Amsterdam 2015
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| Abstract #2378 - Poster 1 | ||||
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Session: 58.4: Poster 1 (Poster) on Tuesday in Chaired by Authors: Presenting Author: Dr. Nicolas Sheon - UCSF, United States |
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| Additional Authors: Dr Kouassi Martin, Mr Brou Sylvain, | ||||
| Method / Issue: Issues: While the HIV infected are living longer thanks to HIV treatments, they are up to 80 times more at risk for anal cancer than the general population. Like cervical cancer, anal cancer is caused by HPV, and precursor anal lesions can be similarly detected using cytology and anoscopy. Unlike routine screening for cervical cancer, however,screening for and removal of anal HPV lesions has yet to be proven effective in preventing anal cancer. As a result, preventive guidelines are lacking and access to screening and treatment of anal HPV is limited. HIV-positive patients have historically been excluded from cancer trials due to risk of interactions with HIV therapy. The transformation of HIV into a chronic disease linked to rare cancers means that cancer trials for HIV positive patients are becoming increasingly necessary. The unprecedented convergence of HIV stigma and anal cancer stigma presents unique challenges for clinical trial recruitment, particularly among ethnic minority populations. Most anal cancer research has traditionally relied on White MSM participants. Although studies have shown that African Americans and Latinos are just as willing to be screened for cancer as Whites, they remain underrepresented in cancer clinical trials. | ||||
| Results / Comments: Project: In 2013, the National Cancer Institutes awarded $90 million to researchers at the University of California, San Francisco to conduct a definitive randomized controlled trial to determine whether the removal of HPV lesions prevents anal cancer. We estimate that the ANCHOR study will need to screen over 17,000 participants to enroll 5,085 with HPV lesions, of whom less than 50 will develop cancer during the course of the trial. Participants will be randomized to receive either treatment or active monitoring of their anal HPV lesions. The ANCHOR study will greatly increase access to anal cancer screening at 15 sites across the US. The success of this trial will depend to a large degree on our ability to not only enroll but also to retain 5,085 participants for up to eight years of observation. | ||||
| Discussion: Lessons Learned: We approached the challenge of recruitment and retention using the theoretical perspective of syndemic theory, which posits the importance of homophobia, AIDS stigma and structural vulnerability for increasing risk for HIV and cancer morbidity. Our insights are based on surveys, focus groups, and longitudinal interviews with HIV -positive clinical trial participants. Those who survived the initial waves of the epidemic express a great deal of altruism and enthusiasm for the trial despite its length and the invasive nature of the procedures. We will also discuss challenges we have encountered in screening participants for structural vulnerabilities and how we are working with an AIDS Service Organization to help. Finally, this presentation will outline our innovative and successful approach to branding and messaging the ANCHOR study that uses humor to appeal to a variety of populations, overcome stigma, and promote retention. | ||||
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