Piloting of a Screen‑Triage‑Treat Surgical Approach Model for Management of Anal Cancer in Liberia

Christopher W. Reynolds; Whitney Lieb; Andrea Schecter; Michael M Gaisa; Stephen K. McGill; Evans L. Adofo; Ann Marie Beddoe

doi:10.5334/aogh.4576

Piloting of a Screen‑Triage‑Treat Surgical Approach Model for Management of Anal Cancer in Liberia

Volume 90 (2024): Issue 1

By: Christopher W. Reynolds, Whitney Lieb, Andrea Schecter, Michael M Gaisa, Stephen K. McGill, Evans L. Adofo and Ann Marie Beddoe

Open Access

|Dec 2024

Abstract

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.

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Articles in this issue

DOI: https://doi.org/10.5334/aogh.4576 | Journal eISSN: 2214-9996

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Language: English

Submitted on: Oct 8, 2024

Accepted on: Nov 2, 2024

Published on: Dec 4, 2024

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Anal cancer,

men who have sex with men (MSM),

Liberia,

surgical care,

human papillomavirus

© 2024 Christopher W. Reynolds, Whitney Lieb, Andrea Schecter, Michael M Gaisa, Stephen K. McGill, Evans L. Adofo, Ann Marie Beddoe, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 90 (2024): Issue 1