12349University of Virginia, School of Medicine, Charlottesville, VA, USA.
Division of Infectious Diseases and International Health, 12349University of Virginia, Charlottesville, VA, USA.
Int J STD AIDS. 2022 Sep;33(10):906-913. doi: 10.1177/09564624221114192. Epub 2022 Jul 14.
Care cascades can inform providers about differences in engagement and retention in care between patient populations thereby improving participation by targeting interventions more effectively. The objective of this study was to assess the uptake and retention of participants along the anal cancer screening algorithm within a single HIV clinic.
Retrospective procedural and demographic data were collected within a Ryan White HIV/AIDS Program clinic from 18 December 2017 to 29 May 2021. A care cascade was constructed among eligible participants who engaged and were retained in the anal cancer screening algorithm. Engagement was defined as having at least one anal Pap smear. Retention was defined as having a follow-up anal Pap smear, and/or high resolution anoscopy, as indicated. Risk ratios (RR) were calculated to reveal factors associated with initiation and retention in screening.
Of 821 eligible participants, 312 (38%) engaged in screening and 205 (66%) were retained in care. Anoreceptive intercourse was positively associated with engagement (RR 2.81, 95% confidence interval [CI] 2.05-3.90, <0.001), whereas male gender was negatively associated (RR 0.26, 95% CI 0.20-0.33, <0.001). Abnormal cytology results on Pap smear were associated with retention (RR 1.39, 95% CI 1.03-1.86, =0.03).
Overall engagement in anal cancer screening is low within our clinic, particularly among men, but retention in the screening program is notably better, especially among those with abnormal cytology. Target populations have been identified to increase awareness, and qualitative studies are underway to understand perceptions and barriers to engagement in anal cancer screening.
护理级联可以为提供者提供关于不同患者群体之间参与和保留护理的信息，从而通过更有效地针对干预措施来提高参与度。本研究的目的是评估在单个 HIV 诊所中，沿着肛门癌筛查算法的参与者的参与度和保留率。
在一个符合 Ryan White HIV/AIDS 计划的诊所中，从 2017 年 12 月 18 日至 2021 年 5 月 29 日，收集了回顾性的程序和人口统计学数据。在符合条件的参与者中构建了一个护理级联，这些参与者参与并保留在肛门癌筛查算法中。参与度定义为至少有一次肛门巴氏涂片检查。保留度定义为有后续的肛门巴氏涂片检查和/或根据需要进行高分辨率肛门镜检查。计算风险比 (RR) 以揭示与筛查开始和保留相关的因素。
在 821 名符合条件的参与者中，有 312 名（38%）参与了筛查，有 205 名（66%）在护理中得到了保留。肛交与参与度呈正相关（RR 2.81，95%置信区间 [CI] 2.05-3.90，<0.001），而男性性别则呈负相关（RR 0.26，95% CI 0.20-0.33，<0.001）。巴氏涂片细胞学异常结果与保留率相关（RR 1.39，95% CI 1.03-1.86，=0.03）。
我们诊所的肛门癌筛查总体参与度较低，尤其是男性，但在筛查计划中的保留率明显更好，尤其是在细胞学异常的人群中。已经确定了目标人群以提高认识，并且正在进行定性研究以了解参与肛门癌筛查的看法和障碍。
