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

Abstract

Background: Men who have sex with men (MSM) living with HIV are at increased risk for anal cancer. We evaluated satisfaction with first-time anal cancer screening using high resolution anoscopy (HRA) as a cross sectional survey among men who have sex with men (MSM) attending a community-engaged clinic in Abuja, Nigeria. Methods: Between March and August 2017, 342 MSM underwent screening and 307 (89%) completed a satisfaction survey that evaluated 8 domains related to expectations, convenience, staff interpersonal skills, physical surroundings, technical competence, pain/discomfort, general satisfaction, and intention to re-screen if symptomatic. The 22-item questionnaire used 5-point Likert scales ranging from 1 (strongly disagree) to 5 (strongly agree). For each domain, responses to specific items were averaged, aggregated, and converted to a 100-point scaled score (SS) with 25 and 75 corresponding to disagree and agree, respectively. Results: Median age was 24 years (interquartile range [IQR]: 22-28), median years since anal coital debut was 7 (IQR: 4-12), and 58% (95% confidence interval [CI]: 52-64%) were living with HIV. Despite respondents reporting pre-procedure anxiety (SS:73), most were comfortable with the setting and procedure and reported overall satisfaction (SS:74-76). Willingness to undergo future screening had the lowest score (SS:69) within the general satisfaction domain. The lowest scoring domains were pain/discomfort (SS:57) and agreement to re-screen if symptomatic (SS:59), which correlated with lower overall satisfaction (p < 0.001). Domain responses did not differ by HIV infection after adjusting for multiple comparisons (p > 0.006) or number of anal biopsies (all p > 0.05). Conclusions: Overall, HRA was satisfactory for those naïve to screening but moving forward necessitates monitoring levels of discomfort with pain scales and normalizing dialogue around clinical symptoms of anal cancer and overall anal health to sustain future screening.

Brief Report: Prevalence and Predictors of Concern About Anal Cancer Among Sexual and Gender Minorites Living With HIV in Abuja, Nigeria

“…There is increasing international evidence that younger people are more likely to use social media for healthrelated information, 38 which can affect health in positive and negative ways. 39,40 Although the general knowledge and awareness of anal cancer may be low in SSA, 9,18,41 increasing age may also be associated with an underestimation of risk of anal cancer. 42 This could be partially explained by age-related differences in worry-related processes that are theorized to be reduced in later adulthood.…”

“…9 In addition, after introducing anal cancer screening and treatment for SGM in Nigeria, our participants reported a poor understanding of the symptoms of anal cancer that would prompt seeking a health care provider, suggesting a need for better knowledge dissemination. 18 Although other studies of MSM living with HIV in Australia and the United States found higher levels of worry for HPV-associated illness, 19,20 there is a dearth of research on these topics in SSA. A better understanding of the levels of concern among SGM for anal cancer in SSA is important to assess future uptake of screening and treatment if it were to become available.…”

“…Moreover, it is prudent to take into account potential barriers to continued screening because psychological factors after experiencing screening may deter future engagement. 27 Screening hesitancy has been associated with intolerance to procedural pains 18 and psychological distress. 28 It is possible that SGM in SSA who engaged in our anal cancer screening pilot study 29 would report a higher level of hesitancy with future screening after undergoing the procedure.…”

Effect of the Rehabilitation Program, ReStOre, on Serum Biomarkers in a Randomized Control Trial of Esophagogastric Cancer Survivors

“…In this study we demonstrate the biological effect of exercise intervention in significantly modulating a number of serum biomarkers involved in inflammation and metastasis. The ReStOre II clinical trial is currently underway and is recruiting a total of 120 patients who have had curative treatment for upper gastrointestinal (UGI) and hepatopancreaticobiliary (HPB) cancers ( 69 ). A secondary outcome of the trial is to establish an UGI cancer survivorship biobank for collaborative translational research studies ( 69 ) and therefore the results of this study will be validated in this larger cohort.…”

Metformin use and the risk of anal intraepithelial neoplasia in type II diabetic patients

“…High-resolution anoscopy requires specialized training, resources and equipment, and relies upon recognition of subtle microscopic changes that take time and experience to learn [7]. When lesions are identified, treatment involves destruction of the affected tissue using a variety of ablation techniques, which can be painful for patients [8]. Management of AIN is therefore hindered by imperfect testing, limited access to trained experts and poor patient compliance.…”