22. Integration of anal Pap screening into a colposcopy clinic for HIV-infected women

Abstract

Background: Persistent human papillomavirus (HPV) infection is a precursor to cervical and anal dysplasia and cancer. Among HIV+ women, HPV is more difficult to treat. While no national standards exist for anal dysplasia screening, it may be an important tool in reducing anal cancer risk. At an urban university hospital in South Florida, HIV+ women lacked access to screening; thus, a pilot project was initiated. Methods: With support from the university, the hospital and the Florida/AIDS Education and Training Center (AETC), we implemented an anal dysplasia clinic within our existing HIV colposcopy clinic. A video developed by the Pennsylvania/Mid-Atlantic AETC provided anal Pap technique training to Advanced Registered Nurse Practitioners. The protocols for specimen collection included Dacron swabs and Thin Prep^® fixative, and cytology samples were read using the Bethesda criteria. AETC funded two gynaecologists to attend ASCCP’s high-resolution anoscopy (HRA) training; Health Resources and Services Administration funded a dedicated colposcope for HRA. Women attending the clinic were offered anal Pap screening with referral to HRA for abnormal results. Results: Anal Pap smears were collected for 124 women between May 2012 and June 2013; 114 (92%) had ASCUS, ASC-H, LSIL or HSIL. Overall, women are receptive to anal Pap screening; however, the no-show rate for follow-up HRA is 64%. Conclusions: Anal pap screening in an existing colposcopy clinic is a feasible model for detecting anal dysplasia and could be replicated for HIV+ women in other locales. Further study should assess the effect of staff engagement and patient education on screening to improve follow-up HRA rates.