Anal cancer is a common cancer in HIV-positive men who have sex with men (MSM) (incidence ~1 in 1000 per year). No national guidelines exist on the best method to screen for this cancer. The ACE study aims to determine if an annual anal examination (AAE) is cost-effective and acceptable amongst patients and doctors.
Methods: 5 years follow up of 1000 HIV-positive MSM, aged 35 years or older in Victoria. Each participant will undergo an AAE and complete questionnaires at recruitment and after each examination. Questions include quality of life measures, and morbidity associated with the AAE. Participants are recruited from a metropolitan sexual health centre, two high caseload general practices and one HIV outpatients of a major tertiary hospital. Recruitment started in February 2013. A baseline questionnaire for doctors to assess views of anal cancer screening and barriers to implementing an AAE was given to doctors involved in this study.
Results: 211 participants has been recruited with an average age of 52 years and a mean duration of HIV of 13 years. 100% (95% CI 98-100%) of participants stated they would be willing to undergo another anal examination, 5% (95% CI 3-9%) found the examination painful and 0% (95% CI 0-2%) had bleeding. Patients reported being worried they were not clean (67%, 95% CI 61-73%), felt ‘embarrassed’ (30%, 95% CI 24-36%) and worried that they may lose control of their bowels (14%, 95% CI 10-19%). Level of confidence in performing AAE and barriers of implementing AAE in the three clinical settings will be discussed.
Conclusion: The implementation of AAE may be feasible as a screening method for anal cancer in HIV positive MSM with high acceptability amongst patients and doctors in Victoria.
The case is of a 30 year-old HIV positive Zimbabwean woman (UK resident) who arrived in Australia in January 2011 on a one-year working visa. She was diagnosed with HIV in 2003 in the UK and commenced on Atripla® in 2005. She was first seen in Adelaide in May 2011, requesting a script for Atripla.®.
Indigenous Australians experience a greater burden of sexually transmitted infections, however are less likely than the general population to access sexual health services. We examined the effectiveness of an Indigenous cultural appropriateness audit in assessing a sexual health clinic with low rates of Indigenous clients.
Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.
Despite the high proportion of young people annually accessing general practices, including Aboriginal Medical Services (AMS), testing for Chlamydia trachomatis remains relatively low in urban areas. A project officer was employed within the Institute of Urban Indigenous Health (IUIH) to serve a mentoring and facilitation role for the SE Queensland network of AMS and their sexual health workers, with a view to improving testing, management and follow-up of chlamydia and other STIs by community controlled medical services.
Monocytes are a heterogeneous cell population having specialised functions and differing phenotype. They are a link between innate immune system and adaptive immune system therefore, to identify if immune activation exists in HIV-1 individuals with controlled virema and recovered CD4 T cell counts, we assessed cell surface monocyte activation markers (MAM) within the monocyte subsets.
Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.