1. Patient compliance with screening and treatment protocols for anal dysplasia in a high-risk population

Abstract

Background: Anal cancer rates are increasing in the US and particularly in patients with HIV. High-resolution anoscopy (HRA) with ablation of precursor lesions is thought to be critical towards reversing this trend but patient compliance is poor. The aim of this study was to identify factors associated with loss to follow-up, so that targeted initiatives might be introduced to improve compliance and maximise cancer prevention. Methods: Data on all patients undergoing HRA at our institution was reviewed. We categorised patients as ‘compliant’ if they underwent continued surveillance or ablation within recommended time intervals or as ‘non-compliant’ if they delayed treatment or were lost to follow-up entirely. Demographic factors and disease-related parameters were compared across both groups. Results: 153 patients underwent HRA, including 114 men (71% MSM) and 123 HIV-positive patients (99.2% on ART). Most patients had LSIL on Pap smear (51%) with 23.5% ASCUS and 7.8% HSIL. 35% of patients had high-grade biopsies. 96 patients were compliant with follow-up (62.7%) and 57 patients were not. There were no significant demographic differences between the two groups. However, the compliant group contained a significantly higher proportion of patients with high-grade lesions compared with the non-compliant group (27.1% vs 15.8%, P = 0.0003). Conclusions: In this preliminary report, there were no demographic variables associated with likelihood of follow-up. However, high-grade pathology was more frequently identified in the compliant group. Whether this was due to more aggressive tracking of these patients remains unclear. Further efforts to identify predictive factors for compliance are essential.