Prevalence and Predictors of Cervical Cytological (Pap Smear) Abnormalities Among HIV-infected Women at the HIV Treatment Center of Jos University Teaching Hospital Jos, Nigeria.

Abstract

Introduction: Cervical cancer is the most common cancer among women living with HIV with the highest burden in sub-Sahara African countries with the highest prevalence of HIV. Early detection of precursor cervical lesions through routine Pap smear screening is central to cervical cancer prevention. This study was aimed at determining the prevalence and predictors of abnormal Pap smear findings among women with HIV in our cervical cancer screening program. Methodology: We carried out a cross sectional study of adult women with HIV who presented for Pap smear test for the first time at the Jos University Teaching Hospital, Jos, North Central Nigeria between November2018 and January 2020. Prevalence of abnormal cervical finding was reported in percentage and also expressed per 100 population of women. The effects of the characteristics of the women of the abnormal pap smear finding was determined using the logistic regression model where 95% confidence interval and adjusted odds were used as point and interval estimates respectively while a probability value of < 0.05 was considered statistically significant. Results: A total of 949 women with HIV participated in the cervical screening program with mean age 43.3 ± 8.1 years. Abnormal smear findings were observed among 183 (19.3%: 19 cases per 100 women) with ASCUS, ASC-H, LSIL, HSIL, HSIL with suspicion of invasion and AGUS accounting for 96 (10.1%), 50(5.3%), 27 (2.9%), 6 (0.6%), 2 (0.2%) and 2(0.2%) respectively. Of the abnormal smear findings, 125 (68.3%) were adjudged to have mild cytological feature while the complementing proportion adjudged to have severe cytological features. Unadjusted odds of abnormal Pap smear result was associated with increasing age, OR 1.15(95% CI 1.127, 1.186; p = 0.001); parity, OR1.08 (95% CI 1.019, 1.141; p = 0.009). In the adjusted model, increasing age remained the only factor predicting abnormal Pap smear finding. Conclusion: Prevalence of abnormal Pap smear results remains high in HIV- infected women and is associated with increasing age. Advocacy to institutionalize screening at earlier age is therefore key to improving dismal outcomes.