BackgroundInvasive 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.MethodsCross-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.ResultsIn 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.DiscussionThe 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.

中文翻译：

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尼日利亚机会性筛查环境中的 HIV 状况、宫颈癌筛查年龄和宫颈细胞学结果：10 年横断面数据分析

背景侵袭性宫颈癌 (ICC) 在 HIV 感染的女性中更为普遍，并且发生在比 HIV 阴性女性更年轻的中位年龄。尼日利亚目前缺乏有组织的宫颈癌筛查 (CCS)，并且该人群的 CCS 年龄未知。我们试图检查 CCS 的年龄、细胞学结果以及结果是否因机会性筛查环境中的 HIV 感染状态而异。尼日利亚在 10 年的时间段内（2006-2016 年）。我们使用逻辑回归模型来估计患者报告的 HIV 和 CCS 年龄的独立影响以及调整其他协变量的异常细胞学结果的优势比。我们还评估了 CCS 的中位年龄与异常宫颈细胞学结果严重程度之间的相关性。在美国德克萨斯州大学城的 STATA 版本 14 上进行了统计分析。结果在 14,088 名样本中，CCS 的中位年龄为 37 岁（IQR；30-45）。对于感染 HIV 的女性 未感染的女性，CCS 发生在较早的年龄（35.0 ± 7.4 vs 38.2 ± 10.2 岁，p < 0.001）。所有完成至少 7 年或以上教育的女性，无论 HIV 感染状况如何，在 35 岁之前患 CCS 的可能性是教育程度较低的女性的 1.27 至 3.51 倍。CCS 异常宫颈细胞学结果的预测因素是：CCS 年龄≥ 35（aOR = 3.57；95% CI：2.74, 4.64），多胎≥5（aOR = 1.27；95% CI：1.03, 1.56）和提供者-转诊（aOR = 1.34；95% CI：1.09, 1.64）。无论报告的艾滋病毒状况如何，我们发现 CCS 的中位年龄与细胞学结果的严重程度呈正相关 讨论 与大多数发达国家指南推荐的年龄相比，研究人群中使用宫颈癌筛查的女性的 CCS 年龄相对较晚。CCS 的晚年与细胞学结果异常的严重程度呈正相关，与 HIV 状态无关。受过更多教育的女性更有可能在早期患有 CCS，并且不太可能出现潜在的异常细胞学结果。CCS 的晚年与细胞学结果异常的严重程度呈正相关，与 HIV 状态无关。受过更多教育的女性更有可能在早期患有 CCS，并且不太可能出现潜在的异常细胞学结果。CCS 的晚年与细胞学结果异常的严重程度呈正相关，与 HIV 状态无关。受过更多教育的女性更有可能在早期患有 CCS，并且不太可能出现潜在的异常细胞学结果。