A decade of anal cancer screening in the context of HIV care.

BACKGROUND

High-resolution anoscopy (HRA) is crucial for detecting and managing high-grade squamous intraepithelial lesions (HSIL), the main precursor to anal cancer. However, program success is often hindered by long-term retention, which in some studies reaches only 50%. Patient acceptability, a major factor in adherence, is often overlooked.

OBJECTIVE

To evaluate the long-term feasibility, safety, acceptability, and retention of an anal cancer screening program in an HIV clinic that prioritizes patient-centered strategies.

METHODS

This single-center, longitudinal cohort study was conducted at a public HIV and Sexual Health Clinic in Spain. Eligible participants included MSM with HIV aged at least 30 years and abnormal cytology, and individuals with prior anal cancer or human papilloma virus (HPV)-related anogenital lesions/dysplasia. Retention was defined as the proportion who remained enrolled or completed protocol. Acceptability, appropriateness, and feasibility were assessed using a validated four-item survey. Safety was measured through adverse event monitoring. The internal consistency of the four-item survey was assessed using Cronbach's alpha.

RESULTS

Of 389 screened participants, 21.3% were diagnosed with HSIL, and 49.4% experienced recurrence. One early-stage anal cancer was detected. Adverse events were mild and self-limited. Retention at 10 years was 88.9%, with a median follow-up duration of 54.5 months (interquartile range 21.7-116.5). Patient satisfaction was high: 96.5% rated the program as acceptable, 97.5% as appropriate, and 96.5% as feasible, though procedural ease scored slightly lower.

CONCLUSION

High long-term retention and strong acceptability suggest that patient-focused approaches may enhance engagement in care and warrant consideration in the design of similar programs in HIV clinics.