Practice-based guidelines recommend HIV testing during initial invasive cervical cancer (ICC) workup. Determinants of HIV testing during diagnosis of AIDS-defining cancers in vulnerable populations, where risk for HIV infection is higher, are under-explored.
We examine factors associated with patterns of HIV testing among Medicaid enrollees diagnosed with ICC. Using linked data from the New Jersey State Cancer Registry and New Jersey Medicaid claims and enrollment files, we evaluated HIV testing among 242 ICC cases diagnosed from 2012 to 2014 in ages 21–64 at (a) any point during Medicaid enrollment (2011–2014) and (b) during cancer workup 6 months pre ICC diagnosis to 6 months post ICC diagnosis. Logistic regression models identified factors associated with HIV testing.
Overall, 13% of women had a claim for HIV testing during ICC workup. Two-thirds (68%) of women did not have a claim for HIV testing (non-receipt of HIV testing) while enrolled in Medicaid. Hispanic/NH-API/Other women had lower odds of non-receipt of HIV testing compared with NH-Whites (OR: 0.40; 95% CI: 0.17–0.94). Higher odds of non-receipt of HIV testing were observed among cases with no STI testing (OR: 4.92; 95% CI 2.27–10.67) and < 1 year of Medicaid enrollment (OR: 3.07; 95% CI 1.14- 8.26) after adjusting for other factors.
Few women had HIV testing claims during ICC workup. Opportunities for optimal ICC care are informed by knowledge of HIV status. Further research should explore if lack of HIV testing claims during ICC workup is an accurate indicator of ICC care, and if so, to assess testing barriers during workup.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
American Cancer Society. Key Statistics for Cervical Cancer. 2018 January 4, 2018 [cited 2018 May 23]; Available from: https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html.
Iarc WG (2007) Human papillomaviruses. IARC Monogr Eval Carcinog Risks Hum 90:1–636
Bouvard V et al (2009) A review of human carcinogens–Part B: biological agents. Lancet Oncol 10(4):321–322
Senkomago V et al (2019) Human papillomavirus–attributable cancers—United States, 2012–2016. Morb Mortal Wkly Rep 68(33):724
Franco EL, Schlecht NF, Saslow D (2003) The epidemiology of cervical cancer. Cancer J 9(5):348–359
Liu G et al (2018) HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer. Aids 32(6):795–808
Abraham AG et al (1999) Invasive cervical cancer risk among HIV-infected women: a North American multi-cohort collaboration prospective study. J Acquir Immune Defic Syndr 62(4):405
Strickler HD et al (2005) Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus–positive women. J Natl Cancer Inst 97(8):577–586
Ahdieh L et al (2001) Prevalence, incidence, and type-specific persistence of human papillomavirus in human immunodeficiency virus (HIV)-positive and HIV-negative women. J Infect Dis 184(6):682–690
Massad LS et al (1999) Evolution of cervical abnormalities among women with HIV-1: evidence from surveillance cytology in the women's interagency HIV study. J Acquir Immune Defic Syndr 27(5):432–442
Hernández-Ramírez RU et al (2017) Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study. The Lancet HIV 4(11):e495–e504
Silverberg MJ et al (2015) Cumulative incidence of cancer among persons with HIV in North America: a cohort study. Ann Intern Med 163(7):507–518
Shiels MS, Engels EA (2017) Evolving epidemiology of HIV-associated malignancies. Curr Opin HIV AIDS 12(1):6–11
Denning P, DiNenno E (2010) Communities in crisis: is there a generalized HIV epidemic in impoverished urban areas of the United States. In XVIII international AIDS conference
Roche LM, Niu X, Henry KA (2015) Invasive cervical cancer incidence disparities in New Jersey—a spatial analysis in a high incidence state. J Health Care Poor Underserved 26(4):1173–1185
Brawner BM et al (2017) Place still matters: racial/ethnic and geographic disparities in HIV transmission and disease burden. J Urban Health 94(5):716–729
Ward M et al (1992) 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 41(RR–17):1–19
Branson BM et al (2006) Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Morb Mortal Wkly Rep 55(14):1-CE-4
Jenkins TC et al (2006) Risk-based human immunodeficiency virus (HIV) testing fails to detect the majority of HIV-infected persons in medical care settings. Sex Transm Dis 33(5):329–333
Duffus WA et al (2009) Risk-based HIV testing in South Carolina health care settings failed to identify the majority of infected individuals. AIDS Patient Care STDs 23(5):339–345
U.S. Preventive Services Task Force. Human Immunodeficiency Virus (HIV) Infection: Screening. 2018; Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening.
Wentzensen N et al (2017) Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States. J Lower Genital Tract Dis 21(4):216–222
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Cervical Cancer 2016; Available from: https://www.tri-kobe.org/nccn/guideline/gynecological/english/cervical.pdf.
Koh W-J et al (2019) Cervical Cancer, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 17(1):64–84
International Federation of Gynecology and Obstetrics. Cervical Cancer and HIV. 2018 December 1, 2018 November 13, 2019]; Available from: https://www.figo.org/news/cervical-cancer-and-hiv.
