The Influence of Home Versus Clinic Anal Human Papillomavirus Sampling on High-Resolution Anoscopy Uptake in the Prevent Anal Cancer Self-Swab Study

Authors

Jenna Nitkowski
Timothy J Ridolfi
Sarah J Lundeen
Anna R Giuliano
Elizabeth Y Chiao
Maria E Fernandez
Vanessa Schick
Jennifer S Smith
Bridgett Brzezinski
Alan G Nyitray

Publication Date

4-1-2024

Journal

Sex Health

Abstract

Background Anal cancer disproportionately affects sexual and gender minority individuals living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability. Methods Sexual and gender minority individuals were randomised to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA 1year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability using χ 2 tests. Results A total of 62.8% of 196 participants who engaged in screening attended HRA. Although not significant (P =0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.40, 95% CI 1.07-1.82), and lower among participants preferring a versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53-0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) (P =0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), (P =0.04). No differences in attendance by race or HIV status were observed in the home arm. Conclusions HRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm.

Keywords

Humans, Male, Anus Neoplasms, Female, Papillomavirus Infections, Adult, Middle Aged, Specimen Handling, Sexual and Gender Minorities, Anal Canal, Patient Acceptance of Health Care, Proctoscopy, Early Detection of Cancer, HIV Infections, Self Care, Human Papillomavirus Viruses, high-resolution anoscopy (HRA), self-sampling, anal cancer, human papillomavirus (HPV), sexual and gender minority (SGM) individuals

DOI

10.1071/SH23210

PMID

38683939

PMCID

PMC11752474

PubMedCentral® Posted Date

1-22-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes