INNOVATION FUND Innovation, Integration, & Implementation Cancer Care SHOWCASE 2016 INNOVATION FUND Innovation, Integration, & Implementation Cancer Care SHOWCASE 2016

Improving access to Papanicolaou testing for people with HIV through nursing scope optimization (Pap Study): A Pilot Study

Cancer Care


Mona Loutfy

Women’s College Hospital


Angela Underhill

Women’s College Hospital

Highlights (Transformation, Adoptability, and/or Outcomes)

We have already begun to see the impact of this project. At the micro level, 9 nurses at 4 clinics completed comprehensive training for Papanicolaou testing, which has increased their skills and enhanced their efficacy in healthcare delivery. The study also has a detailed patient education component. Women/trans men with HIV are being educated about guidelines on cervical screening and cervical cancer risks. We are observing transformations among clinical teams as interprofessional collaboration (IPC) at the clinic/outpatient level. This is an exciting innovation as the focus of IPC has been within inpatient settings, where it has been found to increase efficiency and improve patient outcomes. We believe that by optimizing the scope of nursing practice in HIV clinics, IPC will better meet the needs of clients, leading to the same improved outcomes. Finally, the implementation of an education and screening initiative by nurses potentiates earlier detection of cervical dysplasia in women with HIV. Early detection leads to less invasive treatment, which will reduce overall healthcare expenditure and improve quality of gynecological well-being among women with HIV.


Women with HIV have a high prevalence of co-infection with the human papillomavirus (HPV). The clinical significance of this is at least a two-fold increased risk of invasive cervical cancer when compared to HIV-negative women. Access to routine cervical screening through Papanicolaou testing for people with HIV is a well-documented primary healthcare intervention. Screening leads to early detection and treatment of cervical dysplasia and in circumstances of advanced HPV disease, cervical cancer. The Ontario Cervical Screening Program (OCSP) recommends cervical screening every six months for the first year after documented HIV infection and subsequent annual screening in the absence of cervical dysplasia until age 70. Unfortunately, rates of cervical screening in women with HIV in Ontario do not meet these standards. The limited data that do exist suggest the rates of annual Papanicolaou testing among women with HIV fall below 50%. Low rates of screening are linked to: a lack of knowledge among the community about the increased risk of cervical disease; limited availability of cervical screening by trusted healthcare providers; and barriers related to accessibility, appointment burden, and general fear of the procedure. Research has explored several options for increasing Papincolaou testing beyond the field of HIV. One successful strategy has been the scope optimization of nurses to offer cervical screening rates as it is within their scope of practice when they receive appropriate training. In this study, we are piloting a nurse-led cervical cancer initiative within HIV care clinics. We aim to assess the feasibility of a nurse-led education and screening initiative that could be rolled out as a large provincial intervention study in HIV clinics in Ontario. Data collection is set to finish in December 2016.

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