HPV infection and anal dysplasia in Vancouver:   Preliminary findings from the ManCount Survey Dr. Mark Gilbert BC Centre ...
Acknowledgements <ul><li>Study Team </li></ul><ul><li>BC Centre for Disease Control </li></ul><ul><li>Dr. Mark Gilbert  (P...
ManCount Survey <ul><li>Vancouver site of the M-Track surveillance system </li></ul><ul><li>Recruitment at gay community v...
Self-collection of rectal swabs <ul><li>Can be tested for Human Papillomavirus (HPV),  Chlamydia , gonorrhea, and abnormal...
Objective (Sub-study) <ul><li>Use self-collected rectal swabs to measure the prevalence of HPV,  Chlamydia,  gonorrhea, an...
Methods <ul><li>Subset of ManCount participants (September ‘08 to February ‘09) </li></ul><ul><li>At completion of DBS and...
Results - Participation In total, 252 specimens collected 239 (94.8%) specimens of sufficient quality for testing
Results – Anal Cytology <ul><li>Explanations? </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Not fully inserted ...
Results – Anal cytology *satisfactory specimens only Prevalence estimates from other studies in pink font (setting, popula...
Results – HPV infection Betaglobin (marker of adequacy) Number Percent Betaglobin positive  159 / 239 67% [62-72%] Betaglo...
Results – HPV infection *Betaglobin positive specimens only <ul><li>Low Risk types: 6,11,40,42,43,44,54,61,70,72,81 </li><...
Conclusions <ul><li>Self-collection in community settings  </li></ul><ul><ul><li>may have impact on specimen adequacy </li...
Next steps <ul><li>Consider prevalence of HPV and anal dysplasia in relation to questionnaire data related to risk, HPV va...
<ul><li>www.mancount.ca </li></ul><ul><li>Mark Gilbert </li></ul><ul><ul><li>[email_address] </li></ul></ul>
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HPV infection and anal dysplasia in Vancouver: findings from the ManCount Survey.

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HPV infection and anal dysplasia in Vancouver: findings from the ManCount Survey. Presented by Mark Gilbert, BC CDC, at the 5th Annual Gay Men's Health Summit held in Vancouver, BC on November 9th and 10th, 2009.

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  • Lampinen et al. Illustrated instructions for self-collection of anorectal swab specimens and their adequacy for cytological examination. Sex Transm Dis 2006; 33(6):386-388.
  • HPV infection and anal dysplasia in Vancouver: findings from the ManCount Survey.

