Implementation and early outcomes from an anal cancer screen and treat program in Nigeria

Abstract

Background: The risk for anal cancer is 52-fold higher in men who have sex with men (MSM) living with HIV but screening is not available in Nigeria. This study trained clinicians to screen and treat using high resolution anoscopy (HRA) and evaluate the prevalence of anal precancer. Methods: TRUST/RV368 recruited MSM for anal cancer screening in Abuja, Nigeria. Between Aug/2016-Aug/2017, 426 men completed a screening questionnaire, had a digital anorectal exam and underwent HRA. Participants could enroll in the study's initial training phase, the pilot study, or both. The most severe diagnosis on histology or cytology determined the final result. All men diagnosed with high-grade squamous intraepithelial lesions (HSIL) were offered ablative treatment with a hyfrecator. Results: Median age was 24 years (interquartile range [IQR]: 22–29) and median years since sexual debut was 6 (IQR:3–11). More HIV-infected MSM participated in the training phase as compared to the pilot (80% vs. 59%). For the 121 MSM screened during training, 9.9% (95% CI: 5.2–16.7) had low-grade squamous intraepithelial lesions (LSIL). For the 362 participants seen during the pilot study, 50.2% (95% CI:45.0–55.5) had LSIL, and 6.3% (95% CI:4.1–9.4) had HSIL. HSIL was not detected during training but it was more often detected among HIV-infected as compared to HIV-uninfected (8% vs. 4%, p<0.01) during the pilot study. Conclusions: Screening improved with time and experience. However, HSIL has been reported higher in some experienced clinics, suggesting that more on-site monitoring and experience are needed to further improve technique.