Integrating anal cancer prevention into the HIV response

Key information
- Organisation: Kimirina
- Country: Ecuador
- Region: Latin America and the Caribbean
- Stage of innovation: Stage 6: In the market and ready to scale
- Start date: 01/12/2022
- End date: 26/02/2024
- Type of innovation: Service innovation: new or improved service
- Budget: $300,000
- Funders: Various sources: self-financing, French Embassy, City Hall of Paris
Summary of intervention
In recent decades, incidence of anal cancer has increased globally. Anal cancer prevention is relatively under-implemented, and there is often little information available. While it has a low prevalence in the general population, people living with HIV, men who have sex with men, women with a history of HPV infection and people with immunosuppression are deemed at high risk. Premalignant anal cancer lesions can be asymptomatic and, therefore, often not detected. Stigma about anal health among health workers and their clients can contribute to a delay in care. In this context, prevention strategies — HPV vaccination and proctological care — are vital for key populations.
Ecuador has no adequate registry for anal cancer nor guidelines on its prevention or timely diagnosis. However, Kimirina provides comprehensive care to key populations, including raising awareness of the importance of anal cancer prevention and regular consultations for early detection. Anal health is delivered as part of the sexual health package, which includes promotion, prevention, and early diagnosis and treatment of benign and/or malignant lesions of the anus, enabling clients to have healthy and pleasurable sexual lives.
By including anal pathology screening in community services, Kimirina has become a pioneer in Ecuador and across the region, providing inclusive and holistic health care focused on improving quality of life and reducing morbidity and mortality from preventable anal diseases, especially among key populations.
learnings
Even though the service has not yet been widely communicated, the services have been well accepted and the most vulnerable groups are now aware of the risk of anal cancer.
One of the main challenges is the lack of donor funding, which, although services for some groups are self-funded, prevents rapid expansion of services.
next steps
The next step is to implement broad communication strategies for anal and cervical cancer prevention care targeting key populations and vulnerable groups.
sustainability
Implementing a mixed programme, with some groups self-funding, enables the provision of the service to priority groups free of charge.