Adherence to colposcopy among women with HIV infection

In the general population, nonadherence to the recommendation to have colpo scopy in women with abnormal cytologic smears is estimated at 30% to 80%, b ut studies have failed to identify consistent risk factors for nonadherence . The purpose of this analysis is to assess adherence to colposcopy in a su bset of participants in the Women's Interagency HIV Study (WIHS), an ongoin g multisite longitudinal study of HIV infection in women in the United Stat es and determine factors associated with nonadherence. Identification of su ch predictors would be useful in designing strategies to improve adherence in this group. Methods: Adherence to colposcopy was examined in a cohort of 462 women with , or at risk for, HIV infection with abnormal cervical cytology on entry in to WIHS. Adherence was defined as having colposcopy done within 6 months of an abnormal cytology result. Results: Overall adherence to colposcopy was 65% (302 of 462). A multivaria te logistic regression model revealed that the odds of adherence were signi ficantly lower for the women who were HIV-infected (p = .011), current crac k/cocaine users (p = .040), ever too ill to get medical care (p = .033), no t recruited by WIHS study staff (p = .004), and less concerned about the ca re of their children (p = .037). Among HIV-seropositive women, low CD4 coun ts, high viral loads, and presence of AIDS-defining illness were not predic tive of nonadherence. Discussion: Adherence to colposcopy among WIHS participants was at the uppe r limit of the reported range in the United States. Chemical dependency and domestic violence may negatively impact on colposcopy adherence whereas su pportive study personnel, having health insurance, and concerns about raisi ng one's children appear to be motivators for adherence to colposcopy in th is study. HIV infection was a risk factor for nonadherence, but markers of advanced disease were not predictive of nonadherence.