Table 1.
Patient characteristics and colposcopy outcomes at a community clinic (Hillbrow CHC), and a tertiary-level facility (CMJAH) before and after decentralisation
| Variables | Before versus after decentralisation at CMJAH | HCHC versus CMJAH after decentralisation | |||
| (A) Pre-decentralisation (2012–2014) n=910 |
(B) Post-decentralisation (2014–2016) n=721 |
P value (A vs B) |
(C) Hillbrow CHC (2014–2016) n=399 | P value (B vs C) |
|
| Characteristics | |||||
| Age groups in years | |||||
| <20 | 7 (0.8) | 6 (0.8) | |||
| 20–34 | 351 (39.8) | 209 (30.2) | 150 (37.6) | ||
| 35–44 | 342 (38.8) | 266 (38.4) | 156 (39.1) | ||
| 45–59 | 161 (18.3) | 187 (27.0) | 79 (19.8) | ||
| >60 | 20 (2.3) | 25 (3.6) | 0.001 | 7 (1.8) | 0.003 |
| HIV status known | 650 (71.4) | 429 (59.5) | <0.001 | 399 (100) | <0.001 |
| HIV status* | |||||
| Negative | 105 (16.2) | 59 (13.8) | 62 (15.5) | ||
| Positive | 545 (83.9) | 370 (86.3) | 0.28 | 337 (84.5) | 0.47 |
| On ART† | 428/544 (78.7) | 324/370 (87.6) | <0.001 | 336/337 (99.7) | <0.001 |
| Cervical cancer screening | |||||
| Facility where Pap smear done | |||||
| CMJAH | 115 (12.8) | 124 (17.5) | 0 (0.0) | ||
| HCHC | 114 (12.7) | 43 (6.1) | 307 (76.9) | ||
| Other clinic or hospital | 671 (74.6) | 540 (76.4) | <0.001 | 92 (23.1) | <0.001 |
| Pap smear results | |||||
| NILM | 6 (0.7) | 8 (1.1) | 17 (4.3) | ||
| LSIL | 141 (15.5) | 125 (17.4) | 79 (20.0) | ||
| ASCUS | 19 (2.1) | 34 (4.7) | 4 (1.0) | ||
| HSIL | 678 (74.7) | 478 (66.4) | 263 (66.4) | ||
| ASC-H | 63 (6.9) | 65 (9.0) | 27 (6.8) | ||
| Carcinoma | 1 (0.1) | 10 (1.4) | <0.001 | 6 (1.5) | <0.001 |
| Pap smear risk categories | |||||
| NILM, LSIL or ACSUS | 166 (18.3) | 167 (23.2) | 100 (25.3) | ||
| HSIL, ASC-H or carcinoma | 742 (81.7) | 553 (76.8) | 0.015 | 296 (74.8) | 0.44 |
| Cervical cancer diagnosis | |||||
| Procedure during colposcopy | |||||
| Visual inspection only | 37 (4.1) | 37 (5.2) | 63 (15.9) | ||
| Lletz | 337 (37.2) | 258 (35.9) | 231 (58.2) | ||
| Biopsy | 526 (58.0) | 420 (58.4) | 90 (22.7) | ||
| Other | 7 (0.8) | 4 (0.6) | 0.69 | 13 (3.3) | <0.001 |
| Histology result‡ | |||||
| Normal | 27 (3.1) | 30 (4.4) | 45 (13.8) | ||
| CIN I | 254 (29.3) | 200 (29.3) | 84 (25.7) | ||
| CIN II | 298 (34.3) | 209 (30.7) | 99 (30.3) | ||
| CIN III | 236 (27.2) | 198 (29.0) | 86 (26.3) | ||
| Carcinoma | 3 (0.4) | 9 (1.3) | 2 (0.6) | ||
| Other§ | 34 (3.9) | 19 (2.8) | 2 (0.6) | ||
| Invalid specimen | 16 (1.8) | 17 (2.5) | 0.10 | 9 (2.8) | <0.001 |
χ2 test for categorical variables or Wilcoxon rank-sum test for continuous variables.
*Of those with a known HIV status.
†Of those HIV positive.
‡Of those with a histology specimen taken at biopsy, Lletz or other procedure.
§Other includes infections such as cervicitis, inflammation and dysplasia.
ASC-H, atypical squamous cell and HSIL cannot be excluded; ASCUS, Atypical squamous cell of uncertain significance; CIN, cervical intraepithelial neoplasia; CMJAH, Charlotte Maxeke Johannesburg Academic Hospital; HCHC, Hillbrow Community Health Centre; HSIL, high-grade squamous intraepithelial lesion; LSIL, Low-grade squamous intraepithelial lesion; NILM, Negative for intraepithelial lesion and malignancy; Pap, Papanikolaou.