ASPO Abstracts
Delivering cervical cancer screening and follow-up to women with HIV in an integrated safety-net setting
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Background: Women with HIV are at elevated risk of cervical cancer compared to women without HIV. Preliminary studies in our safety-net setting showed 56% of women with HIV are under-screened for cervical cancer. Of those screened, only 40% completed follow-up colposcopies within 6 months when indicated. This study developed process maps to 1) illustrate patient flow, provider and clinic staff inputs, and gaps in cervical cancer screening and follow-up for women with HIV; and 2) identify quality improvement intervention opportunities to optimize screening and follow-up care.Methods: We conducted interviews with providers and staff in HIV primary care and gynecology specialty clinics. Topics included screening and follow-up processes; provider- and staff- patient communication; patient transition between clinics; perceptions of barriers to screening and follow-up; and suggestions for improvements. We double coded interviews with three deductively driven codes: care processes; barriers to care; and opportunities for interventions. We reviewed coded excerpts and findings biweekly to iteratively inform process map development, and we presented drafts to clinic stakeholders and patients for refinement.Results: Process maps highlighted gaps in care for women with HIV. Gaps included: 1) limitations in electronic health records (EHR) data to identify and track patients overdue for screening/follow-up; 2) logistical issues (e.g., scheduling, staffing); 3) inconsistent communication between clinics; 4) primary care provider discomfort performing Pap tests; and 5) clinic flow not optimized for all providers to perform Pap tests. Intervention opportunities included adaptation of EHR documentation and reporting systems and development of a surveillance registry to identify/track women overdue for a Pap test/follow-up.Conclusion: We identified disparities in care for women living with HIV within our integrated safety-net healthcare system including system-level gaps as patients interfaced with multiple teams moving from primary care to specialty care following abnormal Pap results. Addressing these gaps with quality improvement interventions is critically important for this subpopulation of women at increased risk of cervical dysplasia and cancer.
Keywords: Women with HIVCancer healthcare deliveryCervical cancer screening