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RESEARCH ARTICLE
Contents Vol 21(3)

The influence of home versus clinic anal human papillomavirus sampling on high-resolution anoscopy uptake in the Prevent Anal Cancer Self-Swab Study

Jenna Nitkowski https://orcid.org/0000-0001-5651-8501 A * , Timothy J. Ridolfi B , Sarah J. Lundeen B , Anna R. Giuliano C , Elizabeth Y. Chiao D , Maria E. Fernandez E , Vanessa Schick F , Jennifer S. Smith G , Bridgett Brzezinski A and Alan G. Nyitray A H
+ Author Affiliations
- Author Affiliations

A Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.

B Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.

C Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.

D MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.

E Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.

F Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.

G Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

H Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA.

* Correspondence to: jnitkowski@mcw.edu

Handling Editor: Eric Chow

Sexual Health 21, SH23210 https://doi.org/10.1071/SH23210
Submitted: 23 December 2023  Accepted: 11 April 2024  Published: 29 April 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing

Abstract

Background

Anal cancer disproportionately affects sexual and gender minority individuals living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability.

Methods

Sexual and gender minority individuals were randomised to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA 1 year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability using χ2 tests.

Results

A total of 62.8% of 196 participants who engaged in screening attended HRA. Although not significant (P = 0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.40, 95% CI 1.07–1.82), and lower among participants preferring a versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53–0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) (P = 0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), (P = 0.04). No differences in attendance by race or HIV status were observed in the home arm.

Conclusions

HRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm.

Keywords: anal cancer, high-resolution anoscopy (HRA), HIV, human papillomavirus (HPV), men who have sex with men (MSM), screening, self-sampling, sexual and gender minority (SGM) individuals.

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