HIV Testing in Patients Diagnosed With CIN2 or Worse: Experience at The Jessop Wing Colonoscopy Unit, Sheffield, UK

Debate regarding the value of HIV screening in English colposcopy services is ongoing. With no national guidance provided by the NHSCSP, few colposcopy services offer HIV testing. Sheffield colposcopy introduced standardised HIV testing in January 2023. We assessed prevalence rates and acceptability to HIV testing in our referred population with moderate or worse dyskaryosis, CIN2 or worse.

A retrospective service evaluation with interval analysis was conducted on 1st January to 31st December 2023 at the Jessop Wing Colposcopy Service, Sheffield, UK. All patients with moderate dyskaryosis or worse on referral cytology, CIN2 or worse on biopsy, were offered an HIV test.

Of 367 eligible patients, six (1.6%) were known HIV positive. HIV prevalence rates in patients referred with moderate or worse cytology (16.34 per 1000) (95% confidence interval 6-35), and CIN2 or worse (12.46 per 1000) (95% confidence interval 3-28) were high in comparison with overall prevalence rates for Sheffield (2.14 per 1000). HIV testing was offered to 296 (82%) patients and accepted by 246 (83%). All HIV test results were reported as not detected. Sixty-five (18%) were not offered a test. Consultant colposcopists (p < 0.0001) were less likely to offer an HIV test as compared to colposcopy nurses.

Acceptance of HIV testing in patients attending colposcopy is high, but willingness to offer the test varies at both local and national levels. Whilst there were no new HIV diagnoses in our sampled cohort, knowledge of HIV status is a key prognostic indicator and crucial for determining ongoing management. National societies must join forces and provide national guidance for the colposcopy community regarding HIV testing in colposcopy services. Audit registration number: STH 12112.