HPV and HIV - clinical practices and protocols

HPV and HIV - clinical practices and protocols
Dear Healthcare Professional,

We invite you to anonymously participate in this survey focused on screening for and prevention of HPV-related anal cancer in adult (18+) people living with HIV in Europe, with special focus on women.

Women living with HIV have an increased risk of anal cancer in comparison to women without HIV, yet they are often omitted in guidelines for screening for anal cancer.

This survey aims to provide insight into the clinical practices and protocols followed by healthcare professionals (infectious diseases specialists/HIV specialists/genitourinary specialists/gynecologists/general practitioners/proctologist/oncologists/surgeons/nurses) taking care of people with HIV across different international settings.

By gathering this information, we hope to enhance our understanding of HPV screening practice and improve European guidelines.

This survey consists of 18 questions and takes 10 minutes to complete. And by completing this survey, you give consent to your participation in this study.

Thank you for taking the time to complete this survey.

Sincerely,

European AIDS Clinical Society’s Women Against Viruses in Europe Group

GENERAL INFORMATION
In what country do you work?*
1. What is your profession?

Infectious diseases medical doctorHIV specialistGenitourinary medical doctorGynecologistGeneral practitionerProctologistOncologistSurgeonNurseOther
2. What is the average number of people with HIV treated in your institution annually?

less than 500501-10001001-5000more than 5000
3.On average, how many cisgender women living with HIV are treated in your institution annually?

less than 100101-1000more than 1000
4.How many transgender women living with HIV are treated in your institution annually?

None1-100More than 100I don't know/I am not sure

GUIDELINES – SCREENING
5. Which guidelines do you follow for screening and prevention of HPV-related anal cancer in adult (18+) people living with HIV?

National HIV GuidelinesInternational Anal Neoplasia Society's consensus guidelinesEACS GuidelinesOther (please specify)
Comment:

6. Is screening for anal cancer included in the guidelines you follow for management of the following groups of people with HIV?

	Yes	No	Not applicable – no guidelines
Gay, bisexual and other men who have sex with men (GBMSM)
Men having sex with women (MSW)
Cisgender women
Transgender women (TW)
Cisgender women with history of anogenital HSIL or cancer*

*Anogenital HSIL (high-grade squamous intraepithelial lesion) or cancer referring to vulval, cervical, vaginal and anal
7. Please indicate which anal cancer screening methods are recommended by the HIV guidelines you follow?

Digital ano-rectal examination (DARE)Anoscopy/ High resolution anoscopy (HRA)Anal cytologyAnal HPV DNA testingAnal cytology + HPV co-testingOther (please specify)
GUIDELINES SCREENING – SCREENING FREQUENCY

8. If the HIV guidelines you follow include a screening protocol for anal cancer screening,what is the recommended frequency for screening for each of the following groups?

	Annually	Every two years	Every three years	Other (please specify) **
Gay, bisexual and other men who have sex with men (GBMSM)
Men having sex with women (MSW)
Cisgender women
Transgender women (TW)
Cisgender women with history of anogenital HSIL or cancer*

*Anogenital HSIL (high-grade squamous intraepithelial lesion) or cancer referring to vulval, cervical, vaginal and anal
**Other frequency:

PRACTICE/MANAGEMENT

9. Do you routinely ask your patients about symptoms of anal cancer (bleeding, itching, palpable masses,and/or pain in the anus)?

	Yes	No
Gay, bisexual and other men who have sex with men (GBMSM)
Men having sex with women (MSW)
Cisgender women
Transgender women (TW)
Cisgender women with history of anogenital HSIL or cancer*

*Anogenital HSIL (high-grade squamous intraepithelial lesion) or cancer referring to vulval, cervical, vaginal and anal

10. Are the following available in your clinical setting:

	Yes, by referral to another service	Yes, and integrated within HIV services	No
High resolution anoscopy (HRA)
Cytologist analysing anal cytology
HPV genotyping
Proctologist
Gynecologist

11. Are these resources available for your patients free of charge?

	Free/Fully reimbursed	Partially reimbursed	Not reimbursed	Other (please specify)**
High resolution anoscopy (HRA)
Cytologist analysing anal cytology
HPV genotyping
Proctologist
Gynecologist

**Other reimbursement:
Comments:

PRACTICE – FREQUENCY of DARE

12. At what age do you start the screening of people living with HIV for anal cancer?

	35 years	45 years	> 50 years	Other (please specify)**
Gay, bisexual and other men who have sex with men (GBMSM)
Men having sex with women (MSW)
Cisgender women
Transgender women (TW)
Cisgender women with history of anogenital HSIL or cancer*

**Other age:
*Anogenital HSIL (high-grade squamous intraepithelial lesion) or cancer referring to vulval, cervical, vaginal and anal

13. How often do you or the team in which you work perform digital ano-rectal examination (DARE) for each of the following groups?

	Annually	Every two years	Every three years	Other (please specify)**
Gay, bisexual and other men who have sex with men (GBMSM)
Men having sex with women (MSW)
Cisgender women
Transgender women (TW)
Cisgender women with history of anogenital HSIL or cancer*

*Anogenital HSIL (high-grade squamous intraepithelial lesion) or cancer referring to vulval, cervical, vaginal and anal
**Other frequency:
14. What do you think are barriers to screening for anal cancer of cis gender women? (Please tick all that apply)

Lack of guidelinesLack of resourcesLack of integrated resources in HIV careStigmaLack of consent from patientsI don’t know/I am not sureOther (please specify)

VACCINATION POLICY AND ACCESSIBILITY
15. What is the policy for HPV vaccination in your country (regardless of HIV)? Please tick all that apply.

Free of charge for allFree but only for teenagersFree but only for teenage girlsFree but only for those who have a history of an HPV-related anogenital HSIL or cancerFree but only for MSMFree but only for GBMSMThere is no free vaccination availableOther (please specify)
16. Is the HPV vaccination available free of charge for people living with HIV in your country? Please tick all that apply.

Yes, free of charge for all people living with HIVYes, free of charge but only for those in some specific age groups eg. teenagers, people living with HIV up to the age of 45Yes, free of charge but only for MSM living with HIVNoOther (please specify)
VACCINATION- PRACTICE

17. Do you personally recommend your adult (aged 18-45) patients with HIV to be vaccinated against HPV?

	Yes, to all	Yes, but only to those with a positive HR-HPV result	No
Gay, bisexual and other men who have sex with men (GBMSM)
Men having sex with women (MSW)
Cisgender women
Transgender women (TW)
Cisgender women with history of anogenital HSIL or cancer*

*Anogenital HSIL (high-grade squamous intraepithelial lesion) or cancer referring to vulval, cervical, vaginal and anal
If you recommend it to other groups of patients, please specify:
18. If you answered ‘NO’ to the previous questions, why do you personally not recommend your adult (aged 18-45) patients with HIV to be vaccinated against HPV?

Insufficient data about effectiveness of vaccination in adultsIt is not available free of chargeOther (please specify)
Thank you for participating in the survey. If you have any comments, please share them with us.
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