Adherence to cervical screening and follow-up care in HIV-positive women at a Canadian tertiary care center

Introduction: Women with human immunodeficiency virus (HIV) are at a significantly increased risk of developing cervical cancer. However, adherence to cervical screening guidelines remains suboptimal. Objective: To assess adherence to Pap smear initial screening and follow-up at St. Joseph's Hospital (SJH) in London, Ontario, and to analyze their association with sociodemographic characteristics. Methods: A retrospective cohort study was conducted of women with HIV ≥21 years of age who were attending SJH's HIV clinic between 2015 and 2024. Medical records were reviewed to determine Pap smear completion at HIV diagnosis, follow-up adherence, and management of abnormal results. Results: Of 235 women identified, 211 were included. Only 29% ( n = 62) underwent Pap smear testing at the time of HIV diagnosis. Among 148 women with normal initial cytology, only 28 (19%) completed three consecutive annual follow-up screenings. Thirty-four women (17%) had atypical squamous cells of undetermined significance (ASC-US) results, of whom 29 (85%) underwent appropriate repeat cytology within 6 to 12 months. Fifty-three women (27%) were diagnosed with low-grade squamous intraepithelial lesion (LSIL) or higher-grade lesions, and 42 (79%) were appropriately referred for colposcopy. Adherence to cervical screening was positively associated with year of HIV diagnosis ( p < 0.001); an association with history of injection drug use was observed in unadjusted analyses ( p = 0.018), but did not persist in post-hoc analysis. Conclusion: Substantial gaps exist in cervical cancer screening and follow-up among women with HIV. Despite guideline recommendations, less than one-third of patients in our cohort received Pap smears at the time of HIV diagnosis, and long-term follow-up adherence was low. Enhanced system-based interventions are required to improve screening continuity and outcomes in this high-risk population.