World Health Organization. Sexual and reproductive health : Accelerate Cervical Cancer Elimination Initiative. 2019 September 2019 November 13, 2019]; Available from: https://www.who.int/reproductivehealth/publications/screening-cervical-pre-cancer-lesions-women-with-hiv/en/.
Centers for Disease Control and Prevention (2017) HIV among women. https://www.cdc.gov/hiv/group/gender/women/index.html
Chiao EY et al (2010) Time for oncologists to opt in for routine opt-out HIV testing? JAMA 304(3):334–339
Sam, A., et al. (2019) Improving the prevalence of HIV testing among patients in a gynecologic oncology department: results of a quality improvement project. J Oncol Pract, JOP. 19.00382
Ghebre RG et al (2017) Cervical cancer control in HIV-infected women: past, present and future. Gynecol Oncol Rep 21:101–108
Ntekim A, Campbell O, Rothenbacher D (2015) Optimal management of cervical cancer in HIV-positive patients: a systematic review. Cancer Med 4(9):1381–1393
Torres HA, Mulanovich V (2014) Management of HIV infection in patients with cancer receiving chemotherapy. Clin Infect Dis 59(1):106–114
National Comprehensive Cancer Network. More People Living with HIV and Cancer Should Get Appropriate Cancer Treatment, According to New Guidelines. 2018 February 27, 2018 [cited 2020 February 28]; Available from: https://www.nccn.org/about/news/newsinfo.aspx?NewsID=1010.
Mosimann V et al (2014) Patients with AIDS-defining cancers are not universally screened for HIV: a 10-year retrospective analysis of HIV-testing practices in a Swiss university hospital. HIV Med 15(10):631–634
Sengayi M et al (2015) HIV testing and burden of HIV infection in black cancer patients in Johannesburg, South Africa: a cross-sectional study. BMC Cancer 15(1):144
Chan Y-M et al (2004) Screening for HIV infection in women with newly diagnosed cervical cancer. Gynecol Oncol 92(1):300–303
Brown CA et al (2016) Predictors of timely access of oncology services and advanced-stage cancer in an HIV-endemic setting. Oncologist 21(6):731–738
Dietz PM et al (2015) HIV testing among outpatients with Medicaid and commercial insurance. PLoS ONE 10(12):e0144965
Hwang JP et al (2015) HIV testing in patients with cancer at the initiation of therapy at a large US comprehensive cancer center. J Oncol Pract 11(5):384–390
Bond L, Lauby J, Batson H (2005) HIV testing and the role of individual-and structural-level barriers and facilitators. AIDS Care 17(2):125–140
Rizza SA et al. (2012) HIV screening in the health care setting: status, barriers, and potential solutions. In: Mayo Clinic Proceedings. 2012. Elsevier.
Traynor SM, Rosen-Metsch L, Feaster DJ (2018) Missed opportunities for HIV testing among STD clinic patients. J Commun Health 43:1128–1136
Baggaley RF et al (2017) Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis. Lancet HIV 4(10):e465–e474
Latkin CA et al (2013) Neighborhoods and HIV: a social ecological approach to prevention and care. Am Psychol 68(4):210
Meyerson B et al (2014) Institutional and structural barriers to HIV testing: elements for a theoretical framework. AIDS Patient Care STDs 28(1):22–27
Latkin C et al (2010) A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav 14(2):222–238
McDougall GJ Jr et al (2016) Barriers and facilitators to HIV testing among women. HIV/AIDS Res Treat 2016(SE1):S9
Kim EK et al (2012) Healthcare-related correlates of recent HIV testing in New York City. Prev Med 54(6):440–443
Kilbourne AM et al (2006) Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health 96(12):2113–2121
Tsui J et al. (2018) Association of Medicaid enrollee characteristics and primary care utilization with cancer outcomes for the period spanning Medicaid expansion in New Jersey. Cancer
The Henry J. Kaiser Family Foundation. Increasing Medicaid Primary Care Fees for Certain Physicians in 2013 and 2014: A Primer on the Health Reform Provision and FInal Rule. 2012; Available from: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8397.pdf.
Centers for Disease Control and Prevention. Cervical Cancer. 2019 August 7, 2019 [cited 2019 November 25]; Available from: https://www.cdc.gov/cancer/cervical/basic_info/screening.htm.
Charlson ME et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383
Klabunde CN et al (2000) Development of a comorbidity index using physician claims data. J Clin Epidemiol 53(12):1258–1267
University of Manitoba. Concept: Charlson Comorbidity Index. 2016 January 22, 2016 Available from: https://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?conceptID=1098.
Tsui J et al (2019) Determinants of abnormal cervical cancer screening follow-up and invasive cervical cancer among uninsured and underinsured women in New Jersey. J Health Care Poor Underserved 30(2):680
Centers for Disease Control and Prevention (2016) CDC fact sheet: Today’s HIV/AIDS epidemic. CDC, Atlanta
Coghill AE et al (2019) HIV infection, cancer treatment regimens, and cancer outcomes among elderly adults in the United States. JAMA Oncol 5(9):e191742–e191742
New Jersey Department of Health. Healthy New Jersey 2020: HIV/AIDS, STD and TB. 2018; Available from: https://www.state.nj.us/health/chs/hnj2020/chronic/hivaids/.
