Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia
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...
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| Format: | Article |
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Ubiquity Press
2024-12-01
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| Series: | Annals of Global Health |
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| Online Access: | https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/4576 |
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| author | Christopher W. Reynolds Whitney Lieb Andrea Schecter Michael M Gaisa Stephen K. McGill Evans L. Adofo Ann Marie Beddoe |
| author_facet | Christopher W. Reynolds Whitney Lieb Andrea Schecter Michael M Gaisa Stephen K. McGill Evans L. Adofo Ann Marie Beddoe |
| author_sort | Christopher W. Reynolds |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0618df0c527042268a85f300326ab378 |
| institution | Kabale University |
| issn | 2214-9996 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Annals of Global Health |
| spelling | doaj-art-0618df0c527042268a85f300326ab3782025-01-08T07:52:56ZengUbiquity PressAnnals of Global Health2214-99962024-12-01901757510.5334/aogh.45764576Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in LiberiaChristopher W. Reynolds0Whitney Lieb1Andrea Schecter2Michael M Gaisa3Stephen K. McGill4Evans L. Adofo5Ann Marie Beddoe6Department of Surgery, University of Michigan, Ann Arbor, MIDepartment of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NYDepartment of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NYDivision of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NYMarshall Minority Health Institute, Marshall University, Huntington, West VirginiaStop AIDS in Liberia (SAIL), Monrovia, MontserradoDirector of Global Women’s Health, Mount Sinai Health System, New York, NYBackground: 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.https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/4576anal cancermen who have sex with men (msm)liberiasurgical carehuman papillomavirus |
| spellingShingle | Christopher W. Reynolds Whitney Lieb Andrea Schecter Michael M Gaisa Stephen K. McGill Evans L. Adofo Ann Marie Beddoe Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia Annals of Global Health anal cancer men who have sex with men (msm) liberia surgical care human papillomavirus |
| title | Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia |
| title_full | Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia |
| title_fullStr | Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia |
| title_full_unstemmed | Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia |
| title_short | Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia |
| title_sort | piloting of a screen triage treat surgical approach model for management of anal cancer in liberia |
| topic | anal cancer men who have sex with men (msm) liberia surgical care human papillomavirus |
| url | https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/4576 |
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