447. Improvement of Anal Pap Collection Documentation and Adequacy in PLWHIV in Infectious Diseases Clinic


 
 
 Anal Pap smear is an essential screening tool for high-risk human papillomavirus (hrHPV)-associated anal squamous cell carcinoma (ASCC), particularly in people living with HIV (PLWHIV). Currently, there is no consensus regarding time interval or protocols for screening of anal hrHPV-associated cancer. Limited reports suggest self-collected specimens have similar cytology sensitivity compared to physician-collected samples.
 
 
 
 We utilized a Quality Improvement project (QIP) to assess validity of self-collected anal swab specimens (SCS) for screening of hrHPV-related anal lesions versus physician-collected specimens (PCS) over 3 months. The protocol was implemented in an Infectious Diseases clinic by patients and physicians during routine visits. Patients learned about the QIP via educational handout and were offered self- or physician-collection.
 
 
 
 A total of 60 patients participated. Seventy-five percent opted for self-collection and 35/45 (78%) SCS were adequate for interpretation, compared to 10/15 (67%) PCS. Fisher exact test value was 0.49, indicating no significant difference between groups (at p< .05). In total, 77% of patients completed the satisfaction survey. Only 13% reported preference for physician-performed procedure, while 63% felt that a self-collection option made them more likely to complete the Pap. A limitation to this project is the Hawthorne effect, as participants were aware of the QIP and that validity of the samples depended on appropriate sample collection. There was also a relatively small sample size of self-collected specimens (n=45).
 Survey results
 Final result from surveys answered by patients that participated in the project.
 
 
 
 Survey analysis showed increased patient satisfaction and similar adequacy of samples collected. While the project was not powered to demonstrate an increase in acceptance of anal Paps, increased satisfaction could lead to improvement over time with a simple and inexpensive workflow adjustment. Additionally, with expansion of telehealth, self-collected anal Paps may increase opportunities to complete screening at times physicians are not available. Studies with larger populations, in multiple institutions and with varying educational handouts/instruction methods may provide better data to corroborate recommendations regarding best practices for screening for ASCC.
 
 
 
 All Authors: No reported disclosures.
