Integration of Anal Dysplasia Screening into the Primary Care of Persons Living with HIV

Abstract

Anal dysplasia can lead to anal cancer, which affects persons living with HIV (PLWH) more than people in the general population. Screening for anal dysplasia is recommended to detect anal cancer at an early stage. The aim of our process improvement project was to improve compliance and consistency in implementing anal dysplasia screening for PLWH receiving care at a Ryan White facility covering 18 counties in western North Carolina. There were 291 PLWH screened for anal dysplasia during the 9-month data-gathering period. The compliance rate significantly increased from a preintervention rate of 31.3% to 57.5% (p < .001). There were 109 (37.5%) abnormal screening results. PLWH who had abnormal screening results were more likely to be White. Gender and age were not significantly associated with abnormal screening results. Anal dysplasia screening is a simple procedure to detect precursors to cancer that can be integrated into the primary care of PLWH.

Integration of human papillomavirus associated anal cancer screening into HIV care and treatment program in Pakistan: perceptions of policymakers, managers, and care providers

“…Consistent with previous research [ 40 – 42 ], the interviewee acknowledged the feasibility of nesting cancer control program associated with HPV infection into healthcare in general, and HIV care in particular. Almost all categories of participants thought that setting up another disease specific or verticalized program is neither desirable nor possible.…”

“That’s Only for Women”: The Importance of Educating HIV-Positive Sexual Minority Men on HPV and High Resolution Anoscopy (HRA)

“…Likewise, different from Newman et al's study, whose study population described the anus as "hidden" or "private," this male population discussed with female friends what routine health care for receptive partners should entail. 27 The differences between our study population about using language such as "anal pap" and "anal pap smear" as well as emphasizing identity as a "bottom" and receptive anal sex as opportunities to improve public health messaging concerning HRA require examination of the uniqueness of our population. The participants of our study were directly recruited from Anoscopy clinic, and our population demonstrated high levels of adherence to HRA.…”

“…Likewise, different from Newman et al’s study, whose study population described the anus as “hidden” or “private,” this male population discussed with female friends what routine health care for receptive partners should entail. 27 …”

“…[21][22][23][24][25] Recently, researchers have begun to focus on the role of anal HPV screening and secondary prevention for HIV-positive and HIV-negative MSM as a method of reducing anorectal neoplasm morbidity and mortality. 7,9,[26][27][28][29][30][31][32][33][34] Though no national guidelines regarding who should be screened, how often screening should occur, or the optimal treatment modalities for anal dysplasia exist, 14,[35][36][37] the currently accepted approach to anal HPV screening and management is modeled after approaches taken to screening and management for cervical dysplasia, which is accomplished through routine Papanicolaou cytological screening ("Pap smears") followed by colposcopy of the cervix to visualize and treat dysplastic lesions. 38,39 Patients at risk for anal dysplasia are typically first screened through self-or practitioner-collected anal/rectal swabs, and those with abnormal cytological results, including high-grade squamous intraepithelial lesions (HSIL), low-grade squamous intraepithelial lesions (LSIL), or atypical squamous cells of undetermined significance (ASCUS), are referred for further evaluation using high-resolution anoscopy (HRA).…”

Hallazgos en piel en pacientes con infección por VIH en Bogotá

“…Por consiguiente, el hecho de que aproximadamente 1 de cada 4 pacientes evaluados en nuestro estudio presentara condilomas perianales nos invita a implementar tamización de rutina (36,37); incluso, si el paciente refiere conductas sexuales seguras, dado que no es posible establecer que se trate de un contagio reciente, ya que el VIH altera el aclaramiento de la infección por VPH (38)(39)(40).…”