Foundation., K.F., Fact Sheet: State Medicaid Coverage of Routine HIV Screening. 2014.
Kates J (2011) Medicaid and HIV: a national analysis. San Francisco: Henry J. Kaiser Family Foundationss
Adekeye OA et al (2016) HIV screening rates among medicaid enrollees diagnosed with other sexually transmitted infections. PLoS ONE 11(8):e0161560
Rust G et al (2003) Do clinicians screen Medicaid patients for syphilis or HIV when they diagnose other sexually transmitted diseases? Sex Transm Dis 30(9):723–727
Tai M, Merchant RC (2014) HIV testing in US emergency departments, outpatient ambulatory medical departments, and physician offices, 1992–2010. AIDS Care 26(9):1105–1108
Sood N, Wu Y (2013) The impact of insurance and HIV treatment technology on HIV testing. National Bureau of Economic Research, Cambridge
Sood N, Wagner Z, Wu Y (2015) The impact of insurance on HIV testing. Am J Health Econo 1(4):515–536
Baumann KE et al (2018) Whether patients want it or not, physician recommendations will convince them to accept HIV testing. J Int Assoc Provid AIDS Care (JIAPAC) 17:2325957417752258
Ferrante JM et al (2013) Primary care utilization and colorectal cancer incidence and mortality among medicare beneficiaries: a population-based, case–control study. Ann Intern Med 159(7):437–446
Ferrante JM et al (2011) Primary care utilization and colorectal cancer outcomes among medicare beneficiaries. Arch Intern Med 171(19):1747–1757
Hall HI et al (2010) Epidemiology of HIV infection in large urban areas in the United States. PLoS ONE 5(9):e12756
Martin, E.G. HIV Testing in New Jersey: A 2010 Status Report. 2010 September 12, 2018]; Available from: https://hiv.rutgers.edu/wp-content/uploads/2016/05/HIV-Testing-A-Status-Report-2010a.pdf.
Shi L et al (2012) Perceptions of HIV/AIDS in one’s community predict HIV testing. AIDS Behav 16(7):1926–1933
Blackstock OJ et al (2015) Perceptions of community HIV/STI risk among US women living in areas with high poverty and HIV prevalence rates. J Health Care Poor Underserved 26(3):811
Datta GD et al (2006) Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among US black women. Cancer 106(3):664–669
Singh GK et al (2004) Persistent area socioeconomic disparities in US incidence of cervical cancer, mortality, stage, and survival, 1975–2000. Cancer 101(5):1051–1057
Harper S et al (2009) Trends in area-socioeconomic and race-ethnic disparities in breast cancer incidence, stage at diagnosis, screening, mortality, and survival among women ages 50 years and over (1987–2005). Cancer Epidemiol Prev Biomark 18(1):121–131
Boscoe FP et al (2014) The relationship between area poverty rate and site-specific cancer incidence in the United States. Cancer 120(14):2191–2198
Henry KA et al (2013) The joint effects of census tract poverty and geographic access on late-stage breast cancer diagnosis in 10 US States. Health Place 21:110–121
Bowles KE, et al. (2008) Implementing rapid HIV testing in outreach and community settings: results from an advancing HIV prevention demonstration project conducted in seven US cities. Public Health Rep 123 (3suppl): 78–85.
National Cancer Institute. HIV/AIDS Cancer Match Study 2019 [cited 2019 December 12]; Available from: https://dceg.cancer.gov/research/what-we-study/hivaids-cancer-match.
Ramsey SD et al (2019) Prevalence of hepatitis B virus, hepatitis C virus, and HIV infection among patients with newly diagnosed cancer from academic and community oncology practices. JAMA Oncol 5(4):497–505
We thank Joel Cantor, Derek DeLia, and Margaret Koller from the Rutgers Center for State Health Policy and Gerald Harris from the New Jersey State Cancer Registry for their early contributions and guidance to the initial data linkage activities.
This study was supported in part by a CINJ Cancer Prevention and Control Pilot Award (P30CA072720). Jennifer Tsui is supported by an American Cancer Society Mentored Research Scholar Grant (MRSG-17–099-01-CPHPS). Jennifer McGee-Avila and Michelle Doose are supported by the Robert Wood Johnson Foundation Health Policy Research Scholars program. New Jersey State Cancer Registry data were collected through funding by NCI SEER contract #HHSN261201300021I, by CDC NPCR #5U58DP003931-02, the State of New Jersey, and the Rutgers CINJ.
Conflict of interest
All authors declare that they have no conflicts of interest and have no financial disclosures.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
McGee-Avila, J.K., Doose, M., Nova, J. et al. Patterns of HIV testing among women diagnosed with invasive cervical cancer in the New Jersey Medicaid Program. Cancer Causes Control 31, 931–941 (2020). https://doi.org/10.1007/s10552-020-01333-w