爱沙尼亚 HIV 阳性妇女的宫颈癌筛查模式：一项基于人群的回顾性队列研究。
Cervical cancer screening patterns among HIV-positive women in Estonia: a population-based retrospective cohort study.
机构信息
Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
Department of Computational Biology, University of Lausanne, Lausanne, Switzerland.
出版信息
BMC Cancer. 2021 Apr 1;21(1):350. doi: 10.1186/s12885-021-08076-0.
BACKGROUND
The World Health Organisation (WHO) calls for the elimination of cervical cancer (CC) as a public health issue. To achieve elimination, efforts must be aligned and accelerated. Women living with HIV (WLWH) have excess risk for developing, and dying from, CC over the general population. Estimates of cervical cancer screening programme coverage in Eastern European countries that have experienced HIV epidemics since the early 2000's are scarce.
METHOD
This population-based retrospective study uses a healthcare administrative database and follows cohorts of all WLWH in a ratio of 1:3 randomly matched (age, region) HIV negative women from 2009 to 2018. Annual and longitudinal (over the whole study period) coverage for cervical cancer screening (opportunistic, organised, HIV specific) and adjusted odds ratios (AORs) for longitudinal screening coverage predictors were estimated from 2009 to 2018.
RESULTS
Among WLWH and HIV-negative women, the mean annual coverage with opportunistic screening was 61.45 and 65.59%; and organised screening was 20.4 and 28.7%, respectively (both: p < 0.00001). 19.01% (95% CI 18.05-19.97) HIV-negative and 13.9% (95% CI 12.35-15.45) WLWH were longitudinally covered with organised cervical cancer screening. Among WLWH, the mean annual HIV-specific cervical cancer screening coverage was 49.4, and 24.3% were longitudinally covered. Longitudinal coverage with HIV-specific cervical cancer screening was inversely associated with age, hepatitis C virus (HCV) co-infection (AOR 0.754, 95% CI 0.619, 0.916), not having insurance (AOR 0.331, 95% CI 0.264, 0.412), drug abuse (AOR 0.459, 95% CI 0.336, 0.618) and higher among those retained in HIV care (AOR 1.972, 95% CI 1.615, 2.410). Among HIV-negative women, longitudinal coverage with organised cervical cancer screening was inversely associated with residence in the region and higher among older women.
CONCLUSIONS
Our results highlight unacceptably low coverage of cervical cancer screening of WLWH in Estonia. There is need for dedicated cervical cancer screening efforts for WLWH considering the high cancer risk and rate in the study population.
背景
世界卫生组织（WHO）呼吁消除宫颈癌（CC）这一公共卫生问题。要实现消除宫颈癌的目标，必须协调并加快各项工作。与一般人群相比，感染艾滋病毒的妇女（WLWH）罹患宫颈癌和死于宫颈癌的风险更高。自 21 世纪初以来，东欧国家经历了艾滋病毒流行，对这些国家宫颈癌筛查项目覆盖范围的估计数据非常有限。
方法
本项基于人群的回顾性研究使用医疗保健管理数据库，对 2009 年至 2018 年期间所有 WLWH 进行了队列研究，比例为 1：3 随机匹配（年龄、地区）HIV 阴性妇女。对宫颈癌筛查（机会性、有组织、HIV 特异性）的年度和纵向（整个研究期间）覆盖率进行了估计，并从 2009 年至 2018 年对纵向筛查覆盖率预测因素进行了调整优势比（AOR）估计。
结果
在 WLWH 和 HIV 阴性女性中，机会性筛查的年平均覆盖率分别为 61.45%和 65.59%；组织筛查的年平均覆盖率分别为 20.4%和 28.7%（均<0.00001）。19.01%（95%CI 18.05-19.97）的 HIV 阴性女性和 13.9%（95%CI 12.35-15.45）的 WLWH 进行了纵向组织宫颈癌筛查。在 WLWH 中，HIV 特异性宫颈癌筛查的年平均覆盖率为 49.4%，24.3%进行了纵向覆盖。纵向 HIV 特异性宫颈癌筛查覆盖率与年龄、丙型肝炎病毒（HCV）合并感染（AOR 0.754，95%CI 0.619，0.916）、无保险（AOR 0.331，95%CI 0.264，0.412）、药物滥用（AOR 0.459，95%CI 0.336，0.618）呈负相关，与 HIV 护理保留率较高（AOR 1.972，95%CI 1.615，2.410）呈正相关。在 HIV 阴性女性中，纵向组织宫颈癌筛查的覆盖率与居住地呈负相关，且在年龄较大的女性中覆盖率更高。
结论
我们的研究结果突出表明，爱沙尼亚 WLWH 接受宫颈癌筛查的比例低得令人无法接受。考虑到研究人群中的高癌症风险和发病率，需要针对 WLWH 开展专门的宫颈癌筛查工作。
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