Understanding Barriers to Cervical Cancer Screening: A Quality Improvement Project in the HIV clinics at Dartmouth Health

<h2>Abstract</h2> People living with HIV (PLWH) are at increased risk for HPV infection, precancerous lesions, and cervical cancer, with current guidelines recommending regular cervical cancer screening for this population. At Dartmouth Health HIV clinics, 37 patients were identified as overdue for screening. To explore potential barriers, we conducted interviews with 24 of these patients. Most interviewees had previously undergone cervical cancer screening and felt confident in their understanding of its importance. However, several barriers to timely screening emerged. The most commonly reported challenges included being too busy, fear of pain, and the belief that screening wasn't necessary in the absence of symptoms. Other discouraging factors included prior negative experiences and lack of transportation. Despite these barriers, 11 patients expressed interest in learning more about cervical cancer screening, and 11 were open to staff assistance in scheduling an appointment. Following outreach, 6 appointments were scheduled, and 10 patients received follow-up education from their primary nurses. These findings highlight the need for more frequent, trauma-informed conversations, as well as targeted education and logistical support. Proactive, patient-centered engagement may improve cervical cancer screening rates and outcomes among PLWH.