Mapping the Cervical Cancer Care Cascade in Johannesburg, South Africa: Baseline Cohort Description [36B]

INTRODUCTION: Despite universal access to antiretroviral therapy (ART) in South Africa, the burden of cervical cancer and its precursors among HIV-infected women remains substantial. METHODS: Using electronic medical record data from our cervical cancer prevention program in Johannesburg, we conducted a retrospective analysis (IRB approval obtained) of HIV-infected women undergoing screening, colposcopy, and loop electrosurgical excision procedures (LEEP) for cervical intra-epithelia neoplasia (CIN). We report baseline characteristics of this high-risk cohort. RESULTS: Between January 2011 and June 2018, 2,801 HIV-infected women were included in the cohort. The median age was 42 years (interquartile range [IQR] 35-49). 2,649 (95%) women were receiving ART and the median CD4 count was 520 cells/uL (IQR 359-700). Our analysis database included 3,613 Pap smears, 556 diagnostic biopsies, and 153 LEEPs. More than half of the cytology results (54%) were abnormal, requiring follow-up. The risk of biopsy-confirmed disease was also high: 243/556 (44%) cases of CIN1 and 198/556 (36%) of CIN2/3. Among 153 LEEPs, there were 35 (23%) cases of CIN1 and 106 (69%) of CIN2/3. Of these, residual disease was reported in 65/91 (71%) cases, with one margin positive in 32/91 (35%) and both margins positive in 33/91 (36%). LEEP margin status was not associated with grade of CIN (P=.07). CONCLUSION: In this cohort of HIV-infected women living in urban South Africa, attrition between screening, diagnosis, and treatment was considerable. Additionally, the LEEP margins were positive in more than two-thirds of women, raising concern for treatment failure and subsequent progression to invasive cervical cancer.