Women living with HIV often do not receive preventive health care screenings as frequently as recommended. These include routine screenings for various cancers and sexually transmitted infections (STIs) as well as CD4 and viral load tests.
William R. Short, MD, MPH, of the Perelman School of Medicine at the University of Pennsylvania Department of Medicine’s division of infectious diseases, and colleagues analyzed data from the 2013 to 2015 cycles of the Medical Monitoring Project. Publishing their findings in the Journal of Acquired Immune Deficiency Syndromes, they looked at records regarding 2,766 women with HIV.
A total of 6.8% of the women were 18 to 29 years old, 16% were 30 to 39 years old, 30% were 40 to 49 years old and 48% were 50 years old or older. Sixty-two percent were Black, 20% were Latina and 15% were white. Thirty-one percent did not have a high school diploma, 32% had a high school diploma or its equivalent and 37% had more than a high school education.
Sixteen percent of the women had been diagnosed with HIV within five years, 21% were diagnosed five to nine years prior and 63% were diagnosed at least 10 years prior. Twenty percent of the women had any private insurance, 67% had public insurance and 13% had Ryan White coverage or were uninsured.
A total of 7.7% of the women had experienced homelessness within the previous 12 months, 24% had experienced depression within the past two weeks, 66% had an AIDS diagnosis, 94% had been prescribed antiretrovirals, 66% had a sustained fully suppressed viral load (all viral load test results during the prior 12 months were under 200), 8% had made at least one visit to the emergency department for HIV-related medical care within the previous 12 months and 6% had been admitted to the hospital at least once during the previous 12 months with HIV-related illness.
The screening guidelines that the study analyzed were as follows: Women 21 years old and older should receive a pap examination for cervical cancer every two years; women 40 years old and older should receive a mammogram for breast cancer every two years; all women should be screened for STIs, including gonorrhea, chlamydia and syphilis, every 12 months; all should receive at least one viral load test every six months; and all should receive at least three CD4 or viral load tests every 12 months.
Forty-four percent of the women received the cervical cancer screening, 28% received the breast cancer screening and 35% received the STI screening according to the guidelines. Women 18 to 29 years old were 48% more likely than women age 50 and older to have received STI screening within the past 12 months.
Twenty-six percent of the women did not meet the six-month viral load screening schedule, and 37% did not meet the 12-month CD4 and viral load screening schedule.
After adjusting the data to account for various differences between the women, the study authors found that women who had not had any viral load tests conducted within the past six months were 45% less likely to have sustained viral suppression over a 12-month period. Women who did not receive at least three CD4 or viral load tests within six months were 15% more likely to be living below the poverty level and 6% more likely to have public insurance compared with private insurance.
Women were twice as likely to be admitted to the hospital with an HIV-related illness if they had experienced homelessness within the previous year, and were also twice as likely to have any such hospital admissions if they had experienced depression within the previous two weeks. Compared with those who had not sustained a fully suppressed viral load over the previous year, those who had were half as likely to be admitted to the hospital with HIV-related illness.
“Receipt of recommended preventive care was suboptimal,” the study authors concluded. “Targeted interventions are warranted to help ensure access to comprehensive HIV care and prevention services for women.”
To read the study abstract, click here.