Background: Despite public screening programs, cervical cancer remains the most prevalent cancer and the second leading cause of cancer deaths among women in Peru (IARC 2012). Female sex workers (FSW) in Peru are at elevated risk for cervical HPV infection, with a prevalence of 50.6-66.8%, of which 35.6-42% are high-risk types (Montano 2011, Brown 2012). Peruvian FSW receive annual Papanicolaou screening tests at designated health centers; however, women with positive results are frequently lost to follow-up.
Aim: The objective of this study is to determine rates of follow-up for abnormal Pap smears among FSW in Peru and to identify associated barriers.
Methods: 75 FSW attending the Alberto Barton Health Center in Lima, Peru were surveyed regarding their history of STI screening results and treatment. 15 women with a history of an abnormal Pap smear were interviewed in-depth about their experiences regarding follow-up care.
Results: Preliminary data indicates that of 22 women with abnormal Pap smears, only 7 (31.8%) had obtained follow-up care. The majority of FSW with abnormal Pap smears had not been informed of their results. Qualitative interviews revealed that among FSW informed of their results, lack of understanding of health consequences of HPV was associated with decreased follow-up, while fear of cervical cancer was associated with increased follow-up.
Conclusions: HPV infection is highly prevalent in Peruvian FSW, yet less than one-third of FSW with abnormal Pap smears receive follow-up care. The predominant barriers to follow-up were lack of standardization in recording and communicating test results and insufficient FSW knowledge regarding health consequences of HPV infection. Standardized record-keeping forms and procedures and distribution of educational pamphlets are being implemented to improve follow-up for HPV in this population.