Ong Jason J, Temple-Smith Meredith, Chen Marcus, Walker Sandra, Grulich Andrew, Hoy Jennifer, Fairley Christopher K
Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3010, Australia.
General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, VIC, 3053, Australia.
BMC Public Health. 2015 Jan 31;15:67. doi: 10.1186/s12889-015-1430-1.
Anal cancer is a priority health issue in HIV positive men who have sex with men. Anal cancer screening may be aimed at either detecting the precursor lesion (high grade anal intraepithelial neoplasia(HGAIN)) or early anal cancer. To date no qualitative study has explored the views of HIV physicians regarding anal cancer and its screening.
We conducted indepth interviews with 20 HIV physicians (Infectious diseases, Immunology, Sexual health, General practice) in different settings (hospital, sexual health centres, general practice) from around Australia. Framework analysis was used to identify themes.
HIV physicians viewed anal cancer as a significant health issue and all agreed on the importance of anal cancer screening amongst HIV positive MSM if a valid screening method was available. Barriers for utilizing anal cytology was based primarily on the theme of insufficient evidence (e.g. no studies demonstrating reduction in mortality following screening or effective treatments for HGAIN). Barriers for utilizing DARE for early cancer detection were based on systemic factors (e.g. lack of opportunity, lack of priority, differences in HIV care practices); health provider factors (lack of evidence, difficulty discussing with patients, lack of confidence in DARE) and patient factors (perceived discomfort of DARE for patients, low anal cancer risk awareness). Physicians were willing to consider the idea of patient self-examination and partner-examination although concerns were raised regarding its reliability and issues surrounding partner dynamics.
HIV physicians remain ambivalent regarding the most effective means to screen for anal cancer. More research is needed to address the physicians' concerns before anal cancer screening can be implemented into routine HIV care.
肛管癌是男男性行为的HIV阳性者中的一个重点健康问题。肛管癌筛查的目的可能是检测前驱病变（高级别肛管上皮内瘤变（HGAIN））或早期肛管癌。迄今为止，尚无定性研究探讨HIV医生对肛管癌及其筛查的看法。
我们对来自澳大利亚各地不同机构（医院、性健康中心、全科医疗）的20名HIV医生（传染病、免疫学、性健康、全科医疗）进行了深入访谈。采用框架分析法确定主题。
HIV医生将肛管癌视为一个重大的健康问题，并且一致认为，如果有有效的筛查方法，在HIV阳性的男男性行为者中进行肛管癌筛查非常重要。采用肛门细胞学检查的障碍主要基于证据不足这一主题（例如，没有研究表明筛查后死亡率降低或对HGAIN有有效的治疗方法）。采用DARE进行早期癌症检测的障碍基于系统因素（例如，缺乏机会、缺乏优先级、HIV护理实践的差异）；医疗服务提供者因素（缺乏证据、难以与患者讨论、对DARE缺乏信心）和患者因素（患者认为DARE不舒服、肛管癌风险意识低）。医生愿意考虑患者自我检查和性伴侣检查的想法，尽管有人对其可靠性以及围绕性伴侣关系的问题表示担忧。
HIV医生对于肛管癌最有效的筛查方法仍持矛盾态度。在将肛管癌筛查纳入常规HIV护理之前，需要开展更多研究来解决医生们的担忧。
