Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria

Jonah Musa; Chad J. Achenbach; Charlesnika T. Evans; Neil Jordan; Patrick H. Daru; Lifang Hou; Robert L. Murphy; Isaac F. Adewole; Melissa A. Simon

doi:10.1186/s12913-018-3700-y

Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria

Jonah Musa, Chad J. Achenbach, Charlesnika T. Evans, Neil Jordan, Patrick H. Daru, Lifang Hou, Robert L. Murphy, Isaac F. Adewole, Melissa A. Simon

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

BACKGROUND: Cervical cancer screening (CCS) is an important health service intervention for prevention of morbidity and mortality from invasive cervical cancer. The role of provider recommendation and referral is critical in utilization of this services particularly in settings where screening is largely opportunistic. We sought to understand how patient-reported human immunodeficiency virus (HIV) infection status is associated with provider referral in an opportunistic screening setting. METHODS: We performed a cross-sectional analysis of data on a sample of women who had received a CCS at the "Operation Stop" cervical cancer (OSCC) screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used the de-identified records of women who had their first CCS to analyze the association between patient-reported HIV and likelihood of provider-referral at first CCS. We performed descriptive statistics with relevant test of association using Student t-test (t-test) for continuous variables and Pearson chi square or Fisher exact test where applicable for categorical variables. We also used a bivariable and multivariable logistic regression models to estimate the independent association of patient-reported HIV on provider referral. All statistical tests were performed using STATA version 14.1, College Station, Texas, USA. Level of statistical significance was set at 0.05. RESULTS: During the 10-year period, 14,088 women had their first CCS. The reported HIV prevalence in the population was 5.0%; 95% CI: 4.6, 5.4 (703/14,088). The median age of women who were screened was 37 years (IQR; 30-45). Women who were HIV infected received more referrals from providers compared to women who were HIV uninfected (68.7% versus 49.2%), p-value < 0.001. Similarly, we found an independent effect of patient-reported HIV infection on the likelihood for provider-referral in the screened sample (aOR = 2.35; 95% CI: 1.95, 2.82). CONCLUSION: Our analysis supports the design of health systems that facilitates providers' engagement and provision of necessary counseling for CCS in the course of routine clinical care. The practice of offering recommendation and referrals for CCS to women at high risk of cervical cancer, such as HIV infected women should be supported.

Original language	English (US)
Article number	885
Pages (from-to)	885
Number of pages	1
Journal	BMC health services research
Volume	18
Issue number	1
DOIs	https://doi.org/10.1186/s12913-018-3700-y
State	Published - Nov 22 2018

Funding

We performed a cross-sectional analysis of data on a sample of women who had received a CCS at the “Operation Stop” cervical cancer (OSCC) screening unit in Jos, Nigeria over a 10-year time period (2006–2016). The OSCC unit commenced CCS and treatment in 2006 with funding from Exxon Mobil, Texas, USA, through the African Organization for Research and Training in Cancer (AORTIC). This project offered opportunistic CCS services to eligible women in Jos, neighboring towns, and states in northern Nigeria. Also, the project has maintained an up-to-date electronic database and backup paper records of women utilizing the service. This database has records of patient demographic and risk factor variables that are obtained from eligible women at the first screening visit prior to cervical sample collection for Pap smear test. Each participant is given a unique medical record number, and all subsequent records including the cytopathology reports are entered into a FileMaker Pro version 8.0 database [28]. This work and publication was supported by a training grant #-D43TW009575 from the NIH Fogarty International Center and the National Cancer Institute. This publication is partly supported by grant # 1 U54 CA221205–01 from the National Cancer Institute. The funding agencies cited here did not play a role in the design, collection of data, analysis, interpretation, and writing of this manuscript or decision to publish the results. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of NIH Fogarty International Center and the National Cancer Institute.

Keywords

Cervical Cancer screening
HIV status
Nigeria
Opportunistic screening
Provider-referral
Recommendation
Utilization

ASJC Scopus subject areas

Health Policy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12913-018-3700-y

Cite this

Musa, J., Achenbach, C. J., Evans, C. T., Jordan, N., Daru, P. H., Hou, L., Murphy, R. L., Adewole, I. F., & Simon, M. A. (2018). Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria. BMC health services research, 18(1), 885. Article 885. https://doi.org/10.1186/s12913-018-3700-y

