Integrating Cervical Cancer Screening into Safer Conception Services to Improve Women's Health Outcomes

A Pilot Study at a Primary Care Clinic in South Africa

Natasha E.C.G. Davies, Matthew Chersich, Saiqa Mullick, Nicolette Naidoo, Nokuthula Makhoba, Helen Rees, Sheree Schwartz

Research output: Contribution to journalArticle

Abstract

Background Sub-optimal cervical cancer screening in low- and middle-income countries contributes to preventable cervical cancer deaths, particularly among human immunodeficiency virus (HIV)-positive women. We assessed feasibility and outcomes of integrating cervical cancer screening into safer conception services for HIV-affected women. Methods At a safer conception service in Johannesburg, South Africa, HIV-affected women desiring pregnancy received a standard package of care designed to minimize HIV transmission risks while optimizing prepregnancy health. All eligible women were offered Papanicolaou smear, and those with significant pathology were referred for colposcopy before attempting pregnancy. Multivariable analyses identified associations between patient characteristics and abnormal pathology. Results In total, 454 women were enrolled between June 2015 and April 2017. At enrolment, 91% were HIV-positive, 92% were on antiretroviral therapy (ART) and 82% virally suppressed. Eighty-three percent (376 of 454) of clients were eligible for cervical cancer screening and 85% (321 of 376) of these completed screening. More than half had abnormal cervical pathology (185 of 321) and 20% required colposcopy for possible high-grade or persistently atypical lesions (64 of 321). Compared with HIV-negative women, abnormal pathology was more likely among HIV-positive women, both those on ART <2 years (adjusted prevalence ratio, 2.5; 95% confidence interval, 1.2-5.0) and those on ART 2 years or longer (adjusted prevalence ratio, 2.1; 95% confidence interval, 1.0-4.2). Conclusions Integrating cervical cancer screening into safer conception care was feasible with high coverage, including for HIV-positive women. Significant pathology, requiring colposcopy, was common, even among healthy women on ART. Safer conception services present an opportunity for integration of cervical cancer screening to avert preventable cancer-related deaths among HIV-affected women planning pregnancy.

Original languageEnglish (US)
Pages (from-to)91-97
Number of pages7
JournalSexually Transmitted Diseases
Volume46
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Women's Health
South Africa
Early Detection of Cancer
Uterine Cervical Neoplasms
Primary Health Care
HIV
Colposcopy
Pathology
Pregnancy
Confidence Intervals
Papanicolaou Test
Therapeutics
Standard of Care
Health

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Integrating Cervical Cancer Screening into Safer Conception Services to Improve Women's Health Outcomes : A Pilot Study at a Primary Care Clinic in South Africa. / Davies, Natasha E.C.G.; Chersich, Matthew; Mullick, Saiqa; Naidoo, Nicolette; Makhoba, Nokuthula; Rees, Helen; Schwartz, Sheree.

In: Sexually Transmitted Diseases, Vol. 46, No. 2, 01.02.2019, p. 91-97.

Research output: Contribution to journalArticle

Davies, Natasha E.C.G. ; Chersich, Matthew ; Mullick, Saiqa ; Naidoo, Nicolette ; Makhoba, Nokuthula ; Rees, Helen ; Schwartz, Sheree. / Integrating Cervical Cancer Screening into Safer Conception Services to Improve Women's Health Outcomes : A Pilot Study at a Primary Care Clinic in South Africa. In: Sexually Transmitted Diseases. 2019 ; Vol. 46, No. 2. pp. 91-97.
@article{b6ab59df2a92416ea9ec4a50e27c018b,
title = "Integrating Cervical Cancer Screening into Safer Conception Services to Improve Women's Health Outcomes: A Pilot Study at a Primary Care Clinic in South Africa",
abstract = "Background Sub-optimal cervical cancer screening in low- and middle-income countries contributes to preventable cervical cancer deaths, particularly among human immunodeficiency virus (HIV)-positive women. We assessed feasibility and outcomes of integrating cervical cancer screening into safer conception services for HIV-affected women. Methods At a safer conception service in Johannesburg, South Africa, HIV-affected women desiring pregnancy received a standard package of care designed to minimize HIV transmission risks while optimizing prepregnancy health. All eligible women were offered Papanicolaou smear, and those with significant pathology were referred for colposcopy before attempting pregnancy. Multivariable analyses identified associations between patient characteristics and abnormal pathology. Results In total, 454 women were enrolled between June 2015 and April 2017. At enrolment, 91{\%} were HIV-positive, 92{\%} were on antiretroviral therapy (ART) and 82{\%} virally suppressed. Eighty-three percent (376 of 454) of clients were eligible for cervical cancer screening and 85{\%} (321 of 376) of these completed screening. More than half had abnormal cervical pathology (185 of 321) and 20{\%} required colposcopy for possible high-grade or persistently atypical lesions (64 of 321). Compared with HIV-negative women, abnormal pathology was more likely among HIV-positive women, both those on ART <2 years (adjusted prevalence ratio, 2.5; 95{\%} confidence interval, 1.2-5.0) and those on ART 2 years or longer (adjusted prevalence ratio, 2.1; 95{\%} confidence interval, 1.0-4.2). Conclusions Integrating cervical cancer screening into safer conception care was feasible with high coverage, including for HIV-positive women. Significant pathology, requiring colposcopy, was common, even among healthy women on ART. Safer conception services present an opportunity for integration of cervical cancer screening to avert preventable cancer-related deaths among HIV-affected women planning pregnancy.",
author = "Davies, {Natasha E.C.G.} and Matthew Chersich and Saiqa Mullick and Nicolette Naidoo and Nokuthula Makhoba and Helen Rees and Sheree Schwartz",
year = "2019",
month = "2",
day = "1",
doi = "10.1097/OLQ.0000000000000914",
language = "English (US)",
volume = "46",
pages = "91--97",
journal = "Sexually Transmitted Diseases",
issn = "0148-5717",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Integrating Cervical Cancer Screening into Safer Conception Services to Improve Women's Health Outcomes

