ASSOCIATIONS OF STRUCTURAL POSITION AND HIV TESTING WITH GUIDELINE-CONCORDANT CERVICAL CANCER SCREENING AMONG U.S. WOMEN AT HIGH RISK OF HIV INFECTION
Author(s)
Benjamin A. Encino, PharmD, Julianne A. Mercer, PharmD, Justina Lipscomb, PharmD, Grace Lee, PharmD;
University of Texas at Austin, Austin, TX, USA
University of Texas at Austin, Austin, TX, USA
OBJECTIVES: Women at high HIV risk experience threefold higher cervical cancer (CC) incidence than the general population, underscoring the need to understand screening barriers. This study evaluated associations of structural position and HIV testing with guideline-concordant screening among U.S. women with high HIV risk.
METHODS: This retrospective study used pooled cross-sectional BRFSS data (2020, 2022, 2024) among women with high HIV risk (based on CDC guidelines). Structural position was defined using self-reported socioeconomic and healthcare access indicators (education [low vs high], income [<$50,000 vs ≥ $50,000], marital status, race, and U.S. region [Northeast, Midwest, South, West, Territories]). HIV testing history was classified as yes/no. Guideline-concordant CC screening was defined per USPSTF 2018. Multivariable logistic regression adjusted for sociodemographic, healthcare access, behavioral, clinical covariates, with effect modification by age group (21-29y, [younger] vs 30-65y, [older]). Analyses accounted for complex survey design.
RESULTS: Among women with high HIV risk (n=3.2 million; 11,680 unweighted), 69.3% reported guideline-concordant CC-screening over the study periods. CC-screening declined by nearly half from 84.4% in 2020 to 49.1% in 2022, recovering to 72.1% in 2024 (p<.001). Lower education (aOR 0.70), income (aOR 0.76), and no HIV testing (aOR 0.62) are independently associated with no CC-screening. Multiracial and Other race versus White women had lower odds (aORs 0.44 [0.30-0.63] and 0.48 [0.34-0.68], respectively) for CC-screening. Regional patterns differed by age (p-interaction=0.05): younger women living in the West and older women living in U.S. territories had higher odds for CC-screening versus women living in the Northeast (aOR 1.57, 1.12-2.19 and aOR 2.56, 1.28-5.11, respectively). No associations were detected between education, race, income, marital status, and HIV testing by age (all p-interaction>0.05).
CONCLUSIONS: CC-screening among women at high HIV risk has not recovered to pre-pandemic levels and demonstrates persistent structural, racial and geographic disparities that vary by age.
METHODS: This retrospective study used pooled cross-sectional BRFSS data (2020, 2022, 2024) among women with high HIV risk (based on CDC guidelines). Structural position was defined using self-reported socioeconomic and healthcare access indicators (education [low vs high], income [<$50,000 vs ≥ $50,000], marital status, race, and U.S. region [Northeast, Midwest, South, West, Territories]). HIV testing history was classified as yes/no. Guideline-concordant CC screening was defined per USPSTF 2018. Multivariable logistic regression adjusted for sociodemographic, healthcare access, behavioral, clinical covariates, with effect modification by age group (21-29y, [younger] vs 30-65y, [older]). Analyses accounted for complex survey design.
RESULTS: Among women with high HIV risk (n=3.2 million; 11,680 unweighted), 69.3% reported guideline-concordant CC-screening over the study periods. CC-screening declined by nearly half from 84.4% in 2020 to 49.1% in 2022, recovering to 72.1% in 2024 (p<.001). Lower education (aOR 0.70), income (aOR 0.76), and no HIV testing (aOR 0.62) are independently associated with no CC-screening. Multiracial and Other race versus White women had lower odds (aORs 0.44 [0.30-0.63] and 0.48 [0.34-0.68], respectively) for CC-screening. Regional patterns differed by age (p-interaction=0.05): younger women living in the West and older women living in U.S. territories had higher odds for CC-screening versus women living in the Northeast (aOR 1.57, 1.12-2.19 and aOR 2.56, 1.28-5.11, respectively). No associations were detected between education, race, income, marital status, and HIV testing by age (all p-interaction>0.05).
CONCLUSIONS: CC-screening among women at high HIV risk has not recovered to pre-pandemic levels and demonstrates persistent structural, racial and geographic disparities that vary by age.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH77
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
SDC: Reproductive & Sexual Health