Yes We Can! Improving Rates of Cervical Cancer Screening with a Low Cost Multidisciplinary Women's Wellness Initiative
Sara L. Cross, MD; Nur F. Onen, MD, Rachel M. Presti, MD, PhD, E. Turner Overton, MD, Michael A. Lane, MD
Background: Women with HIV have higher rates of cervical cancer compared to non-HIV infected women; however, many women fail to receive routine annual cervical cancer screening.
Methods: This study was performed at the Washington University Infectious Disease Clinic. We assessed cervical cancer screening rates among women followed at the Washington University HIV Clinic before and after the implementation of a multidisciplinary women's wellness intervention implemented on July 1, 2010. All women with clinic visits in the pre- and post-intervention periods were included (July 2009 - June 2010 versus July 2010 – June 2011). Patient demographics, insurance status, CD4 count, and performance of screening test was obtained from clinical databases. Women were considered to have had screening if they received cervical cancer screening once during the 12 month study period.
Results: A total of 552 women were included in the review, 466 in the pre- and 492 in the post-intervention period. Demographic characteristics were similar in the pre- and post-periods. The intervention resulted in significant improvement in screening for cervical cancer (53.7% vs. 81.1%, p<.001). Age (p .652) and missed appointments (p .129) were not associated with lack of screening. Prior to the intervention, advanced disease (CD4 count <200) (p .038) and lack of receipt of cART (p .047) were associated with lower screening rates. After the intervention, advanced disease (p .078) and lack of receipt of cART (p .813) were not associated with lack of receipt of cervical cancer screening.
Conclusion: This multidisciplinary quality improvement program dramatically increased cervical cancer screening rates. Given the structural barriers to routine health maintenance in HIV primary care, implementation of low-cost initiatives can greatly reduce morbidity and mortality among at risk patients, even in those patients with more advanced HIV infection.
R. Presti, None
T. Overton, None
M. Lane, None