Central Clinical School, Monash University, Melbourne, Victoria, Australia.
London School of Hygiene and Tropical Medicine, London, UK.
J Int AIDS Soc. 2018 Dec;21(12):e25192. doi: 10.1002/jia2.25192.
Men who have sex with men (MSM) living with HIV have a high risk of anal cancer, which is often detected at late stages, when morbidity and mortality are high. The objective of this study was to describe the feasibility and challenges to incorporating regular digital anorectal examination (DARE) into routine HIV care for MSM living with HIV, from the perspective of patients, physicians and the health service.
In 2014, we recruited 327 MSM living with HIV, aged 35 and above from one major sexual health centre (n = 187), two high HIV caseload general practices (n = 118) and one tertiary hospital (n = 22) in Melbourne, Australia. Men were followed up for two years and DARE was recommended at baseline, year 1 and year 2. Data were collected regarding patient and physician experience, and health service use. An ordered logit model was used to assess the relationship between sociodemographic factors and the number of DAREs performed.
Mean age of men was 51 (SD ± 9) years, 69% were Australian born, 32% current smokers, and mean CD4 was 630 (SD ± 265) cells per mm , with no significant differences between clinical sites. Overall, 232 (71%) men received all three DAREs, 71 (22%) received two DAREs, and 24 (7%) had one DARE. Adverse outcomes were rarely reported: anal pain (1.2% of total DAREs), bleeding (0.8%) and not feeling in control of their body during the examination (1.6%). Of 862 DAREs performed, 33 (3.8%) examinations resulted in a referral to a colorectal surgeon. One Stage 1 anal cancer was detected.
Incorporation of an early anal cancer detection programme into routine HIV clinical care for MSM living with HIV showed high patient acceptability, uncommon adverse outcomes and specialist referral patterns similar to other cancer screening programmes.
男男性行为者（MSM）感染 HIV 后，肛门癌的风险很高，而且常常在晚期才被发现，此时发病率和死亡率都很高。本研究的目的是从患者、医生和卫生服务的角度，描述将定期进行数字肛门直肠检查（DARE）纳入 MSM 感染 HIV 者常规 HIV 护理中的可行性和挑战。
2014 年，我们从澳大利亚墨尔本的一家主要性健康中心（n=187）、两家高 HIV 发病人数的普通诊所（n=118）和一家三级医院（n=22）招募了 327 名年龄在 35 岁及以上的 MSM 感染 HIV 者。这些男性随访了两年，在基线、第 1 年和第 2 年都推荐了 DARE。收集了有关患者和医生体验以及卫生服务使用的数据。采用有序逻辑回归模型评估社会人口因素与 DARE 次数之间的关系。
男性的平均年龄为 51（±9）岁，69%为澳大利亚出生，32%为当前吸烟者，平均 CD4 为 630（±265）个细胞/mm ，三个临床地点之间无显著差异。总体而言，232（71%）名男性接受了所有三次 DARE，71（22%）名接受了两次 DARE，24（7%）名只接受了一次 DARE。很少有不良后果报告：肛门疼痛（总 DARE 的 1.2%）、出血（0.8%）和在检查过程中感觉无法控制自己的身体（1.6%）。在进行的 862 次 DARE 中，有 33 次（3.8%）检查导致转诊至结直肠外科医生。发现 1 例 1 期肛门癌。
将早期肛门癌检测计划纳入 MSM 感染 HIV 者的常规 HIV 临床护理中，显示出较高的患者接受度，不良后果罕见，且专科转介模式与其他癌症筛查计划相似。
