Care cascade of anal dysplasia screening among MSM living with HIV from a single-center outpatient clinic.

Abstract

e18607 Background: Anal cancer is the fourth most common cancer among people living with HIV with an incidence estimated to be 89 per 100,000 among men living with HIV who have sex with men (MSM). In comparison, the incidence of anal cancer in the general population is 1.6 per 100,000. The ANCHOR study which was a randomized control trial found that treating anal high-grade squamous intraepithelial lesions (HSIL) reduces the incidence of anal cancer by more than half. These findings provide a rationale for screening for anal dysplasia in people with HIV and could have an impact on recommendations for screening and treatment. The study also highlights the need for effective strategies to improve the screening and treatment of anal HSIL and providers trained in high-resolution anoscopy (HRA). Our goal was to determine the rate of screening for anal dysplasia among men who have sex with men (MSM) living with HIV attending our clinic and subsequent referral for HRA and completion of HRA in case of abnormal results. Methods: We assessed the rate of screening for anal dysplasia among the patients identifying as MSM (n = 305) at a large HIV clinic in Brooklyn, New York. An anal dysplasia care cascade was completed. The number of patients screened for anal dysplasia and the results of the screening were obtained from the EMR. All patients with results of Atypical Squamous cell of undetermined significance (ASCUS), Low-grade intra-epithelial neoplasia (LSIL), or High-grade intra-epithelial neoplasia (HSIL) on anal cytology were evaluated for evidence of referral for HRA and the number who completed the HRA was included in the descriptive analysis. Results: 60% of the total eligible patients included in the study were screened by anal cytology, 72% of those with abnormal cytology were referred for HRA and 37% completed the anoscopy (table 1). The patients in the age group 20-40 years were more likely to be screened. The number of patients with HSIL was low. Conclusions: The engagement of MSM clients in anal dysplasia screening and management was low based on our care cascade. Considering the results of our study, we aim to identify the barriers to screening as well as to referral and completion of HRA among MSM living with HIV in our patient population. [Table: see text]