A decade of anal cancer screening in the context of HIV care: feasibility, acceptability, and long-term retention.

High-resolution anoscopy (HRA) is crucial for detecting and managing high-grade squamous intraepithelial lesions (HSIL), the main precursor to anal cancer. However, program success is often hindered by long-term retention, which in some studies reaches only 50%. Patient acceptability, a major factor in adherence, is often overlooked. To evaluate the long-term feasibility, safety, acceptability, and retention of an anal cancer screening program in an HIV clinic that prioritizes patient-centered strategies. This single-center, longitudinal cohort study was conducted at a public HIV and Sexual Health Clinic in Spain. Eligible participants included MSM with HIV aged ≥30 years and abnormal cytology, or individuals with prior anal cancer or HPV-related anogenital dysplasia. Retention was defined as the proportion who remained enrolled or completed protocol. Acceptability, appropriateness, and feasibility were assessed using a validated 4-item survey. Safety was measured through adverse event monitoring. The internal consistency of the 4-item survey was assessed using Cronbach's alpha. Of 389 screened participants, 21.3% were diagnosed with HSIL and 49.4% experienced recurrence. One early-stage anal cancer was detected. Adverse events were mild and self-limited. Retention at 10 years was 88.9%, with a median follow-up duration of 54.5 months (interquartile range, 21.7-116.5). Patient satisfaction was high: 96.5% rated the program as acceptable, 97.5% as appropriate, and as 96.5% feasible, though procedural ease scored slightly lower. High long-term retention and strong acceptability suggest that patient-focused approaches may enhance engagement in care and warrant consideration in the design of similar programs in HIV clinics.