) and women from the most deprived neighborhoods (vs least deprived, risk ratio=0.95 [0.90, 1.00]) had lower likelihoods of receiving colposcopy within 3 months of screening. Findings for 6 months of follow-up were similar to that of 3 months. Our observations confirmed prioritization of diagnostic follow-up for women with human papillomavirus 16/18+ as well as high-grade cytology results. Barriers to incomplete colposcopy follow-up and disparity should be better understood and addressed.