Improving Cervical Cancer Screening Rates in HIV-Positive Women

Student Researcher:
Bernadine Jugdutt

Supervisor / Principle Investigator:
Dr. Shannon Turvey

Additional Authors:
Dr. Stephanie Smith
Pamela Mathura
Dr. Daniel Friedman

MD Class of 2021


Introduction: HIV-positive women are at increased risk of cervical cancer, as causative human papilloma virus (HPV) infections can result in accelerated oncogenesis in immunocompromised patients. Regular Pap smears, an effective means of screening for cervical cancer, are essential in this vulnerable population. Currently only 72% of HIV-positive women in the Northern Alberta Program HIV clinics are meeting the minimum screening standard per Alberta guidelines.

Methods: A mixed-method approach was used, with qualitative analysis consisting of: Gemba walks at clinic sites; 2) Process Mapping to determine workflow and identify gaps; and 3) Cause-and-Effect mapping; and quantitative analysis via a chart review of the clinics’ pre-formed database to determine patients’ last Pap smears and key patient demographics that might affect guideline compliance.

Results: The largest barrier discovered was that patients in need of a routine Pap smear were not identified until the day before their appointment; too soon to prepare within clinic workflow, resulting in screening being omitted. Other concerns included communication with family physicians, patient education, and screening availability outside the HIV clinic. Many unscreened patients were not closely followed or, for personal or cultural reasons, were unwilling to let their family physician perform Pap smears.

Conclusions: The first PDSA cycle began on October 1st, 2018. Our primary intervention is activating functionality in the electronic medical record (e-Clinician) to allow clinic staff to track Pap smears and automatically flag overdue patients, assisting in proactive scheduling. Secondary interventions include an overdue patient “hotlist” for booking clerks, patient education via pamphlets and discussion with ID physicians, standardized screening kits for faster completion, and better communication with family physicians regarding screening guidelines via physicians’ clinic notes and updating the Alberta Referral Directory. Process and outcome measures of each intervention will be reviewed in late November 2018.