38. Anal cancer screening in HIV primary care: uptake and outcomes
Bibliographic record
Abstract
Background Anal cytology (Pap tests) plus high-resolution anoscopy (HRA) as required are felt to be the optimal approach to anal cancer screening. We present preliminary results from STANDOUT, a study of acceptability and outcomes of anal cancer screening of HIV+ MSM in primary care practices. Methods: All previously unscreened HIV+ MSM from 9 HIV primary care practices, were invited by email or letter to receive anal cancer screening. Responders had anal cytology done at specially arranged or routine clinic visits. Those with high-grade squamous intraepithelial lesions (HSIL) on anal cytology were offered HRA to assess for anal intraepithelial neoplasia (AIN). Those with AIN 2/3 on biopsy were randomised to receive trichloroacetic acid (TCA) or infrared coagulator (IRC) treatments. Results: 1733 patients were invited and 921 (53%) agreed to have anal cytology done. Among those screened, 3 had unsatisfactory samples; 596 (65%) had normal cytology, 253 (27%) had low-grade squamous intraepithelial lesions (LSIL) and 69 (7.5%) had HSIL. HRA results are available in 64: 41 (64%) had histologic high-grade disease (29 had AIN2 and 12 had AIN3). Those with AIN 2/3 were randomised to receive treatment with TCA (16 patients) or IRC (18 patients). Treatment successes at 3 months were 6 of 15 patients for TCA (40%) and 11 of 16 patients for IRC (69%). Conclusions: In this sample of HIV+ MSM, about half of those invited for anal cancer screening agreed to have it done. Most with HSIL had histological high-grade disease and were treated. IRC was more successful than TCA at ablating high-grade disease.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".