(140) Counting Every Cervix: Advancing Sexual Health Equity by Improving Cervical Cancer Screening Data Accuracy in a Sexual and Gender Minority-Serving Community Health Center

Abstract Introduction Cervical cancer is the fourth most common cancer among individuals assigned female at birth worldwide, with 95% of cases caused by chronic human papillomavirus (HPV) infection (1). Early detection yields a 5-year survival rate over 90%, yet sexual and gender minority (SGM) populations, including sexual minority women and gender diverse individuals, remain significantly underscreened in comparison to the cisgender female population (2-5). This screening disparity can be attributed to multiple factors, including discriminatory healthcare practices, poorly informed providers, lower reported rates of insurance coverage, limited access to gender affirming care, misconceptions about HPV and cervical cancer risk, and gender dysphoria triggered by intrusive pelvic exams (5-9). Studies have shown high acceptability and accuracy for self-collected primary HPV screening in these populations, offering a less invasive and more affirming approach to CCS (6, 10-14). In 2022, a local community health center (CHC) dedicated to SGM health identified CCS rates significantly lower than the national average; in response, the CHC implemented a CCS initiative incorporating self-collected primary HPV screening in order to increase CCS uptake. However, post-implementation monitoring revealed that the population health data platform (PHDP) data was complicated by patients being identified as needing screening when they did not (ie, including transgender women without a cervix and transgender men and cisgender women who had a hysterectomy), leading to inaccurate metrics and obscuring progress towards equitable screening. Objective Conduct a manual audit of PHDP CCS data at an SGM-serving CHC in order to evaluate the accuracy of PHDP-identified CCS care gaps, identifying and characterizing sources of discrepancies affecting sexual health monitoring metrics. Methods From October 2025 - December 2025, patient lists will be extracted weekly from the PHDP, listing the individuals who completed a primary care visit at the CHC that week and were flagged as overdue for CCS. Each patient’s chart in the electronic medical record (EMR) will be manually reviewed in order to assess true screening eligibility based on organ inventory and the Uniform Data System and American Cancer Society criteria. Types and reasons for discrepancies will be recorded. Descriptive statistics will be used to assess agreement between system-identified and manually-verified CCS care gaps. Discrepancies will be categorized by type and frequency, and adjusted CCS rates will then be re-calculated based on the manual audit. Results This manual audit will identify patterns of misclassification of CCS eligibility in an SGM-serving health center by PHDP and/or EMR software, illuminating barriers to accurate assessment of CCS care gaps. Conclusions By identifying and categorizing systemic data inaccuracies, this manual audit will inform EMR and workflow interventions to improve accurate measurement of CCS rates at this SGM-serving CHC. Enhancing data integrity is critical to ensuring equitable sexual health care delivery, as well as validity of metrics that guide both CCS program evaluation and CHC funding. References found in additional files. Disclosure No.