Open AccessIncorporating digital anorectal examinations for anal cancer screening into routine HIV care for men who have sex with men living with HIV : a prospective cohort study
Author(s) -
Ong Jason J,
Walker Sandra,
Grulich Andrew,
Hoy Jennifer,
Read Tim RH,
Bradshaw Catriona,
Chen Marcus,
Garland Suzanne M,
Hillman Richard,
Templeton David J,
Hocking Jane,
Eu Beng,
Tee Bian Kiem,
Chow Eric P F,
Fairley Christopher K
Publication year - 2018
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25192
Subject(s) - medicine , anal cancer , men who have sex with men , referral , cohort , prospective cohort study , interquartile range , family medicine , gerontology , human immunodeficiency virus (hiv) , syphilis
Men who have sex with men ( MSM ) living with HIV have a high risk of anal cancer, which is often detected at late stages, when morbidity and mortality are high. The objective of this study was to describe the feasibility and challenges to incorporating regular digital anorectal examination ( DARE ) into routine HIV care for MSM living with HIV , from the perspective of patients, physicians and the health service. Methods In 2014, we recruited 327 MSM living with HIV , aged 35 and above from one major sexual health centre (n = 187), two high HIV caseload general practices (n = 118) and one tertiary hospital (n = 22) in Melbourne, Australia. Men were followed up for two years and DARE was recommended at baseline, year 1 and year 2. Data were collected regarding patient and physician experience, and health service use. An ordered logit model was used to assess the relationship between sociodemographic factors and the number of DARE s performed. Results Mean age of men was 51 ( SD ± 9) years, 69% were Australian born, 32% current smokers, and mean CD 4 was 630 ( SD ± 265) cells per mm 3 , with no significant differences between clinical sites. Overall, 232 (71%) men received all three DARE s, 71 (22%) received two DARE s, and 24 (7%) had one DARE . Adverse outcomes were rarely reported: anal pain (1.2% of total DARE s), bleeding (0.8%) and not feeling in control of their body during the examination (1.6%). Of 862 DARE s performed, 33 (3.8%) examinations resulted in a referral to a colorectal surgeon. One Stage 1 anal cancer was detected. Conclusion Incorporation of an early anal cancer detection programme into routine HIV clinical care for MSM living with HIV showed high patient acceptability, uncommon adverse outcomes and specialist referral patterns similar to other cancer screening programmes.