Cervical cancer screening and treatment among HIV+ women in Cambodia: feasible and high yielding M.-E. Raguenaud 1, P. Isaakidis 1, S.A. Khim 1, C. Ping 2, C. Kim 1, L. Martello 1, T. Reid 3 1 Médecins Sans Frontières (MSF), Cambodia, 2 Reproductive Health Association of Cambodia (RHAC), 3 Médecins Sans Frontières, Operational centre of Brussels Background: HIV-infected women have a higher risk of cervical intraepithelial neoplasia (CIN) and cervical cancer than the general population Objectives of pilot screening: To assess feasibility of offering cervical screening for patients attending two HIV clinics under routine programme conditions. Intervention: A referral system was set up between each HIV clinic and a near-by reproductive health clinic Women were counseled on the relevance of cervical screening in the HIV clinic Women accepting screening were referred to the reproductive health clinic where PAP smears were done. Referral of patients with abnormal PAP smears (for biopsy and treatment) was organized by the HIV clinic. All services were offered free of charge for patients and support for transportation was provided where possible.

RESULTS Total consecutive women screened Median age : 35 years - No on ART : 150 Yield Number with abnormal PAP smear: 53 (26%) Number with pre-cancerous lesion or cervical cancer: 34 (17%) Uptake of services Biopsy acceptance: 34/53 (64%) Treatment uptake: 28/34 (82%) Loss to follow-up among women with abnormal cytology: 7/53 (13%)

LESSONS LEARNED A high yield was obtained in offering cervical cancer screening in HIV+ women One in four patients screened had abnormal cytology One in five patients screened had pre-cancerous lesion or cervical cancer Integrating cervical cancer screening in an HIV program provides an “opportunity” for achieving good coverage and follow-up rates as women are regular clinic attendees and a recall system is in place Need for referral for biopsy hinders uptake of services A “one-stop service” with a point-of-care “minimal package” of VIA screening + cryotherapy treatment seems most appropriate for this setting