HIV status, age at cervical Cancer screening and cervical cytology outcomes in an opportunistic screening setting in Nigeria: A 10-year Cross sectional data analysis

Jonah Musa*, Chad J. Achenbach, Charlesnika T. Evans, Neil Jordan, Patrick H. Daru, Olugbenga Silas, Atiene S. Sagay, Rose Anorlu, Supriya D. Mehta, Firas Wehbe, Melissa A. Simon, Isaac F. Adewole, Lifang Hou, Robert L. Murphy

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Invasive cervical cancer (ICC) is more prevalent in HIV infected women and occurs at younger median age than in HIV negative women. Organized cervical cancer screening (CCS) is presently lacking in Nigeria, and the age at CCS is not known in this population. We sought to examine the age at CCS, the cytology outcomes and whether outcomes differ by HIV infection status in an opportunistic screening setting. Methods: Cross-sectional analysis of data on a sample of women who had received a CCS in an opportunistic screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used logistic regression models to estimate the independent effect of patient-reported HIV and age at CCS and odds ratios for abnormal cytology outcomes adjusting for other covariates. We also assessed the correlation between median age at CCS and severity of abnormal cervical cytology outcomes. Statistical analyses were done on STATA version 14, College Station, Texas, USA. Results: In a sample of 14,088, the median age at CCS was 37 years (IQR; 30-45). For HIV infected women vs. uninfected women, CCS occurred at earlier ages (35.0 ± 7.4 vs 38.2 ± 10.2 years, p < 0.001). All women, regardless of HIV status, who completed at least 7 or more years of education were 1.27 to 3.51 times more likely to have CCS before age 35 than women with less education. The predictors of an abnormal cervical cytology outcome at CCS were: Age at CCS ≥ 35 (aOR = 3.57; 95% CI: 2.74, 4.64), multiparity ≥5 (aOR = 1.27; 95% CI: 1.03, 1.56), and provider-referral (aOR = 1.34; 95% CI: 1.09, 1.64). Irrespective of reported HIV status, we found a positive correlation between median age at CCS and severity of cytology outcome. Discussion: The age at CCS in women who have utilized cervical cancer screening in the study population is relatively late compared to the recommended age by most guidelines from developed settings. Late age at CCS correlates positively with severity of abnormal cytology outcome irrespective of HIV status. More educated women are more likely to have CCS at early age and less likely to have underlying abnormal cytology outcomes.

Original languageEnglish (US)
Article number43
JournalInfectious Agents and Cancer
Volume14
Issue number1
DOIs
StatePublished - Nov 29 2019

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antineoplaston A10
Nigeria
Early Detection of Cancer
Uterine Cervical Neoplasms
Cell Biology
Cross-Sectional Studies
HIV
Logistic Models
Education
Parity

Keywords

  • Age at screening
  • Cervical cancer screening
  • Cytology outcome
  • HIV status
  • Nigeria
  • Opportunistic screening

ASJC Scopus subject areas

  • Epidemiology
  • Oncology
  • Infectious Diseases
  • Cancer Research

Cite this

@article{fd0b07d2113140c09af4a4e0cfb8c571,
title = "HIV status, age at cervical Cancer screening and cervical cytology outcomes in an opportunistic screening setting in Nigeria: A 10-year Cross sectional data analysis",
abstract = "Background: Invasive cervical cancer (ICC) is more prevalent in HIV infected women and occurs at younger median age than in HIV negative women. Organized cervical cancer screening (CCS) is presently lacking in Nigeria, and the age at CCS is not known in this population. We sought to examine the age at CCS, the cytology outcomes and whether outcomes differ by HIV infection status in an opportunistic screening setting. Methods: Cross-sectional analysis of data on a sample of women who had received a CCS in an opportunistic screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used logistic regression models to estimate the independent effect of patient-reported HIV and age at CCS and odds ratios for abnormal cytology outcomes adjusting for other covariates. We also assessed the correlation between median age at CCS and severity of abnormal cervical cytology outcomes. Statistical analyses were done on STATA version 14, College Station, Texas, USA. Results: In a sample of 14,088, the median age at CCS was 37 years (IQR; 30-45). For HIV infected women vs. uninfected women, CCS occurred at earlier ages (35.0 ± 7.4 vs 38.2 ± 10.2 years, p < 0.001). All women, regardless of HIV status, who completed at least 7 or more years of education were 1.27 to 3.51 times more likely to have CCS before age 35 than women with less education. The predictors of an abnormal cervical cytology outcome at CCS were: Age at CCS ≥ 35 (aOR = 3.57; 95{\%} CI: 2.74, 4.64), multiparity ≥5 (aOR = 1.27; 95{\%} CI: 1.03, 1.56), and provider-referral (aOR = 1.34; 95{\%} CI: 1.09, 1.64). Irrespective of reported HIV status, we found a positive correlation between median age at CCS and severity of cytology outcome. Discussion: The age at CCS in women who have utilized cervical cancer screening in the study population is relatively late compared to the recommended age by most guidelines from developed settings. Late age at CCS correlates positively with severity of abnormal cytology outcome irrespective of HIV status. More educated women are more likely to have CCS at early age and less likely to have underlying abnormal cytology outcomes.",
keywords = "Age at screening, Cervical cancer screening, Cytology outcome, HIV status, Nigeria, Opportunistic screening",
author = "Jonah Musa and Achenbach, {Chad J.} and Evans, {Charlesnika T.} and Neil Jordan and Daru, {Patrick H.} and Olugbenga Silas and Sagay, {Atiene S.} and Rose Anorlu and Mehta, {Supriya D.} and Firas Wehbe and Simon, {Melissa A.} and Adewole, {Isaac F.} and Lifang Hou and Murphy, {Robert L.}",
year = "2019",
month = "11",
day = "29",
doi = "10.1186/s13027-019-0263-4",
language = "English (US)",
volume = "14",
journal = "Infectious Agents and Cancer",
issn = "1750-9378",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - HIV status, age at cervical Cancer screening and cervical cytology outcomes in an opportunistic screening setting in Nigeria

T2 - A 10-year Cross sectional data analysis

AU - Musa, Jonah

AU - Achenbach, Chad J.

