Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia

Sep 21, 2026

The study pilots a screen-triage-treat strategy to address limited anal cancer screening and treatment access in Liberia, especially among men who have sex with men (MSM). It evaluates feasibility for anal high-grade squamous intraepithelial lesions (aHSIL) using anal self-swabbing for high-risk HPV and offered HIV testing. Participants with positive results proceed through high-resolution anoscopy and infrared coagulation, with data analyzed in SPSS.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Objective

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Introduction

Piloting of a Screen-TriageTreat Surgical Approach Model for Management of Anal Cancer in Liberia CHRISTOPHER W. REYNOLDS WHITNEY LIEB ANDREA SCHECTER MICHAEL M GAISA STEPHEN K. MCGILL EVANS L. ADOFO ANN MARIE BEDDOE *Author affiliations can be found in the back matter of this article ABSTRACT Background: While cancer is a leading cause of death worldwide, significant disparities exist in care access in low-and middle-income countries (LMICs) . In Liberia, screening and treatment for anal cancers remain limited, and are exacerbated among vulnerable groups, including men who have sex with men (MSM) . Screen-triage-treat models for cancerous lesions have been successful in reducing cervical cancer mortality, but the feasibility of this approach has not been studied for anal cancers in a low-resource context. Objective: The aim of this study is to determine the feasibility of implementing a screen-triage-treat model for anal high-grade squamous intraepithelial lesions (aHSIL) among MSM in Liberia. Methods: This descriptive study represented a collaboration between Stop AIDS in Liberia (SAIL) and health institutions in Liberia and the USA. MSM and transgender participants were recruited through convenience sampling with SAIL peer-educators. A survey validated by SAIL experts assessed demographics and sexual risk factors. Participants underwent anal self-swabbing for high-risk human papillomavirus (HPV) and offered human immunodeficiency virus (HIV) testing. Those with positive results were offered a screen-triage-treat model through high-resolution anoscopy (HRA) and infrared coagulation (IRC) . Data were cleaned and analyzed in SPSS. Findings: Among 110 participants, most were single (n = 94, 88%) and without formal employment (n = 21, 75%). Participants engaged in regular anal (n = 64, 60%), oral (n = 62, 58%), and receptive sex (n = 58, 54%), and sex with women (n = 51, 48%) . Nearly 20% of participants reported being HIV positive (n = 21). In all, 50 participants (45%) tested positive for anal high-risk HPV, 34 (68%) elected to undergo HRA, and 10 (84%) were treated with IRC. Of those who underwent HRA, 75% tested HIV positive. ORIGINAL RESEARCH CORRESPONDING AUTHOR: Christopher W. Reynolds Department of Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA [chwre@med.umich.edu](chwre@med.umich.edu) KEYWORDS: Anal cancer, men who have sex with men (MSM), Liberia, surgical care, human papillomavirus TO CITE THIS ARTICLE: Reynolds CW, Lieb W, Schecter A, Gaisa MM, McGill SK, Adofo EL, Beddoe AM. Piloting of a Screen-Triage-Treat Surgical Approach Model for Management of Anal Cancer in Liberia. Annals of Global Health. 2024; 90(1): 75, 1– 11. DOI: [https://doi.org/10.5334](https://doi.org/10.5334)[ ](https://doi.org/10.5334)[/aogh.4576](/aogh.4576) Conclusions: Our findings suggest that a screen-triage-treat model presents a feasible option to identify and reduce the incidence of anal cancer among MSM in Liberia. The screen-triage-treat model, with proven success in management of cervical dysplasia, may be a viable option to treat aHSIL for anal cancer prevention in LMICs. Reynolds et al. Annals of Global Health DOI: 10.5334/aogh.4576 2 INTRODUCTION Although commitments to health equity are gaining increasing international attention, significant disparities in access to cancer care persist around the world [1] . Despite cancer being the second leading cause of death worldwide, a significant untreated disease burden remains in low-and middle-income countries (LMICs) [2] . Out of approximately 9.9 million cancer deaths in 2020, nearly 70% were in LMICs, with the most significant disparities between high-and low-income countries being from preventable and treatable cancers [3, 4]. Persons with immunocompromising conditions are at increased risk of developing and experiencing significant morbidity and mortality from cancer, including those with human im

FAQs

What was the study’s main objective in Liberia?

To determine the feasibility of implementing a screen-triage-treat model for anal high-grade squamous intraepithelial lesions (aHSIL) among MSM in Liberia.

How did the study identify participants at risk?

Participants underwent anal self-swabbing for high-risk HPV and were offered HIV testing; those with positive results were offered follow-up within the screen-triage-treat pathway.

What procedures were used for screening, triage, and treatment in positive participants?

High-resolution anoscopy (HRA) and infrared coagulation (IRC) were used within the screen-triage-treat model for those with positive findings.

What did the findings indicate about feasibility?

The results suggest the screen-triage-treat model is a feasible option to identify and reduce the incidence of anal cancer among MSM in Liberia.

Sep 21, 2026

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