Predictors of anal and cervical cancer screening uptake among adults with and without HIV: survey of a community-based health clinic network

People with HIV (PWH) in the United States (U.S.) are disproportionately impacted by human papillomavirus-related cancers. We aimed to identify sociodemographic, health, and social predictors of anal and cervical cancer screening uptake among adults with and without HIV. We implemented a cross-sectional survey between April and June 2024 among adult patients receiving care at a community-based clinic network (predominantly based in Florida, U.S.) that delivers HIV prevention and treatment services. Outcomes included any receipt of anal cancer screening and guideline-adherent receipt of cervical cancer screening among eligible participants. We computed adjusted prevalence ratios (aPRs) to identify multilevel predictors associated with screening uptake. Among the survey respondents, 412 (42%) were eligible for anal cancer screening and 294 (30%) for cervical cancer screening. Participants eligible for anal cancer screening included 88.8% living with HIV and 82.3% men. Men with HIV were more likely to receive anal cancer screening compared to men without HIV (aPR 1.57, 95% CI 1.08, 2.27). Among men with HIV, anal cancer screening uptake was associated with any precancer diagnosis and having three or more comorbidities. Women eligible for cervical cancer screening included 43.5% living with HIV. Women with HIV were less likely to receive guideline-adherent cervical cancer screening compared to women without HIV (aPR 0.60, 95% CI 0.47, 0.77). HIV-related disclosure concerns were associated with lower guideline-adherent cervical screening uptake among women with HIV (aPR 0.75, 95% CI 0.60, 0.94). Screening-eligible participants with HIV were more likely to receive anal cancer screening and less likely to receive cervical cancer screening. Anal and cervical cancer screening uptake differed among subpopulations of people with HIV, including by race/ethnicity, household size, any precancer, comorbidities, and HIV-related stigma. Efforts to improve anal and cervical cancer screening uptake among high-risk and screening-eligible populations are needed.