ACCESS Study (Anal CanCer Equity in Screening Services)

ACCESS Study (Anal CanCer Equity in Screening Services)

This ACCESS project will gather evidence for implementation of equitable anal screening for people living with HIV (PLHIV) in Ontario. People living with HIV have a 20- to 90-times higher risk for anal cancer than the general population. However, there is no routine anal screening program as there is for cervical or colorectal screening, either in Ontario or in any other jurisdiction in Canada. Recent research shows that treating early anal disease reduces the risk of progression to anal cancer by 60%. Clinical guidelines recommend periodic screening of middle-aged and older adults living with HIV for early anal cancers and for pre-cancerous lesions. The study will explore implementation of anal screening for PLHIV. The study will gather evidence in three phases: 

1. Interviews and focus groups to learn the needs of PLHIV, healthcare providers, and Ontario’s health system.
2. Work with clinicians and PLHIV and prepare toolkits to train clinicians in anal screening. Co-design media to educate PLHIV about anal screening and encourage screening participation.
3. Learn how well anal screening works by implementing and evaluating it in clinics that proceed with implementation. Lastly, to gather evidence so that anal screening can become part of routine HIV care, anal cancer is prevented, and quality of life is improved among PLHIV. 

We are using a mixed-methods design in Ontario to understand who needs to do what to implement and sustain equitable anal screening for people living with HIV, what factors are likely to facilitate or impede its implementation, and what strategies could address anticipated challenges. Our plans are informed by the Theoretical Domains Framework, the Consolidated Framework for Implementation Research, the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), and Institutional Ethnography. 

Data gathering includes: 

1. Qualitative focus groups and key informant interviews combined with document analysis (Aim 1);
2. Assembling implementation toolkits for people involved in screening deliverery and conducting focus groups with people living with HIV, the people who are targeted for screening (Aim 2);
3. And a quasi-experimental study of anal screening using field notes, electronic medical records, and qualitative interviews to measure process and outcome evaluation outcomes (Aim 3). 

Using a health equity lens, we will pay specific attention to differences by age; sex and gender, including transgender identity; sexual orientation; race/ethnicity; and geography.

The ACCESS Team is in the active phases of data collection, with preliminary findings expected to be disseminated starting in spring 2025, and more to follow in 2026.

Co-Principal Investigators 

Ann Burchell (Unity Health Toronto)
Troy Grennan (BCCDC)
Meghan Walker (Ontario Health)

Co-Investigators 

Gordon Arbess (Unity Health Toronto)
Tyler Chesney (Unity Health Toronto)
Christine Fahim (Unity Health Toronto)
Daniel Grace (University of Toronto)
Aisha Lofters (Women’s College Hospital)
Paul MacPherson (Ottawa Hospital)
Devan Nambiar (Gay Men’s Sexual Health Alliance)
Mary Ndung’u (Women’s Health in Women’s Hands)
Irving Salit (University Health Network)
Michael Silverman (St. Joseph’s Hospital London)
Kevin Woodward (HQ Toronto)