AU - Evans, Charlesnika T.

AU - Jordan, Neil

AU - Daru, Patrick H.

AU - Silas, Olugbenga

AU - Sagay, Atiene S.

AU - Anorlu, Rose

AU - Mehta, Supriya D.

AU - Wehbe, Firas

AU - Simon, Melissa A.

AU - Adewole, Isaac F.

AU - Hou, Lifang

AU - Murphy, Robert L.

PY - 2019/11/29

Y1 - 2019/11/29

N2 - Background: Invasive cervical cancer (ICC) is more prevalent in HIV infected women and occurs at younger median age than in HIV negative women. Organized cervical cancer screening (CCS) is presently lacking in Nigeria, and the age at CCS is not known in this population. We sought to examine the age at CCS, the cytology outcomes and whether outcomes differ by HIV infection status in an opportunistic screening setting. Methods: Cross-sectional analysis of data on a sample of women who had received a CCS in an opportunistic screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used logistic regression models to estimate the independent effect of patient-reported HIV and age at CCS and odds ratios for abnormal cytology outcomes adjusting for other covariates. We also assessed the correlation between median age at CCS and severity of abnormal cervical cytology outcomes. Statistical analyses were done on STATA version 14, College Station, Texas, USA. Results: In a sample of 14,088, the median age at CCS was 37 years (IQR; 30-45). For HIV infected women vs. uninfected women, CCS occurred at earlier ages (35.0 ± 7.4 vs 38.2 ± 10.2 years, p < 0.001). All women, regardless of HIV status, who completed at least 7 or more years of education were 1.27 to 3.51 times more likely to have CCS before age 35 than women with less education. The predictors of an abnormal cervical cytology outcome at CCS were: Age at CCS ≥ 35 (aOR = 3.57; 95% CI: 2.74, 4.64), multiparity ≥5 (aOR = 1.27; 95% CI: 1.03, 1.56), and provider-referral (aOR = 1.34; 95% CI: 1.09, 1.64). Irrespective of reported HIV status, we found a positive correlation between median age at CCS and severity of cytology outcome. Discussion: The age at CCS in women who have utilized cervical cancer screening in the study population is relatively late compared to the recommended age by most guidelines from developed settings. Late age at CCS correlates positively with severity of abnormal cytology outcome irrespective of HIV status. More educated women are more likely to have CCS at early age and less likely to have underlying abnormal cytology outcomes.

AB - Background: Invasive cervical cancer (ICC) is more prevalent in HIV infected women and occurs at younger median age than in HIV negative women. Organized cervical cancer screening (CCS) is presently lacking in Nigeria, and the age at CCS is not known in this population. We sought to examine the age at CCS, the cytology outcomes and whether outcomes differ by HIV infection status in an opportunistic screening setting. Methods: Cross-sectional analysis of data on a sample of women who had received a CCS in an opportunistic screening service in Jos, Nigeria over a 10-year time period (2006-2016). We used logistic regression models to estimate the independent effect of patient-reported HIV and age at CCS and odds ratios for abnormal cytology outcomes adjusting for other covariates. We also assessed the correlation between median age at CCS and severity of abnormal cervical cytology outcomes. Statistical analyses were done on STATA version 14, College Station, Texas, USA. Results: In a sample of 14,088, the median age at CCS was 37 years (IQR; 30-45). For HIV infected women vs. uninfected women, CCS occurred at earlier ages (35.0 ± 7.4 vs 38.2 ± 10.2 years, p < 0.001). All women, regardless of HIV status, who completed at least 7 or more years of education were 1.27 to 3.51 times more likely to have CCS before age 35 than women with less education. The predictors of an abnormal cervical cytology outcome at CCS were: Age at CCS ≥ 35 (aOR = 3.57; 95% CI: 2.74, 4.64), multiparity ≥5 (aOR = 1.27; 95% CI: 1.03, 1.56), and provider-referral (aOR = 1.34; 95% CI: 1.09, 1.64). Irrespective of reported HIV status, we found a positive correlation between median age at CCS and severity of cytology outcome. Discussion: The age at CCS in women who have utilized cervical cancer screening in the study population is relatively late compared to the recommended age by most guidelines from developed settings. Late age at CCS correlates positively with severity of abnormal cytology outcome irrespective of HIV status. More educated women are more likely to have CCS at early age and less likely to have underlying abnormal cytology outcomes.

KW - Age at screening

KW - Cervical cancer screening

KW - Cytology outcome

KW - HIV status

KW - Nigeria

KW - Opportunistic screening

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UR - http://www.scopus.com/inward/citedby.url?scp=85075870118&partnerID=8YFLogxK

U2 - 10.1186/s13027-019-0263-4

DO - 10.1186/s13027-019-0263-4

M3 - Article

C2 - 31798680

AN - SCOPUS:85075870118

VL - 14

JO - Infectious Agents and Cancer

JF - Infectious Agents and Cancer

SN - 1750-9378

IS - 1

M1 - 43

ER -