Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland.
Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Sex Transm Infect. 2022 Mar;98(2):143-149. doi: 10.1136/sextrans-2021-055111. Epub 2021 Sep 20.
Women and girls are relatively under-represented across the HIV treatment cascade. Two conditions unique to women, pregnancy and cervical cancer/dysplasia, share a common acquisition mode with HIV. This scoping review aimed to explore HIV testing practices in voluntary termination of pregnancy (TOP) and colposcopy services.
The scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched articles published up to 20 December 2020 using three electronic databases (PubMed/Medline, Embase, Google Scholar) and including the keywords "HIV Testing", "Abortion, Induced", "Colposcopy", "HIV screen*" and "termination of pregnancy".
A total of 1496 articles were identified, of which 55 met the inclusion criteria. We included studies providing background HIV prevalence in addition to prevalence in the study population and studies of women seeking TOP rather than presenting with TOP complications. This limited our review to high-income, low HIV prevalence settings. We observed two study phases: studies pre-antiretroviral therapy (ART) using unlinked anonymous testing data and examining HIV risk factors associated with positive HIV tests and studies post-ART using routine testing data and exploring HIV testing uptake. HIV prevalence was estimated at >0.2% in most TOP settings and >1% (range 1.7%-11.4%) in colposcopy services. Many TOP providers did not have local HIV testing policies and HIV testing was not mentioned in many specialist guidelines. Testing uptake was 49%-96% in TOP and 23%-75% in colposcopy services.
Given the estimated HIV prevalence of >0.1% among women attending TOP and colposcopy services, HIV testing would be economically feasible to perform in high-income settings. Explicit testing policies are frequently lacking in these two settings, both at the local level and in specialist guidelines. Offering HIV testing regardless of risk factors could normalise testing, reduce late HIV presentation and create an opportunity for preventive counselling.
在艾滋病毒治疗连续体中，女性和女孩的代表性相对较低。两种仅发生在女性身上的情况，妊娠和宫颈癌/发育不良，与艾滋病毒具有共同的获得模式。本范围综述旨在探讨自愿终止妊娠（TOP）和阴道镜检查服务中的艾滋病毒检测实践。
根据系统评价和荟萃分析扩展的首选报告项目进行范围综述。我们使用三个电子数据库（PubMed / Medline、Embase、Google Scholar）搜索了截至 2020 年 12 月 20 日发表的文章，并使用了“HIV 检测”、“人工流产，诱导”、“阴道镜检查”、“HIV 筛查”和“终止妊娠”等关键词。
共确定了 1496 篇文章，其中 55 篇符合纳入标准。我们纳入了提供背景艾滋病毒流行率以及研究人群中流行率的研究，以及寻求 TOP 而不是出现 TOP 并发症的女性的研究。这使我们的审查仅限于高收入、低艾滋病毒流行率的环境。我们观察到两个研究阶段：在抗逆转录病毒治疗（ART）之前使用未链接的匿名测试数据并检查与阳性 HIV 测试相关的艾滋病毒风险因素的研究，以及在 ART 之后使用常规测试数据并探索 HIV 测试接受度的研究。在大多数 TOP 环境中，艾滋病毒流行率估计超过 0.2%，在阴道镜检查服务中估计超过 1%（范围 1.7%-11.4%）。许多 TOP 提供者没有当地的艾滋病毒检测政策，许多专家指南也没有提到艾滋病毒检测。TOP 中的检测接受率为 49%-96%，阴道镜检查服务中的检测接受率为 23%-75%。
鉴于在接受 TOP 和阴道镜检查服务的女性中估计有超过 0.1%的艾滋病毒流行率，在高收入环境中进行艾滋病毒检测在经济上是可行的。这两个环境都缺乏明确的检测政策，无论是在当地一级还是在专家指南中。无论风险因素如何，提供艾滋病毒检测都可以使检测正常化，减少晚期艾滋病毒出现，并为预防性咨询创造机会。
