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

Abstract

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 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 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.

Retention of a cohort of men who have sex with men and transgender women at risk for and living with HIV in Abuja and Lagos, Nigeria: a longitudinal analysis

“…Together, facilities focused on the social, legal and sexual health needs of study participants and sensitization training was provided to promote integration of the two entities. Services included education about safer sex practices, distribution of condoms and condom‐compatible lubricants and diagnosis and treatment of HIV and other sexually transmitted infections (STIs) [14‐19]. Despite these services, we have previously reported a high HIV incidence of 15 infections per 100 person‐years in the cohort [20].…”

Adolescent and non-consensual anal sexual debut among Chinese men who have sex with men: a cross-sectional study

“…Another potential explanation for this phenomenon is that both adolescent and non-consensual sexual debut can lead to psychological problems and self-harm, while these issues are highly correlated with condomless sex. [33,34] However, we did not collect this information in our study, and further studies on understanding the mechanism of this phenomenon among Chinese MSM are needed. Approaches for promoting condom use during and after sexual debut among MSM would be essential.…”

Satisfaction with high-resolution anoscopy for anal cancer screening among men who have sex with men: a cross-sectional survey in Abuja, Nigeria

“…Anal cancer screening was conducted as a primary analysis for a year in the TRUST/RV368 cohort in Abuja, Nigeria [21][22][23]. The purpose of the TRUST/RV368 cohort, was to engage men who have sex with men in an HIV treatment-as-prevention study at "trusted" community centers that specialized in the clinical care and sexual health needs of sexual and gender minorities.…”

“…Nucleic acid amplification diagnoses of rectal Neisseria gonorrhoeae and Chlamydia trachomatis [26] were further categorized as none, individual infections, or both. Data on smoking, lifetime number of receptive partners, external warts, number of anal biopsies and anal biopsy results were obtained from the anal cancer screening study [23]. Anal biopsy results were a composite variable defined as worst diagnosis from either cytology or histology.…”