# Integrated Model for the Prevention of Anal Cancer using screen and Treat for HSIL (IMPACT)

> **NIH NIH U01** · UNIVERSITY OF MARYLAND BALTIMORE · 2022 · $773,239

## Abstract

Project Abstract
Anal cancer risk is 80-fold higher among men who have sex with men (MSM) living with HIV compared to the
general population, making MSM a critical population for implementing evidence-based anal cancer prevention
interventions. A randomized controlled trial at 21 clinical sites in the United States of people living with HIV,
recently established treatment of high-grade squamous intraepithelial lesions (HSIL) as an evidence-based
intervention (EBI) for anal cancer prevention. Given its established efficacy, HSIL screening and treatment
should be implemented as prophylactic care to prevent anal cancer in low- and middle-income country (LMIC)
settings where HIV is highly prevalent. To accelerate adoption of HSIL screening and treatment in LMIC settings,
we will leverage an existing HIV infrastructure, the TRUST clinic, an MSM-friendly facility in Nigeria that has
been providing HIV care to a cohort of MSM since 2012. We conducted a proof-of-concept anal cancer screening
and treatment study at the TRUST clinic and found high uptake in the MSM community; representativeness, as
those screened had similar prevalence of HIV and high-risk human papillomavirus as our overall cohort; and
overall patient satisfaction. Despite high screening volumes, we under-detected and under-treated HSIL.
Knowledge gaps in HSIL screening and treatment among both the care team and the participants were identified
as major barriers that impeded implementation of the EBI with fidelity. The objective of the proposed Integrated
Model for the Prevention of Anal Cancer using screen and Treat for HSIL (IMPACT) study is to address these
barriers while capitalizing on facilitators within the existing TRUST clinic infrastructure to create an enhanced
training on Screening and Treatment of HSIL (e-STH) intervention. To achieve this goal, in AIM 1, we will use
the Consolidated Framework for Implementation Research (CFIR) and mixed methods to identify barriers and
facilitators to usual training on the EBI at the TRUST clinic. In AIM 2, we will engage an implementation team to
co-design the e-STH intervention by matching the barriers identified with CFIR with specific strategies in the
Expert Recommendations for Implementing Change (ERIC) framework. We will then take an iterative
improvement approach to test and refine the implementation of the e-STH intervention based on specific
outcomes. In AIM 3, we will conduct a prospective study to evaluate the reach, efficacy, and implementation and
explore the sustainability of e-STH compared to usual training using the RE-AIM framework. The proposed
IMPACT study will provide insight into implementation of an HSIL screening and treatment EBI adapted for
existing community-based HIV clinics in Nigeria and generate essential evidence for scalability across LMICs.

## Key facts

- **NIH application ID:** 10540829
- **Project number:** 1U01CA275053-01
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Sylvia Adebajo
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $773,239
- **Award type:** 1
- **Project period:** 2022-09-15 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10540829

## Citation

> US National Institutes of Health, RePORTER application 10540829, Integrated Model for the Prevention of Anal Cancer using screen and Treat for HSIL (IMPACT) (1U01CA275053-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10540829. Licensed CC0.

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