    1. 1. HPV infection and anal dysplasia in Vancouver: Preliminary findings from the ManCount Survey Dr. Mark Gilbert BC Centre for Disease Control Gay Men’s Health Summit, Nov 10 ‘09
    2. 2. Acknowledgements <ul><li>Study Team </li></ul><ul><li>BC Centre for Disease Control </li></ul><ul><li>Dr. Mark Gilbert (PI), Michael Kwag, Wendy Mei </li></ul><ul><li>BC Centre for Excellence in HIV </li></ul><ul><li>Dr. Bob Hogg (PI), Eric Druyts, Arn Schilder Dr. David Moore </li></ul><ul><li>Community-Based Research Centre </li></ul><ul><li>Dr. Rick Marchand, Dr. Terry Trussler </li></ul><ul><li>Health Initiative for Men </li></ul><ul><li>Phillip Banks, Jim Sheasgreen </li></ul><ul><li>Public Health Agency of Canada </li></ul><ul><li>Dana Paquette, Rhonda Kropp, Stephen Cule, Susanna Ogunnaike-Cooke, Maureen Perrin, Marissa Maguire, Liz Venditti, Gayatri Jayaraman, Dr. Chris Archibald </li></ul><ul><li>Vancouver Coastal Health </li></ul><ul><li>Dr. Réka Gustafson (PI), Miranda Compton </li></ul><ul><li>Survey Interviewers: </li></ul><ul><li>Jody Jollimore, Adam Graham, Dirceu Campos, Lukas Maitland, Olivier Ferlatte, Seamus Sullivan, Ray Sullivan </li></ul><ul><li>HPV (Self-collection) Component </li></ul><ul><li>BC Cancer Agency </li></ul><ul><li>Dr. Chen Zhou, Dr. Dirk van Niekerk, Dr. Kathy Seballos, Jane Lo </li></ul><ul><li>BC Centre for Disease Control </li></ul><ul><li>Dr. Gina Ogilvie, Darlene Taylor </li></ul><ul><li>National Microbiology Laboratory </li></ul><ul><li>Dr. Alberto Severini </li></ul><ul><li>Community Advisory Committee </li></ul><ul><li>Robert Hong (VCH), Paul Harris (BCCFE), Shimpei Chihara (ASIA), Elgin Lim (BCPWA), Richard O’Donnell (VCH), Chris Buchner (Qmunity), Matthew Taylor (PEERS), Hywel Tuscano (YouthCO), Devon MacFarlane (VCH) </li></ul>
    3. 3. ManCount Survey <ul><li>Vancouver site of the M-Track surveillance system </li></ul><ul><li>Recruitment at gay community venues, groups, events </li></ul><ul><li>Questionnaire and collection of dried blood spots (DBS) for testing for HIV and other sexually transmitted infections </li></ul><ul><li>Eligible if identified as a man who has sex with men, age 19 years or older </li></ul><ul><li>Survey ran from August 2008 to February 2009 </li></ul><ul><li>1169 men participated </li></ul><ul><li>1139 (97.4%) contributed a dried blood spot </li></ul>
    4. 4. Self-collection of rectal swabs <ul><li>Can be tested for Human Papillomavirus (HPV), Chlamydia , gonorrhea, and abnormal anal cells (anal dysplasia) </li></ul><ul><li>High prevalence among gay men and other MSM, particularly HIV positive men </li></ul><ul><li>In general, considered equivalent to specimens collected by health care providers </li></ul><ul><li>Methodology developed and validated in the Vanguard study (BCCFE) </li></ul>Lampinen et al. STD 2006; 33(6):386-388.
    5. 5. Objective (Sub-study) <ul><li>Use self-collected rectal swabs to measure the prevalence of HPV, Chlamydia, gonorrhea, and abnormal anal cytology among gay, bisexual and other MSM in Vancouver </li></ul><ul><li>Incorporating into Mancount allows for the analysis to include questionnaire and DBS data (e.g., risk behaviours, HIV status) along with swab results </li></ul>
    6. 6. Methods <ul><li>Subset of ManCount participants (September ‘08 to February ‘09) </li></ul><ul><li>At completion of DBS and questionnaire, consented for self-collection component </li></ul><ul><li>On-site (Option 1) or at follow-up site (Option 2) </li></ul><ul><li>Given self-collection kit </li></ul><ul><li>$10 honorarium </li></ul><ul><li>Tested HPV, Ct, Gc, cyt </li></ul>
    7. 7. Results - Participation In total, 252 specimens collected 239 (94.8%) specimens of sufficient quality for testing
    8. 8. Results – Anal Cytology <ul><li>Explanations? </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Not fully inserted </li></ul></ul><ul><ul><li>Lubricant, douching </li></ul></ul><ul><ul><li>Environmental factors </li></ul></ul>Lampinen et al. STD 2006; 33(6):386-388. Specimen adequacy Number Percent Satisfactory for analysis 149 / 239 62% [56-69%] Unsatisfactory for analysis 90 / 239 38% [32-44%] Unsatisfactory for analysis (Vanguard study, same protocol) 17% [12-22%]
    9. 9. Results – Anal cytology *satisfactory specimens only Prevalence estimates from other studies in pink font (setting, populations may vary). Category Total (n=149) HIV+ (n=42) HIV- (n=107) Normal cytology 58% [50-66%] 36% [21-50%] 29-76% 66% [57-75%] 68-100% High grade squamous intra-epithelial lesion (HSIL) 11% [6-17%] 31% [17-45%] 5-22% 4% [0-7%] 3-5% Low grade squamous intra-epithelial lesion (LSIL) 19% [13%-25%] 26% [13-40%] 19-49% 16% [9-23%] 7-5% Atypical results (ASCUS, ASC-H) 12% [7-17%] 7% [0-15%] 7-26% 14% [7-21%] 5%
    10. 10. Results – HPV infection Betaglobin (marker of adequacy) Number Percent Betaglobin positive 159 / 239 67% [62-72%] Betaglobin negative 80 / 239 33% [28-38%]
    11. 11. Results – HPV infection *Betaglobin positive specimens only <ul><li>Low Risk types: 6,11,40,42,43,44,54,61,70,72,81 </li></ul><ul><li>High Risk types: 16,18,26,31,33,35,39,45,51,52,53,56,58,59,66,68,73,82 </li></ul>Prevalence estimates from other studies in pink font (setting, populations, HPV classification may vary). Munoz, NEJM 2003; 348:518-527. Category Total (n=159) HIV+ (n=42) HIV- (n=116) HPV Negative 38% [30-45%] 17-35% 21% [9-33%] 6-65% 43% [34-52%] 8-60% Low Risk HPV type 37% [30-44%] 36-59% 62% [47-77%] 7-52% 28% [20-37%] 8-67% High Risk HPV type 47% [39-55%] 29-41% 71% [57-85%] 25-84% 39% [30-48%] 22-33%
    12. 12. Conclusions <ul><li>Self-collection in community settings </li></ul><ul><ul><li>may have impact on specimen adequacy </li></ul></ul><ul><li>Prevalence estimates are similar </li></ul><ul><li>Wide confidence intervals (small sample) </li></ul><ul><li>Preliminary results & further analysis required: </li></ul><ul><ul><li>How comparable are participants to non-participants? </li></ul></ul><ul><ul><li>Impact of excluding “Option 2” from analysis </li></ul></ul>
    13. 13. Next steps <ul><li>Consider prevalence of HPV and anal dysplasia in relation to questionnaire data related to risk, HPV vaccine and anal pap testing </li></ul><ul><li>Goal is to inform BC policy and program discussions regarding HPV vaccine and anal dysplasia screening among gay men and other MSM </li></ul>
    14. 14. <ul><li>www.mancount.ca </li></ul><ul><li>Mark Gilbert </li></ul><ul><ul><li>[email_address] </li></ul></ul>
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