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UG1 Digital Ano-Rectal Examination (DARE) as anal cancer screening in HIV positive Men who have Sex with Men (HMSM) – is it acceptable to patients?
  1. Tamara Lewis1,
  2. Selvavelu Samraj2,
  3. Raj Patel1,2,
  4. Sangeetha Sundaram2
  1. 1School of Medicine, University of Southampton, Southampton, UK
  2. 2Dept. of Sexual Health, Solent NHS Trust, Royal South Hants Hospital, Southampton, UK

Abstract

Background/introduction Anal cancer is more common in HMSM than in HIV negative MSM or the general population. Tumours in HMSM tend to be larger and more advanced at diagnosis resulting in poorer prognosis. The European AIDS Clinical Society Guidelines recommend DARE with a screening interval of 1–3 years. However, this is only based on expert opinion. The benefit of such a strategy in a UK GUM managed HIV cohort is still unknown.

Aim(s)/objectives To assess acceptability of annual DARE to HMSM and establish patient experience of having DARE.

Methods From pre-published clinic lists covering the 8-week recruitment period, patients fitting the inclusion criteria (HMSM aged ≥ 35) were invited to participate in the study when they attended clinic. Patients were asked to complete a questionnaire and invited to have DARE as part of their consultation.

Results Of the 43 patients invited into the study, 29 [67%; 95% confidence interval (CI) 53–81] proceeded to DARE. Principal reason for refusal of DARE was ‘lack of time’ and ‘not feeling clean’. Of the 29 having DARE, 12 [41%; 95% CI 23–59] were found to have a previously unrecorded clinical abnormality. 5 [17%; 95% CI 3–31] required colorectal referral - 3 [10%] for lesions suspicious of anal intraepithelial neoplasia. Outcomes of colorectal consultation are awaited. 100% of respondents said they would have DARE again.

Discussion/conclusion Annual DARE is an acceptable addition to the routine care of HMSM. Pre-warning patients to expect DARE at a routine visit when it is due may further improve acceptability.

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