Implementation of and Early Outcomes From Anal Cancer Screening at a Community-Engaged Health Care Facility Providing Care to Nigerian Men Who Have Sex With Men
Implementation of and Early Outcomes From Anal Cancer Screening at a Community-Engaged Health Care Facility Providing Care to Nigerian Men Who Have Sex With Men
Blog Article
PURPOSE: Anal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa.We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria.METHODS: From August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort.HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL).
HRA proficiency was assessed by evaluating COQ10 W HAWTHORN the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied.Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated.Multinomial logistic regression was used to identify those at the highest risk of SIL.RESULTS: Median age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.
2% to 63.6%) were HIV infected.Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies.Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.
0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.
0% to 9.3%).HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL.CONCLUSION: Proficiency with HRA increased with experience over time.
However, HSIL detection rates were AEG DCE731110M Touch Control Multifunction A+ Rated Double Oven low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding.HRA is a feasible first-line screening tool at an MSM-friendly health care facility.Years since anal coital debut and external warts could prioritize screening.