The Impact of an Educational Program on Cervical Cancer Knowledge Among HIV-Positive Women in Bali, Indonesia

Background: The burden of Human papillomavirus (HPV)-related cancers is expected to rise in Indonesia as there has been an increase in the availability of medication that prolongs the survival of women infected with the human immunodeficiency virus (HIV+). There is an urgent need for cervical cancer (CC) screening to address this concern. Objective: The objectives of the current study were to determine the burden of HPV infections and cervical pre-cancer lesions and evaluate the effectiveness of an education program to improve HPV and CC knowledge among women attending HIV clinics in Bali, Indonesia. Methods: A questionnaire focused on HPV and CC was administered to 200 HIV+ women before (pre-education) and after the education program (post-education). Cervical cells were used to perform the Papanicolaou (Pap) and test for 13 high-risk (HR) HPV genotypes. Women diagnosed with Pap diagnoses of greater than atypical squamous cells of undetermined significance (>= ASCUS+) were identified as abnormal Pap. Results: Fifty-four percent of women were diagnosed with ASCUS+ and 81% of those women were positive for any one of the 13 HR-HPV genotypes while 71% were positive for any HPV genotype included in the 9-valent (9V) HPV vaccine. The percentages of women who answered questions correctly at the pre-education interview was 3-25% while 97-100% gave the correct answers to the same questions at the post-education interview (P<0.0001). Conclusion: Our study for the first-time documented that a significant proportion of women who attend HIV clinics in Bali are diagnosed with ASCUS+ and HR-HPVs which put them at high risk for developing CC. It would have been possible to prevent the development of ASCUS+ in at least 70% of those women if 9V HPV vaccine was given to these women. Since all 200 women educated by our program consented for screening, we clearly demonstrated that HIV+ women attending HIV clinics can be successfully educated to participate in CC screening.