You are here

  • Home
  • Archive
  • Volume 10, Issue 1
  • Impact of healthcare access and HIV testing on utilisation of cervical cancer screening among US women at high risk of HIV infection: cross-sectional analysis of 2016 BRFSS data

Article Text

Article menu

Download PDFPDF

XML
Epidemiology
Original research
Impact of healthcare access and HIV testing on utilisation of cervical cancer screening among US women at high risk of HIV infection: cross-sectional analysis of 2016 BRFSS data
  1. Dongyu Zhang1,
  2. Shailesh Advani1,2,
  3. Megan Huchko3,
  4. Dejana Braithwaite1
  1. 1 Department of Oncology, Georgetown University School of Medicine, Washington, District of Columbia, USA
  2. 2 Social Behavioral Research Branch, National Institutes of Health, Bethesda, Maryland, USA
  3. 3 Department of Obstetrics and Gynecology, Duke Global Health Institute, Durham, North Carolina, USA
  1. Correspondence to Dr Dongyu Zhang; dz216{at}georgetown.edu; Dr Dejana Braithwaite; db1393{at}georgetown.edu

Abstract

Objective Previous studies identified several factors associated with cervical cancer screening. However, many of them used samples from the general population and limited studies focused on women with high-risk health behaviours. We aimed to disentangle the association of cervical cancer screening with healthcare access and HIV testing among women at a high risk of HIV infection.

Design Nationwide cross-sectional survey in the USA.

Setting 2016 Behavioral Risk Factor Surveillance System.

Participants 3448 women with a history of high-risk behaviours associated with HIV infection

Exposure and outcome Clinical check-up, having personal healthcare provider, health coverage and HIV testing history were treated as exposures. Appropriate cervical cancer screening, which was defined according to 2016 US Preventive Services Task Force guideline, was treated as the outcome of interest.

Data analysis Multivariable logistic regression model was performed to evaluate associations of healthcare access and HIV testing with the uptake of cervical cancer screening; adjusted odds ratio (aOR) and 95% CI were reported. We further investigated if educational attainment modified associations identified in the primary multivariable model.

Results A total of 2911 (84.4%) high-risk women in our sample underwent cervical cancer screening. In the multivariable model, delayed clinical check-up (≥5 years ago vs within the past year: aOR: 0.19, 95% CI: 0.14 to 0.26), having no health insurance (aOR: 0.60, 95% CI: 0.46 to 0.79) and no history of HIV testing (no testing vs testing within the past year: aOR: 0.46, 95% CI: 0.35 to 0.61) were inversely associated with cervical cancer screening utilisation.

Conclusion Factors reflecting healthcare access, specifically clinical check-up and health coverage, as well as history of HIV testing were associated with cervical cancer screening in this population-based study of high-risk women. Targeted interventions are warranted to further increase cervical cancer screening among women at high risk of HIV infection.

  • epidemiology
  • cervical cancer
  • cancer screening
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-031823

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors DZ and DB helped in the research question development. DZ performed the data acquisition. Analytical plan development was done by DZ and DB. DZ performed the data analysis. DZ, SA, MH and DB helped in the results interpretation. Drafting manuscript was done by DZ and manuscript revision was done by DZ, SA, MH and DB. All authors reviewed and commented on the manuscript.

    • Funding This project was supported by an the Global Health Initiative, Georgetown University

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval BRFSS is a publicly available de-identified dataset and does not require IRB approval.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository.