Implementation of and Early Outcomes From Anal Cancer Screening at a Community-Engaged Health Care Facility Providing Care to Nigerian Men Who Have Sex With Men.

PurposeAnal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa. We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria.MethodsFrom August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort. HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL). HRA proficiency was assessed by evaluating the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied. Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated. Multinomial logistic regression was used to identify those at the highest risk of SIL.ResultsMedian age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.2% to 63.6%) were HIV infected. Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies. Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.0% to 9.3%). HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL.ConclusionProficiency with HRA increased with experience over time. However, HSIL detection rates were low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding. HRA is a feasible first-line screening tool at an MSM-friendly health care facility. Years since anal coital debut and external warts could prioritize screening

Application of efficient soft computing approaches for modeling methyl ester yield from Azadirachta Indica (Neem) seed oil: A comparative study of RSM, ANN and ANFIS

This work centers on methyl ester yield modeling; by Azadirachta Indica seed oil (AISO) transesterification, using Adaptive Neuro-fuzzy Inference System (ANFIS), Artificial Neural Network (ANN) and Response Surface Methodology (RSM). AISO was obtained from the seeds of Azadirachta Indica tree. The oils were extracted from the seeds using solvent extraction method. The physicochemical properties of AISO and Azadirachta Indica seed oil methyl ester (MAISOt) were determined using standard methods. Fatty acid composition was determined using, Gas Chromatography (GC). Statistical evaluations of these models show their efficacy in the order RSM < ANN < ANFIS, with ANFIS as the best; as indicated by its very high R2 value of 0.9999 and low RMS error value of 0.0011. The ANFIS predicted minimum and maximum values for % methyl ester yields were 54.66 and 90.25 %, respectively, while the other models predicted similar methyl ester yields. The physicochemical characterization results of AISO and MAISOtsamples, show that their respective viscosity, dielectric strength (DS), pour and flash points values were (8.83 and 3.47 mm 2s−1), (33.42 and 48.93 KV), (9 and -6 °C), and (162 and 174 °C). These results indicated the MAISOtsample’s potential use as a transformer fluid. GC result indicated that MAISOtwas unsaturated. Finally, on the basis of the gotten model results, ANFIS was adjudged as the best predictive model, followed by ANN and RSM, in that order

Implementation and early outcomes from an anal cancer screen and treat program in Nigeria

Background: The risk for anal cancer is 52-fold higher in men who have sex with men (MSM) living with HIV but screening is not available in Nigeria. This study trained clinicians to screen and treat using high resolution anoscopy (HRA) and evaluate the prevalence of anal precancer. Methods: TRUST/RV368 recruited MSM for anal cancer screening in Abuja, Nigeria. Between Aug/2016-Aug/2017, 426 men completed a screening questionnaire, had a digital anorectal exam and underwent HRA. Participants could enroll in the study's initial training phase, the pilot study, or both. The most severe diagnosis on histology or cytology determined the final result. All men diagnosed with high-grade squamous intraepithelial lesions (HSIL) were offered ablative treatment with a hyfrecator. Results: Median age was 24 years (interquartile range [IQR]: 22–29) and median years since sexual debut was 6 (IQR:3–11). More HIV-infected MSM participated in the training phase as compared to the pilot (80% vs. 59%). For the 121 MSM screened during training, 9.9% (95% CI: 5.2–16.7) had low-grade squamous intraepithelial lesions (LSIL). For the 362 participants seen during the pilot study, 50.2% (95% CI:45.0–55.5) had LSIL, and 6.3% (95% CI:4.1–9.4) had HSIL. HSIL was not detected during training but it was more often detected among HIV-infected as compared to HIV-uninfected (8% vs. 4%, p<0.01) during the pilot study. Conclusions: Screening improved with time and experience. However, HSIL has been reported higher in some experienced clinics, suggesting that more on-site monitoring and experience are needed to further improve technique

Satisfaction with high-resolution anoscopy for anal cancer screening among men who have sex with men: a cross-sectional survey in Abuja, Nigeria.

BACKGROUND:Men who have sex with men (MSM) living with HIV are at increased risk for anal cancer. We evaluated satisfaction with first-time anal cancer screening using high resolution anoscopy (HRA) as a cross sectional survey among men who have sex with men (MSM) attending a community-engaged clinic in Abuja, Nigeria. METHODS:Between March and August 2017, 342 MSM underwent screening and 307 (89%) completed a satisfaction survey that evaluated 8 domains related to expectations, convenience, staff interpersonal skills, physical surroundings, technical competence, pain/discomfort, general satisfaction, and intention to re-screen if symptomatic. The 22-item questionnaire used 5-point Likert scales ranging from 1 (strongly disagree) to 5 (strongly agree). For each domain, responses to specific items were averaged, aggregated, and converted to a 100-point scaled score (SS) with 25 and 75 corresponding to disagree and agree, respectively. RESULTS:Median age was 24 years (interquartile range [IQR]: 22-28), median years since anal coital debut was 7 (IQR: 4-12), and 58% (95% confidence interval [CI]: 52-64%) were living with HIV. Despite respondents reporting pre-procedure anxiety (SS:73), most were comfortable with the setting and procedure and reported overall satisfaction (SS:74-76). Willingness to undergo future screening had the lowest score (SS:69) within the general satisfaction domain. The lowest scoring domains were pain/discomfort (SS:57) and agreement to re-screen if symptomatic (SS:59), which correlated with lower overall satisfaction (p &lt; 0.001). Domain responses did not differ by HIV infection after adjusting for multiple comparisons (p &gt; 0.006) or number of anal biopsies (all p &gt; 0.05). CONCLUSIONS:Overall, HRA was satisfactory for those naïve to screening but moving forward necessitates monitoring levels of discomfort with pain scales and normalizing dialogue around clinical symptoms of anal cancer and overall anal health to sustain future screening

Implementation of and Early Outcomes From Anal Cancer Screening at a Community-Engaged Health Care Facility Providing Care to Nigerian Men Who Have Sex With Men.

PurposeAnal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa. We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria.MethodsFrom August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort. HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL). HRA proficiency was assessed by evaluating the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied. Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated. Multinomial logistic regression was used to identify those at the highest risk of SIL.ResultsMedian age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.2% to 63.6%) were HIV infected. Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies. Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.0% to 9.3%). HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL.ConclusionProficiency with HRA increased with experience over time. However, HSIL detection rates were low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding. HRA is a feasible first-line screening tool at an MSM-friendly health care facility. Years since anal coital debut and external warts could prioritize screening