In the ongoing quest to curb the incidence of anal cancer, particularly among at-risk populations such as sexual minority men (SMM) living with HIV, a recent qualitative study conducted in Abuja, Nigeria, sheds new light on the complexities involved in adopting high-resolution anoscopy (HRA) as a routine screening modality. Early detection of anal precancer is crucial to improving patient outcomes, and HRA represents a state-of-the-art diagnostic procedure designed to identify suspicious lesions with unparalleled precision. However, the integration of this technically demanding procedure into healthcare systems, especially within low-resource settings, requires a nuanced understanding of both systemic facilitators and barriers.
The investigative team utilized the Consolidated Framework for Implementation Research (CFIR) to delve into local experiences and perspectives concerning the learning and application of HRA. By conducting nineteen semi-structured, in-depth interviews in September 2023 with key stakeholders—including patients who underwent HRA, healthcare providers, and health system officials—the study assembled a comprehensive picture of the sociocultural and institutional ecosystem governing the uptake of this innovation in Abuja. Employing thematic analysis anchored in CFIR, researchers were able to delineate eight core thematic elements that either impeded or enhanced the adoption and sustainability of HRA technology.
One of the foremost challenges identified was a foundational lack of knowledge and understanding about HRA itself. Participants from all stakeholder groups expressed a palpable need for tailored research and educational efforts contextualized to the nuances of low-resource settings, highlighting that wider acceptance depends heavily on culturally appropriate evidence generation. The study further underscored concerns about the financial implications of implementing HRA, with apprehensions noted both at the institutional level—regarding clinic operational costs—and from patients who might face economic hurdles in accessing this emerging service.
Conversely, the study illuminated compelling facilitators that could accelerate HRA integration. Organizational commitment emerged as a pivotal factor, exemplified by institutional leadership embracing the procedure not merely as an ancillary service but as a core component of HIV care frameworks. Furthermore, robust social networks within SMM communities played a critical role in disseminating awareness, fostering peer support, and mitigating stigma, thereby encouraging patients to engage with HRA services. Crucially, the establishment of safe and confidential clinic environments was identified as indispensable in nurturing patient trust and long-term engagement.
These facilitatory elements, combined with the recognition and acceptance of extant research evidence championing HRA’s efficacy, portend a promising horizon for its sustainability in Nigerian healthcare settings. Stakeholders voiced optimism about the health benefits conferred by early cancer detection, reinforcing the value proposition of incorporating HRA into standard preventive oncology protocols. Importantly, the study demonstrated a unanimous welcome by patients, providers, and health system representatives toward framing HRA as an evidence-based intervention synergistic with HIV treatment strategies.
The intricate interplay between cultural sensitivity, community engagement, and organizational infrastructure emerged as a recurrent motif throughout the findings. By contextualizing the implementation process within social and structural realities, the study advocates a paradigm shift from generic, technology-focused rollouts toward locally tailored, patient-centered models. The healthcare providers interviewed emphasized that procedural training must extend beyond clinical competencies to include communication skills adept at navigating the stigmatized nature of anal cancer risk among sexual minorities.
Another salient observation was the influence of research localization. Participants iterated that data emanating directly from Nigerian settings would enhance legitimacy and trustworthiness of HRA technologies, thereby smoothing pathways toward broader acceptance. The relative paucity of region-specific studies reveals an urgent gap in knowledge that, if addressed, could catalyze scale-up endeavors across sub-Saharan Africa and similar contexts worldwide.
Financial sustainability remains a pivotal hurdle. The high costs associated with procuring and maintaining sophisticated anoscopy equipment and delivering specialized training to providers were recurrent themes. To mitigate these challenges, the study suggests exploring innovative financing models, including partnerships with international NGOs, targeted government subsidies, and integration with existing HIV care funding streams, recognizing that multi-sectoral collaboration is key to overcoming budgetary constraints.
The research further highlights that a well-orchestrated community outreach strategy is essential to dispel myths and normalize anal cancer screening. Engaging trusted community leaders and leveraging SMM social networks to propagate accurate information can counteract entrenched stigma and amplify the demand for HRA services. The importance of a nonjudgmental, confidential clinical atmosphere cannot be overstated, as these factors directly impact patient willingness to seek evaluation.
Training and capacity building for healthcare providers were deemed indispensable for the technical mastery and confidence required to perform high-resolution anoscopy effectively. Continuous professional development, mentorship, and supportive supervision emerged as best practices to ensure competency retention and procedural standardization, thereby improving diagnostic accuracy and patient outcomes.
Moreover, the study envisions interoperable health information systems that can monitor patient trajectories and procedural outcomes to inform quality improvement initiatives. Leveraging digital tools for data collection and analysis can offer real-time insights, guiding adaptive strategies that respond to emerging implementation challenges.
As the Nigerian healthcare landscape grapples with myriad competing priorities, integrating HRA for anal cancer screening necessitates demonstrating tangible health benefits coupled with cost-effectiveness. The study’s contributors emphasize that showcasing early wins and positive patient testimonials can galvanize institutional enthusiasm and attract funding support.
Ultimately, the findings of this comprehensive qualitative inquiry underscore the necessity of adopting a holistic approach that balances technological innovation with socio-cultural pragmatism. By fostering organizational buy-in, empowering communities, and ensuring safe clinical environments, Abuja’s healthcare systems can pave the way for expanded use of high-resolution anoscopy. This would mark a significant stride toward reducing the burden of anal cancer among vulnerable populations, delivering hope through early detection and intervention.
The evidence emerging from this study serves as a clarion call for policymakers, clinicians, and advocates to collaboratively invest in research, education, and infrastructure that support sustainable, context-sensitive cancer screening programs. It is through such integrative efforts that cutting-edge medical advancements translate into meaningful health improvements on the ground, particularly in settings historically underserved by cancer diagnostics.
As global health priorities increasingly emphasize equity and inclusion, the Nigerian experience with HRA exemplifies how qualitative insights into facilitators and barriers can inform scalable solutions. This marks an exciting chapter in the fight against HIV-associated malignancies—a battle that hinges not only on scientific innovation but also on the human stories, community resilience, and strategic frameworks that bring new interventions to life.
Subject of Research: Perspectives on the implementation and learning of high-resolution anoscopy (HRA) for anal cancer screening among sexual minority men living with HIV in Abuja, Nigeria.
Article Title: Facilitator and barrier perspectives on learning and implementing high-resolution anoscopy in Abuja, Nigeria: a qualitative study
Article References:
Mansfield, M.E., Volpi, C.R., John, C. et al. Facilitator and barrier perspectives on learning and implementing high-resolution anoscopy in Abuja, Nigeria: a qualitative study. BMC Cancer 25, 1766 (2025). https://doi.org/10.1186/s12885-025-15120-w
Image Credits: Scienmag.com
DOI: 14 November 2025
Keywords: high-resolution anoscopy, anal cancer screening, HIV care, sexual minority men, Nigeria, implementation research, qualitative study, Consolidated Framework for Implementation Research, CFIR, healthcare barriers, healthcare facilitators, cancer prevention, early detection, sustainability
