Evaluation of anal self-sampling in HIV populations

Division Of Cancer Epidemiology And Genetics

Investigators

Abstract

People living with HIV (PLHIV) have a much higher risk of developing human papillomavirus (HPV)-related anogenital cancers compared to the general population. Anal cancer is the second leading non-AIDS defining cancer in PLHIV; the highest anal cancer incidence has been observed in men-who-have-sex-with-men living with HIV (MSM-HIV). The high risk of anal cancer in the HIV MSM population and the promising results from a randomized trial demonstrating that treating anal precancer can prevent anal cancer support offering anal cancer screening to all HIV-MSM. However, there is currently not sufficient capacity to provide screening for this population. Anal self-collection provides an option to extend the reach of anal cancer screening to a much larger population that currently does not have access to anal screening clinics, or for which existing clinic capacity is not sufficient. HPV self-collection has been successfully evaluated for cervical screening and is now part of large, organized screening programs to reach non-participants. However, data on anal self-collection are scarce. We propose to evaluate anal self-collection to provide samples that will be tested for HPV and other biomarkers for detection of anal precancer. Self-collected and provider-collected anal specimens will be collected from 500 HIV-MSM attending two clinics in California and Nevada. We will conduct paired analyses of biomarker positivity and we will compare the performance of biomarkers from both sample types for detection of anal precancer. Additionally, we will evaluate the attitude to and experience with anal self-collection among the study participants. If successful, anal self-sampling could be offered to HIV-MSM as an anal cancer screening approach in various settings, including clinics where they receive specialty care for HIV but that currently do not have an infrastructure for anal cancer screening.