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title = "Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria",

abstract = "BACKGROUND: Cervical cancer screening (CCS) is an important health service intervention for prevention of morbidity and mortality from invasive cervical cancer. The role of provider recommendation and referral is critical in utilization of this services particularly in settings where screening is largely opportunistic. We sought to understand how patient-reported human immunodeficiency virus (HIV) infection status is associated with provider referral in an opportunistic screening setting. METHODS: We performed a cross-sectional analysis of data on a sample of women who had received a CCS at the {"}Operation Stop{"} cervical cancer (OSCC) screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used the de-identified records of women who had their first CCS to analyze the association between patient-reported HIV and likelihood of provider-referral at first CCS. We performed descriptive statistics with relevant test of association using Student t-test (t-test) for continuous variables and Pearson chi square or Fisher exact test where applicable for categorical variables. We also used a bivariable and multivariable logistic regression models to estimate the independent association of patient-reported HIV on provider referral. All statistical tests were performed using STATA version 14.1, College Station, Texas, USA. Level of statistical significance was set at 0.05. RESULTS: During the 10-year period, 14,088 women had their first CCS. The reported HIV prevalence in the population was 5.0%; 95% CI: 4.6, 5.4 (703/14,088). The median age of women who were screened was 37 years (IQR; 30-45). Women who were HIV infected received more referrals from providers compared to women who were HIV uninfected (68.7% versus 49.2%), p-value < 0.001. Similarly, we found an independent effect of patient-reported HIV infection on the likelihood for provider-referral in the screened sample (aOR = 2.35; 95% CI: 1.95, 2.82). CONCLUSION: Our analysis supports the design of health systems that facilitates providers' engagement and provision of necessary counseling for CCS in the course of routine clinical care. The practice of offering recommendation and referrals for CCS to women at high risk of cervical cancer, such as HIV infected women should be supported.",

keywords = "Cervical Cancer screening, HIV status, Nigeria, Opportunistic screening, Provider-referral, Recommendation, Utilization",

author = "Jonah Musa and Achenbach, {Chad J.} and Evans, {Charlesnika T.} and Neil Jordan and Daru, {Patrick H.} and Lifang Hou and Murphy, {Robert L.} and Adewole, {Isaac F.} and Simon, {Melissa A.}",

note = "Funding Information: We performed a cross-sectional analysis of data on a sample of women who had received a CCS at the “Operation Stop” cervical cancer (OSCC) screening unit in Jos, Nigeria over a 10-year time period (2006–2016). The OSCC unit commenced CCS and treatment in 2006 with funding from Exxon Mobil, Texas, USA, through the African Organization for Research and Training in Cancer (AORTIC). This project offered opportunistic CCS services to eligible women in Jos, neighboring towns, and states in northern Nigeria. Also, the project has maintained an up-to-date electronic database and backup paper records of women utilizing the service. This database has records of patient demographic and risk factor variables that are obtained from eligible women at the first screening visit prior to cervical sample collection for Pap smear test. Each participant is given a unique medical record number, and all subsequent records including the cytopathology reports are entered into a FileMaker Pro version 8.0 database [28]. Funding Information: This work and publication was supported by a training grant #-D43TW009575 from the NIH Fogarty International Center and the National Cancer Institute. This publication is partly supported by grant # 1 U54 CA221205–01 from the National Cancer Institute. The funding agencies cited here did not play a role in the design, collection of data, analysis, interpretation, and writing of this manuscript or decision to publish the results. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of NIH Fogarty International Center and the National Cancer Institute.",

year = "2018",

month = nov,

day = "22",

doi = "10.1186/s12913-018-3700-y",

language = "English (US)",

volume = "18",

pages = "885",

journal = "BMC health services research",

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Musa, J, Achenbach, CJ , Evans, CT , Jordan, N, Daru, PH, Hou, L , Murphy, RL, Adewole, IF & Simon, MA 2018, 'Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria', BMC health services research, vol. 18, no. 1, 885, pp. 885. https://doi.org/10.1186/s12913-018-3700-y

TY - JOUR

T1 - Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria

AU - Musa, Jonah

AU - Achenbach, Chad J.

AU - Evans, Charlesnika T.

AU - Jordan, Neil

AU - Daru, Patrick H.

AU - Hou, Lifang

AU - Murphy, Robert L.

AU - Adewole, Isaac F.

AU - Simon, Melissa A.

