# Full Project 2: Determining Optimal Anal Cancer Prevention Strategies for HIV-Infected Individuals Living in Puerto Rico

> **NIH NIH U54** · UNIVERSITY OF TX MD ANDERSON CAN CTR · 2021 · $115,793

## Abstract

FULL PROJECT 2: DETERMINING OPTIMAL ANAL CANCER PREVENTION STRATEGIES 
FOR HIV-INFECTED INDIVIDUALS LIVING IN PUERTO RICO 
PROJECT SUMMARY/ABSTRACT 
Squamous cell carcinoma of the anus (SCCA) is an epidemic among persons living with HIV (PLWH). Studies 
in the US and Puerto Rico (PR) have reported >80-fold risk of SCCA among PLWH when compared with the 
general population. Guidelines based on expert opinion recommend anal cancer screening for PLWH. To 
inform evidence-based use of screening, studies are currently underway; however, findings from those studies 
will not be generalizable to PLWH in PR. This is because racial and ethnic composition, disease prevalence, 
anal cancer treatment outcomes including cost and quality of life (QOL) substantially differ for PLWH in PR. 
This increases the importance of anal cancer screening evaluation specifically and separately for PLWH in PR 
majority of which are of Hispanic origin. Furthermore, no ongoing or future randomized controlled trials (RCTs) 
will evaluate mortality benefits of screening as it unethical to evaluate a “no screening” arm. As such, a 
mathematical model (incorporating epidemiological, cost, and quality of life data specific to PLWH in PR) could 
be utilized as a unique tool to evaluate survival and QOL benefits and cost-effectiveness of screening with the 
goal to promote health and value-based care. Our overarching goal is to optimize anal cancer prevention for 
PLWH in PR. We will study the epidemiology of SCCA, and evaluate the cost of and QOL after SCCA 
treatment to inform a mathematical model that will determine the best screening regimen for PLWH in PR. We 
also seek to study critical barriers and facilitators necessary to decrease potential uncertainty in screening 
adoption and adherence to screening recommendations. Our Specific Aims are: (1) Determine epidemiological, 
cost, and QOL measures of anal precancer and cancer among PLWH living in PR. (2) Identify barriers to and 
facilitators of screening for anal cancer, and adherence to anal cancer screening and high-grade squamous 
intraepithelial lesions (HSIL) treatment. (3) Construct and execute a mathematical model to determine effective 
and cost-effective screening strategies for the detection of anal precancer among PLWH in PR. (4) Use value 
of information (VOI) analysis to determine high priority future clinical studies to improve screening accuracy 
and adherence to screening recommendations. In Aims 1 and 2, we will perform secondary data analyses of 
existing databases, and conduct focus groups and three epidemiologic studies (two cross-sectional studies 
and one cohort study) that involve patient recruitment. Parameters identified through these activities will inform 
the development of the SCCA screening model and the execution of the VOI analysis (Aims 3 and 4). The end 
result of this study will be utilized to inform an optimal anal cancer screening regimen specific to PLWH in PR.

## Key facts

- **NIH application ID:** 10249300
- **Project number:** 5U54CA096300-18
- **Recipient organization:** UNIVERSITY OF TX MD ANDERSON CAN CTR
- **Principal Investigator:** Ashish A. Deshmukh
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $115,793
- **Award type:** 5
- **Project period:** 2002-08-16 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10249300

## Citation

> US National Institutes of Health, RePORTER application 10249300, Full Project 2: Determining Optimal Anal Cancer Prevention Strategies for HIV-Infected Individuals Living in Puerto Rico (5U54CA096300-18). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10249300. Licensed CC0.

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