The 2008 National HIV testing guidelines recommend HIV testing for patients attending TOP services and patients diagnosed with CIN Grade 2 or above. The aim is to reduce the time between acquiring and analyzing HIV by encouraging testing in settings where patients present with indicator diseases. Benefits of earlier HIV diagnosis include improved survival, prevention of onward transmission, and optimization of maternal health when planning a pregnancy. There is evidence that HIV reduces the effectiveness of standard treatment for CIN 2/3 and cervical cancer. The experience of antenatal screening indicates that most women accept HIV screening if it is offered as part of a package of care.
The authors found that three women were diagnosed with CIN Grade 2 or above before HIV diagnosis; HIV testing at the time of TOP may have resulted in earlier diagnosis for three women. There was at least one missed opportunity for earlier diagnosis in five cases.
The authors suggest that researchers undertake further work to establish HIV prevalence in TOP and colposcopy services. HIV testing should become standard practice in the management of CIN 2/3 and cervical cancer.