Social determinants of health associated to the cervical cancer-related care across the cancer control continuum among women living with HIV in Puerto Rico

Cervical cancer is a leading cause of cancer-related morbidity and mortality among women globally, including those living with HIV (WLWH). Although cervical cancer screening is included in routine clinical care guidelines for WLWH, this population often experiences gaps in screening, timely follow-up, and access to treatment for precancerous lesions and cervical cancer. Currently, there is no consensus on the most actionable factors, such as those related to individual, community, and healthcare system context, that hinder access to care across the cervical cancer care continuum (screening, diagnosis, and treatment) among WLWH. The central goal of this study is to employ a mixed-methods approach to identify multi-level factors influencing timely cervical cancer care among WLWH in Puerto Rico (PR). PR is a jurisdiction within the United States (US) with one of the highest rates of HIV/AIDS incidence and prevalence; it has experienced a notable increase in cervical cancer incidence between 2001 and 2017. Our specific aims are to: (1) Examine how HIV status influences delays in cervical cancer care (screening, diagnosis and treatment) among cervical cancer patients diagnosed in PR from 2013 to 2020; (2) Identify individual, healthcare, and community- level factors associated with timely cervical cancer care among women with high-grade cervical lesions (HSIL) or cervical cancer in PR; and (3) Assess the use of primary (HPV vaccination) and secondary (screening and treatment of HSIL) prevention strategies among women diagnosed with HIV or AIDS in PR in 2023 and 2024. Our ultimate goal is to enhance access to timely cervical cancer care among WLHW and reduce morbidity and mortality related to this malignancy. This 3-year project also includes a structured research and training plan to support Dr. Soto’s progression toward becoming an independent investigator focused on the intersection of infectious diseases and cancer control. Findings from this project will help inform the design of targeted interventions to improve cervical cancer prevention and care for a broader population. This information could also potentially be adapted to Hispanic WLWH in the US and other populations.