title: The inside story. Physicians' views on digital ano-rectal examination for anal cancer screening of HIV positive men who have sex with men.
abstract: OBJECTIVE
  Anal cancer is relatively common amongst HIV positive men who have sex with men (MSM), but little is known about the anal cancer screening practices of HIV physicians, and whether digital ano-rectal examination (DARE) is utilized for this. To determine the practice of anal cancer screening among HIV physicians, and to identify any barriers for implementing DARE as a method for anal cancer screening.
  
  
  METHODS
  36 physicians from a sexual health centre, 2 tertiary hospital infectious diseases outpatient clinics, and 2 general practices completed a questionnaire on their practice of anal cancer screening amongst HIV positive MSM. Physicians were asked about their confidence in using DARE for anal cancer screening, and whether they perceived barriers to implementing this in their clinic.
  
  
  RESULTS
  Most physicians (86%, 95% CI: 71-95) thought that anal cancer screening was important, but only 22% (95% CI: 10-39) were currently screening. Reasons for not screening were the absence of guidelines (87%, 95% CI: 60-98), lack of time (47%, 95% CI: 30-65), and concern about patient acceptability of DARE (32%, 95% CI: 17-51). Whilst 67% (95% CI: 49-81) of physicians felt confident in performing a DARE, only 22% (95% CI: 10-39) were confident in recognizing anal cancer using DARE.
  
  
  CONCLUSIONS
  Although HIV physicians were aware of the need for anal cancer screening among the HIV + MSM population, few were routinely screening. If DARE were to be incorporated into routine HIV care, guidelines recommending screening and up-skilling of HIV physicians to recognize anal cancer are needed.
authors.affiliation: University of Melbourne, School of Population and Global Health.
authors.forename: Jason
authors.initials: J
authors.lastname: Ong
authors.forename: Marcus
authors.initials: M
authors.lastname: Chen
authors.forename: Meredith
authors.initials: M
authors.lastname: Temple-Smith
authors.forename: Sandra
authors.initials: S
authors.lastname: Walker
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hoy
authors.forename: Ian
authors.initials: I
authors.lastname: Woolley
authors.forename: Andrew
authors.initials: A
authors.lastname: Grulich
authors.forename: Christopher
authors.initials: C
authors.lastname: Fairley
mesh_terms: D001005:Anus Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male
keywords: Anal cancer; Anal cancer screening; Digital ano-rectal examination (DARE); HIV; Men who have sex with men (MSM)