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Background: Anal cancer disproportionately affects sexual and gender minority individuals living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability. Methods: Sexual and gender minority individuals were randomised to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA 1 year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability using χ 2 tests. Results: A total of 62.8% of 196 participants who engaged in screening attended HRA. Although not significant (P = 0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.40, 95% CI 1.07–1.82), and lower among participants preferring a versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53–0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) (P = 0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), (P = 0.04). No differences in attendance by race or HIV status were observed in the home arm. Conclusions: HRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm. Anal cancer disproportionately affects men who have sex with men living with HIV. We examined whether anal HPV sampling at home versus in a clinic impacts uptake of high-resolution anoscopy (HRA), an in-clinic procedure. Anal cytology history and insertive anal sex position were associated with higher HRA uptake, and attendance differed by race and HIV status in the clinic arm. Given that people living with HIV and Black men who have sex with men are disproportionately affected by anal cancer, interventions are needed to support their clinic attendance. [ABSTRACT FROM AUTHOR]

Sexual minority men are at increased risk for anal squamous cell carcinoma. Our objective was to compare screening engagement among individuals randomized to self‐collect an anal canal specimen at home or to attend a clinic appointment. Specimen adequacy was then assessed for human papillomavirus (HPV) DNA genotyping. A randomized trial recruited cisgendered sexual minority men and transgender people in the community and assigned them to use a home‐based self‐collection swabbing kit or attend a clinic‐based swabbing. Swabs were sent for HPV genotyping. The proportions of participants completing screening in each study arm and the adequacy of their specimens for HPV genotyping were assessed. Relative risks were estimated for factors associated with screening. A total of 240 individuals were randomized. Age (median, 46 years) and HIV status (27.1% living with HIV) did not differ by study arm. A total of 89.2% and 74.2% of home‐arm and clinic‐arm individuals returned the swab, respectively (P =.003), difference between groups, 15.0% (95% CI 5.4%‐24.6%). Among black individuals, 96.2% and 63.2% in the home and clinic arms screened (P =.006). Among individuals with HIV, 89.5% and 51.9% in the home and clinic arms screened (P <.001). Self‐collected swabs and clinician‐collected swabs were comparable in adequacy for HPV genotyping (96.3% and 93.3%, respectively). People at highest risk for anal cancer may be more likely to screen if they are able to self‐collect swabs at home rather than attend a clinic. [ABSTRACT FROM AUTHOR]

Background: While self-sampling could help address anal cancer screening barriers, no studies have investigated annual engagement with this method or compared it to annual screening with a provider. Building on our baseline paper,(7) we compared annual anal screening engagement between home-based self-sampling and clinic-based clinician sampling., Methods: The Prevent Anal Cancer Self-Swab Study recruited and randomized sexual and gender minority individuals 25 years and over who have sex with men to a home or clinic arm. Home-based participants were mailed an anal human papillomavirus self-sampling kit at baseline and 12 months, while clinic-based participants were asked to schedule and attend one of five participating clinics at baseline and 12 months. Using Poisson regression, we conducted an intention-to-treat analysis of 240 randomized participants who were invited to screen at both timepoints., Results: 58.8% of participants completed annual (median = 370 days) anal screening. In the home arm, 65.0% of participants engaged in annual screening compared to 52.5% of clinic-based participants (p = 0.049). When stratified by HIV status, persons living with HIV had a higher proportion of home (71.1%) versus clinic (22.2%) annual screening (p < 0.001). Non-Hispanic Black participants participated more in home-based annual anal screening(73.1%) than annual clinic screening(31.6%) (p = 0.01). Overall, annual screening engagement was significantly higher among participants who had heard of anal cancer from an LGBTQ organization, reported "some" prior anal cancer knowledge, preferred an insertive anal sex position, and reported any prior cancer diagnosis., Conclusions: Annual screening engagement among those at disproportionate anal cancer risk was higher in the home arm., Competing Interests: Conflicts of Interest: The authors declare no conflicts of interest., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)