T2 - A Pilot Study at a Primary Care Clinic in South Africa

AU - Davies, Natasha E.C.G.

AU - Chersich, Matthew

AU - Mullick, Saiqa

AU - Naidoo, Nicolette

AU - Makhoba, Nokuthula

AU - Rees, Helen

AU - Schwartz, Sheree

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background Sub-optimal cervical cancer screening in low- and middle-income countries contributes to preventable cervical cancer deaths, particularly among human immunodeficiency virus (HIV)-positive women. We assessed feasibility and outcomes of integrating cervical cancer screening into safer conception services for HIV-affected women. Methods At a safer conception service in Johannesburg, South Africa, HIV-affected women desiring pregnancy received a standard package of care designed to minimize HIV transmission risks while optimizing prepregnancy health. All eligible women were offered Papanicolaou smear, and those with significant pathology were referred for colposcopy before attempting pregnancy. Multivariable analyses identified associations between patient characteristics and abnormal pathology. Results In total, 454 women were enrolled between June 2015 and April 2017. At enrolment, 91% were HIV-positive, 92% were on antiretroviral therapy (ART) and 82% virally suppressed. Eighty-three percent (376 of 454) of clients were eligible for cervical cancer screening and 85% (321 of 376) of these completed screening. More than half had abnormal cervical pathology (185 of 321) and 20% required colposcopy for possible high-grade or persistently atypical lesions (64 of 321). Compared with HIV-negative women, abnormal pathology was more likely among HIV-positive women, both those on ART <2 years (adjusted prevalence ratio, 2.5; 95% confidence interval, 1.2-5.0) and those on ART 2 years or longer (adjusted prevalence ratio, 2.1; 95% confidence interval, 1.0-4.2). Conclusions Integrating cervical cancer screening into safer conception care was feasible with high coverage, including for HIV-positive women. Significant pathology, requiring colposcopy, was common, even among healthy women on ART. Safer conception services present an opportunity for integration of cervical cancer screening to avert preventable cancer-related deaths among HIV-affected women planning pregnancy.

AB - Background Sub-optimal cervical cancer screening in low- and middle-income countries contributes to preventable cervical cancer deaths, particularly among human immunodeficiency virus (HIV)-positive women. We assessed feasibility and outcomes of integrating cervical cancer screening into safer conception services for HIV-affected women. Methods At a safer conception service in Johannesburg, South Africa, HIV-affected women desiring pregnancy received a standard package of care designed to minimize HIV transmission risks while optimizing prepregnancy health. All eligible women were offered Papanicolaou smear, and those with significant pathology were referred for colposcopy before attempting pregnancy. Multivariable analyses identified associations between patient characteristics and abnormal pathology. Results In total, 454 women were enrolled between June 2015 and April 2017. At enrolment, 91% were HIV-positive, 92% were on antiretroviral therapy (ART) and 82% virally suppressed. Eighty-three percent (376 of 454) of clients were eligible for cervical cancer screening and 85% (321 of 376) of these completed screening. More than half had abnormal cervical pathology (185 of 321) and 20% required colposcopy for possible high-grade or persistently atypical lesions (64 of 321). Compared with HIV-negative women, abnormal pathology was more likely among HIV-positive women, both those on ART <2 years (adjusted prevalence ratio, 2.5; 95% confidence interval, 1.2-5.0) and those on ART 2 years or longer (adjusted prevalence ratio, 2.1; 95% confidence interval, 1.0-4.2). Conclusions Integrating cervical cancer screening into safer conception care was feasible with high coverage, including for HIV-positive women. Significant pathology, requiring colposcopy, was common, even among healthy women on ART. Safer conception services present an opportunity for integration of cervical cancer screening to avert preventable cancer-related deaths among HIV-affected women planning pregnancy.

UR - http://www.scopus.com/inward/record.url?scp=85059918246&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059918246&partnerID=8YFLogxK

U2 - 10.1097/OLQ.0000000000000914

DO - 10.1097/OLQ.0000000000000914

M3 - Article

VL - 46

SP - 91

EP - 97

JO - Sexually Transmitted Diseases

JF - Sexually Transmitted Diseases

SN - 0148-5717

IS - 2

ER -