Improving Adherence to Cervical Cancer Screening Guidelines in Women Living with HIV: A Quality Improvement Initiative

Abstract

Background: Women Living with HIV (WLHIV) are at increased risk for cervical cancer and acquisition of this disease is an Acquired Immunodeficiency Syndrome (AIDS)-defining malignancy; however, screening rates for this vulnerable population remain low. Purpose: This project aimed to identify factors associated with inadequate screening in WLHIV and implement a pilot intervention tailored to address these issues in an urban, academic, HIV-clinic. Method: A two-phase, multicomponent quality improvement study was conducted. The first phase identified factors associated with inadequate screening through a cross-sectional survey. In phase two of the study, a quasi-experimental, one-group pre/posttest design pilot intervention was implemented. The number of Pap tests completed pre- and post- implementation were analyzed to examine the clinical impact of the intervention. Results: In the pre-implementation period, three women (1.7%) underwent cervical cancer screening in the form of Papanicolaou (Pap) testing. In the post implementation period, six women (3.4 %) underwent screening. WLHIV eligible for screening most commonly reported forgetting to schedule an appointment (33%) as a barrier to screening. Significance: A multicomponent quality improvement intervention was successful in overcoming barriers and increasing cervical cancer screening rates in an urban, academic HIV-clinic and may offer a low-cost intervention to improve health of WLHIV.