Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia

Abstract

Background: While cancer is a leading cause of death worldwide, significant disparities exist in care access in low- and middle-income countries (LMICs). In Liberia, screening and treatment for anal cancers remain limited, and are exacerbated among vulnerable groups, including men who have sex with men (MSM). Screen-triage-treat models for cancerous lesions have been successful in reducing cervical cancer mortality, but the feasibility of this approach has not been studied for anal cancers in a low-resource context. Objective: The aim of this study is to determine the feasibility of implementing a screen-triage-treat model for anal high-grade squamous intraepithelial lesions (aHSIL) among MSM in Liberia. Methods: This descriptive study represented a collaboration between Stop AIDS in Liberia (SAIL) and health institutions in Liberia and the USA. MSM and transgender participants were recruited through convenience sampling with SAIL peer-educators. A survey validated by SAIL experts assessed demographics and sexual risk factors. Participants underwent anal self-swabbing for high-risk human papillomavirus (HPV) and offered human immunodeficiency virus (HIV) testing. Those with positive results were offered a screen-triage-treat model through high-resolution anoscopy (HRA) and infrared coagulation (IRC). Data were cleaned and analyzed in SPSS. Findings: Among 110 participants, most were single (n = 94, 88%) and without formal employment (n = 21, 75%). Participants engaged in regular anal (n = 64, 60%), oral (n = 62, 58%), and receptive sex (n = 58, 54%), and sex with women (n = 51, 48%). Nearly 20% of participants reported being HIV positive (n = 21). In all, 50 participants (45%) tested positive for anal high-risk HPV, 34 (68%) elected to undergo HRA, and 10 (84%) were treated with IRC. Of those who underwent HRA, 75% tested HIV positive. Conclusions: Our findings suggest that a screen-triage-treat model presents a feasible option to identify and reduce the incidence of anal cancer among MSM in Liberia. The screen-triage-treat model, with proven success in management of cervical dysplasia, may be a viable option to treat aHSIL for anal cancer prevention in LMICs.

Keywords

• anal cancer
• men who have sex with men (msm)
• liberia
• surgical care
• human papillomavirus