Completed in 2015

ACES took a broad view in examining options to find, diagnose and treat anal cancer earlier in this population group:

  • Using DARE in routine HIV care
  • Awareness and risk of anal cancer in HIV+ MSM
  • Anal HPV detection related to anal sexual activity
  • Using DARE to detect early anal cancer in HIV+ MSM
  • Performing ASE

The outcomes of each study are summarised below.

Using DARE in routine HIV care

We evaluated the use of digital anorectal examination (DARE) in routine HIV care for MSM living with HIV, from the perspective of patients, physicians and the health service.

We found that including 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.

Awareness and risk of anal cancer in HIV+ MSM

We also surveyed 327 MSM living with HIV to measure their awareness, knowledge and perceived level of personal risk for anal cancer. The results showed that men who underestimated their risk were older, had poor anal cancer knowledge, and had more likely never had an anal examination. This survey showed that this population has limited awareness, knowledge level and estimation of risk for anal cancer. Further educational and public health initiatives are needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV.

Anal HPV detection related to anal sexual activity

We looked at whether anal HPV DNA detection is related to recent anal sexual activity, what types of anal sexual activity or the persistence of HPV genotypes. This study involved 281 MSM living with HIV. We detected anal HPV in MSM living with HIV in the majority of men throughout all age groups. Anal HPV detection remains high even in men reporting no anal sexual activity in the preceding six months.

Using DARE to detect early anal cancer in HIV+ MSM

We also investigated DARE as a way to detect early anal cancer in MSM living with HIV. We surveyed MSM about their anal and sexual health, adverse effects from the anal examination, cancer worry and quality of life. Annual DARE to detect anal cancer in MSM living with HIV was acceptable for patients. Strategies to increase HIV physician’s patient recruitment would be needed if DARE were to be implemented in anal cancer screening.

Performing ASE

We also interviewed MSM living with HIV to explore if anal self-examination (ASE) is acceptable as a method of anal cancer screening. Men were generally comfortable with the idea of ASE as a means for detecting anal cancer. Men expressed discomfort with ASE and anxiety about finding an abnormality. Participants preferred examination by a health professional.

Researchers

Principal investigators

Prof Christopher Fairley AO MB BS, PhD, FRACP, FAFPHM, FAChSHM, FAAHMS
Dr Jason Ong PhD, MMed, MBBS, FAChSHM, FRACGP

Associate investigators

Prof Marcus Chen FRCP, FAChSHM, PhD
Prof Philip Clarke PhD, MEcon, BEcon
Prof Andrew Grulich MB BS Adel, PhD UNSW, MScEpid Lond, DipObst Flin, FAFPHM, DRACOG, FAAHMS
Prof Meredith Temple-Smith BSc, Dip App Child Psych, MPH, DHSc

Publications

Incidence, clearance, and persistence of anal human papillomavirus in men who have sex with men living with human immunodeficiency virus: implications for human papillomavirus vaccination

Ong JJ, Walker S, Grulich A, Hoy J, Read TRH, Bradshaw CS, Chen MY, Garland SM, Cornall A, Hillman R, Templeton DJ, Hocking J, Eu B, Tee BK, Chow EPF, Fairley CK

(2019), Sexually Transmitted Diseases,

DOI: 10.1097/OLQ.0000000000000958

Incorporating digital ano-rectal examinations for anal cancer screening into routine HIV care for men who have sex with men living with HIV: a prospective cohort study

Ong JJ, Walker S, Grulich A, Hoy J, Read T, Bradshaw C, Chen M, Garland S, Hillman R, Templeton D, Hocking J, Eu B, Tee BK, Chow EPF, Fairley CK

(2018), Journal of International AIDS Society,

DOI: 10.1002/jia2.25192

Exposing the gaps in awareness, knowledge and estimation of risk for anal cancer in men who have sex with men living with HIV: a cross-sectional survey in Australia.

Ong JJ, Chen M, Grulich AG, Walker S, Temple-Smith M, Bradshaw CS, Garland SM, Hilman R, Templeton D, Hocking J, Beng E, Tee BK, Fairley CK

(2015), Journal of the International AIDS Society,

DOI: 10.7448/IAS.18.1.19895

Anal HPV detection in men who have sex with men living with HIV according to age group and recent anal sexual behaviours: Baseline analysis of the anal cancer examination (ACE) study

Ong JJ, Chen MY, Tabrizi SN, Grulich AE, Cornall A, Garland SM, Jin F, Tee BK, Eu B, Tee BK, Fairley CK

(2015), Sexually Transmitted Infections,

DOI: 10.1136/sextrans-2015-052121

Baseline findings from the anal cancer examination (ACE) study: screening using digital ano-rectal examination in HIV-positive men who have sex with men

Ong JJ, Grulich AE, Walker S, Hoy J, Read TRH, Bradshaw CS, Garland SM, Hillman R, Templeton D, Hocking JS, Eu B, Tee BK, Fairley CK

(2015), Journal of Medical Screening,

DOI: 10.1177/0969141315604658

Exploring anal self-examination as a means of screening for anal cancer in HIV positive men who have sex with men: a qualitative study.

Ong JJ, Temple-Smith M, Chen MY, Walker SM, Grulich AE, Fairley CK

(2014), BMC Public Health ,

DOI: 10.1186/1471-2458-14-1257