N1 - Funding Information: We performed a cross-sectional analysis of data on a sample of women who had received a CCS at the “Operation Stop” cervical cancer (OSCC) screening unit in Jos, Nigeria over a 10-year time period (2006–2016). The OSCC unit commenced CCS and treatment in 2006 with funding from Exxon Mobil, Texas, USA, through the African Organization for Research and Training in Cancer (AORTIC). This project offered opportunistic CCS services to eligible women in Jos, neighboring towns, and states in northern Nigeria. Also, the project has maintained an up-to-date electronic database and backup paper records of women utilizing the service. This database has records of patient demographic and risk factor variables that are obtained from eligible women at the first screening visit prior to cervical sample collection for Pap smear test. Each participant is given a unique medical record number, and all subsequent records including the cytopathology reports are entered into a FileMaker Pro version 8.0 database [28]. Funding Information: This work and publication was supported by a training grant #-D43TW009575 from the NIH Fogarty International Center and the National Cancer Institute. This publication is partly supported by grant # 1 U54 CA221205–01 from the National Cancer Institute. The funding agencies cited here did not play a role in the design, collection of data, analysis, interpretation, and writing of this manuscript or decision to publish the results. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of NIH Fogarty International Center and the National Cancer Institute.

PY - 2018/11/22

Y1 - 2018/11/22

N2 - BACKGROUND: Cervical cancer screening (CCS) is an important health service intervention for prevention of morbidity and mortality from invasive cervical cancer. The role of provider recommendation and referral is critical in utilization of this services particularly in settings where screening is largely opportunistic. We sought to understand how patient-reported human immunodeficiency virus (HIV) infection status is associated with provider referral in an opportunistic screening setting. METHODS: We performed a cross-sectional analysis of data on a sample of women who had received a CCS at the "Operation Stop" cervical cancer (OSCC) screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used the de-identified records of women who had their first CCS to analyze the association between patient-reported HIV and likelihood of provider-referral at first CCS. We performed descriptive statistics with relevant test of association using Student t-test (t-test) for continuous variables and Pearson chi square or Fisher exact test where applicable for categorical variables. We also used a bivariable and multivariable logistic regression models to estimate the independent association of patient-reported HIV on provider referral. All statistical tests were performed using STATA version 14.1, College Station, Texas, USA. Level of statistical significance was set at 0.05. RESULTS: During the 10-year period, 14,088 women had their first CCS. The reported HIV prevalence in the population was 5.0%; 95% CI: 4.6, 5.4 (703/14,088). The median age of women who were screened was 37 years (IQR; 30-45). Women who were HIV infected received more referrals from providers compared to women who were HIV uninfected (68.7% versus 49.2%), p-value < 0.001. Similarly, we found an independent effect of patient-reported HIV infection on the likelihood for provider-referral in the screened sample (aOR = 2.35; 95% CI: 1.95, 2.82). CONCLUSION: Our analysis supports the design of health systems that facilitates providers' engagement and provision of necessary counseling for CCS in the course of routine clinical care. The practice of offering recommendation and referrals for CCS to women at high risk of cervical cancer, such as HIV infected women should be supported.

AB - BACKGROUND: Cervical cancer screening (CCS) is an important health service intervention for prevention of morbidity and mortality from invasive cervical cancer. The role of provider recommendation and referral is critical in utilization of this services particularly in settings where screening is largely opportunistic. We sought to understand how patient-reported human immunodeficiency virus (HIV) infection status is associated with provider referral in an opportunistic screening setting. METHODS: We performed a cross-sectional analysis of data on a sample of women who had received a CCS at the "Operation Stop" cervical cancer (OSCC) screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used the de-identified records of women who had their first CCS to analyze the association between patient-reported HIV and likelihood of provider-referral at first CCS. We performed descriptive statistics with relevant test of association using Student t-test (t-test) for continuous variables and Pearson chi square or Fisher exact test where applicable for categorical variables. We also used a bivariable and multivariable logistic regression models to estimate the independent association of patient-reported HIV on provider referral. All statistical tests were performed using STATA version 14.1, College Station, Texas, USA. Level of statistical significance was set at 0.05. RESULTS: During the 10-year period, 14,088 women had their first CCS. The reported HIV prevalence in the population was 5.0%; 95% CI: 4.6, 5.4 (703/14,088). The median age of women who were screened was 37 years (IQR; 30-45). Women who were HIV infected received more referrals from providers compared to women who were HIV uninfected (68.7% versus 49.2%), p-value < 0.001. Similarly, we found an independent effect of patient-reported HIV infection on the likelihood for provider-referral in the screened sample (aOR = 2.35; 95% CI: 1.95, 2.82). CONCLUSION: Our analysis supports the design of health systems that facilitates providers' engagement and provision of necessary counseling for CCS in the course of routine clinical care. The practice of offering recommendation and referrals for CCS to women at high risk of cervical cancer, such as HIV infected women should be supported.

KW - Cervical Cancer screening

KW - HIV status

KW - Nigeria

KW - Opportunistic screening

KW - Provider-referral

KW - Recommendation

KW - Utilization

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Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria

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UN SDGs

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