468. Poor rates of Colposcopy Attendence at a Ryan White Funded HIV Clinic Despite “One Stop Shopping”
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
  • Abuelo Colpo Poster.4.pdf (399.0 kB)
  • Poor rates of Colposcopy Attendence at a Ryan White funded HIV Clinic despite “one stop shopping”

    Background: Identification and eradication of cervical intraepithelial neoplasia (CIN) decreases mortality from cervical cancer (CC). Colposcopy with biopsy provides the gold standard for diagnosis of CC, an AIDS defining condition.

    Methods: This is a chart review of 180 HIV+ women with abnormal Pap smears at the Miriam Hospital. Inclusion criteria are being a patient of the Immunology Clinic with an abnormal cervical smear. Cytology is reported with Bethesda System Terminology as invasion, high or low grade squamous intraepithelial lesion (HSIL or LSIL), atypical glandular cells (AGC), atypical squamous cells suggesting High Grade (ASC-H) or atypical cells of undetermined significance (ASCUS). Initially, all HIV patients with ASCUS or higher were referred for colposcopy. In 2006 the recommendations changed to colposcopy for two consecutive ASCUS smears or those with high risk HPV. The percentage of women missing colposcopy is the number who did not attend divided by the number referred. Logistic regression was used to build a model predicting lack of follow-up.

    Results: The number of women referred for colposcopy from 12/2003 to 12/2009 was 180 with a loss to follow-up rate of 33%. The number of ASCUS was 46, of ASCUS or LGSIL can’t r/o HGSIL was 4, of LGSIL was 110, AGC was 1, and of HGSIL was 17. The subjects’ mean age was 40 with CD4 of 395 and plasma viral load (PVL) of 29480. Risk factors examined for missing appointments were intravenous drug use (IVD), smoking, PVL, CD4 count, cytology, country of origin, race, language, and age. Significant and collinear predictors of lack of attendance were IVD and smoking. The final model included PVL, language, and IVD which showed that IVD had an OR of 2.6 (p 0.009) of missing the colposcopy appointment.

    Conclusion: Even HIV clinics with free colposcopy and interpreters experience loss to follow-up in patients with IVD.

    Subject Category: H. HIV/AIDS and other retroviruses

    Carolina Abuelo, MD MSc, Miriam Hospital Brown University, Providence RI, MA, Jason Machan, PhD, Lifespan-RIH, Providence, RI, Michael DeSimone, BS, Arnold Laboratory, Brown University, Providence, RI, Fizza Gillani, PhD, Brown Medical School, Providence, RI and Susan Cu-Uvin, MD, The Miriam Hospital, Brown University, Providence, RI


    C. Abuelo, None

    J. Machan, None

    M. DeSimone, None

    F. Gillani, None

    S. Cu-Uvin, None

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