Cancer screening for undocumented-uninsured immigrants living with HIV. Results of a descriptive cohort study and 5-year follow-up
摘要
Undocumented and uninsured immigrants living with HIV often face barriers to preventive services, including cancer screening. Evidence is limited regarding how structured screening can be implemented for this population. We evaluated the feasibility, clinical outcomes, and longer-term impact of a cancer screening program delivered through a voluntary HIV-Social clinic in Israel.
MethodsWe conducted a single-center historic–prospective cohort study among undocumented and uninsured immigrants, aged 18 years or above, receiving care at the HIV-Social clinic at Sheba Medical Center. A cancer screening program was established to offer all patients treated in our clinic cancer screening tests, accordingly: cervical cancer screening (Pap smear) to all women, breast imaging to women aged > 45 years, and colonoscopy to adults aged > 50 years. Screening outcomes, follow-up completion, and program costs were recorded. Electronic medical records were reviewed for five years following the program to assess subsequent screening uptake and cancer outcomes.
ResultsFifty patients were included (mean age 42 years; 62% women; 88% from Africa). A total of 48 screening tests were performed, of which 21% had abnormal findings. The total program cost was USD 6,942. During the five-year follow-up period, 42 additional screening tests were performed. Among eight patients requiring follow-up tests after abnormal or insufficient results, six completed the recommended evaluation (75%). No cancers were diagnosed during follow-up.
ConclusionsA structured cancer screening program delivered through a voluntary HIV-Social clinic was feasible for undocumented and uninsured immigrants living with HIV in Israel and achieved 62% uptake. These findings suggest that integrating screening into similar HIV care settings may help reduce inequities in preventive healthcare and support early detection strategies in undocumented and uninsured patients living with HIV in Israel.