Factors associated with uptake of gynaecological care and cervical cancer screening among women in the Swiss HIV Cohort Study

Objectives: We assessed factors associated with attendance at gynaecological visits and cervical cancer screening, and estimated the incidence of cervical dysplasia and cancer among women with HIV (WWH) in Switzerland over two decades. Methods: We used self-reported gynaecological information, collected biannually, in the Swiss HIV Cohort Study between April 2001 and June 2022. We used mixed-effects logistic regression to examine factors associated with attending yearly gynaecological visits and having cervical smears performed. We estimated cervical dysplasia and cancer incidence rates per 100 000 person-years and used Cox regression to assess factors associated with incident dysplasia and cancer. Results: Among 4052 included WWH, cervical smears were collected in 83% of 33 097 pregnancy-unrelated visits. Gynaecological visits were less common among older women, among those with lower education, or with a history of intravenous drug use. If a gynaecological visit occurred, cervical smears were less common among women of Black than White ethnicity. Among 3970 women included in the incidence analysis, 218 cervical dysplasias (crude rate: 466/100 000 person-years) and 14 cervical cancers (crude rate: 28/100 000 person-years) were recorded. Women who had cervical smears documented in a higher proportion of time periods were more likely to have a cervical dysplasia diagnosis but less likely to have a cervical cancer diagnosis documented. Conclusions: We found substantial disparities in the uptake of gynaecological visits and cervical smears by age, education level, ethnicity and intravenous drug use. Implementing more targeted and integrated cervical cancer screening and gynaecological care models may help reduce these disparities and improve prevention of cervical cancer among WWH in Switzerland.