Background: Cervical cancer remains a leading cause of cancer-related mortality among Nigerian women, with HIVpositive women bearing a disproportionate burden. The postpartum period offers a unique opportunity for targeted screening interventions. This study, a follow-up to an earlier work on awareness, aimed to compare the prevalence, patterns, and predictors of abnormal cervical cytology among HIV-positive and HIV-negative women attending postnatal care.

Methods: A cross-sectional study was conducted among 104 women (52 HIV-positive, 52 HIV-negative matched for parity) attending the 6-week postnatal clinic at Federal Medical Centre, Yenagoa, Nigeria, between June and October 2018. Cervical smears were obtained using conventional Papanicolaou staining and reported using the 2014 Bethesda system. Data were analyzed using SPSS version 22, with logistic regression to identify predictors of epithelial cell abnormality. Statistical significance was set at p < 0.05.

Results: Of 102 satisfactory smears analyzed (51 per group), the overall prevalence of abnormal cervical cytology was 26.5%. HIV-positive women demonstrated significantly higher prevalence (35.3%) compared to HIV-negative women (17.6%) (OR = 2.55; 95%CI: 1.01–6.39; p = 0.043). Among HIV-positive women, abnormalities included ASCUS (15.7%), LSIL (15.7%), and HSIL (3.9%). Independent predictors of abnormal cytology were age 30–39 years (OR = 18.81; p = 0.006), age 40–49 years (OR = 45.35; p = 0.034), history of sexually transmitted infection (OR = 7.89; p = 0.012), and multiple lifetime sexual partners (OR = 8.64; p = 0.037).

Conclusion: The prevalence of abnormal cervical cytology among postpartum women in this region is alarmingly high, particularly among HIV-positive women who bear twice the burden of their HIV-negative counterparts. These findings, viewed alongside the profound knowledge gaps and negligible screening uptake reported previously, underscore the urgent need for integrating cervical cancer screening into routine postnatal care services in Nigeria.