Cervical Cancer Screening Patterns Among HIV-positive Women in Estonia: A Population Based Retrospective Cohort Study

Abstract IntroductionThe World Health Organisation (WHO) calls fot the elimination of cervical cancer (CC) as a public health issue. To achieve elimination, efforts must be aligned and accelerated. Women living with HIV (WLWH) have excess risk for developing and dying from CC over the general population. Estimates of cervical cancer screening (CCS) program coverage in Eastern European countries that have experienced HIV epidemics since early 2000s are scarce. MethodsThis population-based retrospective study uses healthcare administrative database and follows cohorts of all WLWH and in a ratio 1:3 randomly matched (age, region) HIV negative women from 2009-2018. Annual and longitudinal (over the whole study period) coverage for CCS (opportunistic, organised, HIV specific) and adjusted odds ratios (AORs) for longitudinal screening coverage predictors were estimated from 2009-2018.ResultsAmong WLWH and HIV negative women, the mean annual coverage with opportunistic screening was 61.45%, and 65.59%; organised screening 20.4%, and 28.7%, respectively (both: p<0.00001). 19.01% (95% CI 18.05-19.97) HIV negative and 13.9% (95% CI 12.35-15.45) WLWH were longitudinally covered with organised CCS. Among WLWH, the mean annual HIV specific CCS coverage was 49.4 % and 24.3% were longitudinally covered. Longitudinal coverage with HIV specific CCS was inversely associated with age, HCV co-infection AOR 0.754 (95% CI 0.619, 0.916), not having insurance AOR 0.331 (95% CI 0.264, 0.412), drug abuse (AOR 0.459, 95%CI 0.336, 0.618) and higher among those retained in HIV care AOR 1.972 (95% CI 1.615, 2.410). Among HIV negative women, longitudinal coverage with organised CCS was inversely associated with residence region and higher among older women. ConclusionsOur results highlight unacceptably low coverage of WLWH with cervical cancer screening in Estonia. There is a need for a dedicated cervical cancer screening efforts for WLWH considering the high cancer risk and rate in the study population.