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Swabs in Screening for HPV (SWISH) (SWISH)

25 de agosto de 2026 atualizado por: Kirby Institute

Randomised Controlled Trial of Self-collected vs Clinician-collected Anal Swabs for Anal Cancer Screening in People Living With HIV (PLHIV) in Australia

This trial aims to evaluate if self-collected anal swabs (SCS) can be used for anal cancer screening. Currently, only clinician-collected anal swabs (CSC) are recommended for anal cancer screening, and this may be a barrier for people to access screening. About 700 people living with HIV (PLHIV) in Australia will randomly undergo a SCS followed by a CSC, or the other way around. Swabs will be tested for high-risk human Papillomavirus (HRHPV, which causes most anal cancer) and if the swab is positive for HRHPV, it will also be tested for pre-cancerous cells. The anal swabs will be tested for new biomarkers, "methylation", which might help us predict if precancerous lesions will develop into anal cancer. Everyone will be asked about their preferences for swab collection. If someone tests positive for HRHPV, they will receive further care. We expect that more screening options will result in more people being screened.

Visão geral do estudo

Status

Ainda não está recrutando

Condições

Intervenção / Tratamento

Descrição detalhada

This multi-centred, order-randomised, controlled, cross-over clinical trial of self-versus clinician- collected swabs (SCS) and clinician-collected swabs (CCS), enrolling 700 participants across participating clinical trial recruitment sites in Australia. Participants will undertake SCS immediately followed by CCS, or vice versa, in an order-randomised manner with all participants completing both methods of collection. Both anal swabs will be tested for HRHPV, cytology, and methylation.

In the cervix, evidence suggests that a second swab taken on the same day may produce an inferior sample for cytology compared with the first swab. For this reason, studies comparing two swabs must control for the order of collection. In this trial, the order of the self-collected and clinician-collected anal swabs will be randomised. Randomisation will be stratified by clinical trial site.

Clinicians and participants will be unblinded to allow for swab collection; diagnostic and research laboratory staff, and research investigators who analyse the study outcomes will be blinded to both the order and method of collection for each swab.

Enrolment will continue until 700 participants have been randomised at a mixture of metropolitan and regional clinical trial sites. The study duration is 5 years.

Participants will be recruited via their regular HIV medical care at participating clinical trial sites.

Participants will be either gay or bisexual man (GBM) or trans women living with HIV aged 35 years or older, or all other people living with HIV aged 45 years or older. It is expected that most participants will be GBM, reflecting the Australian HIV epidemic but to ensure diversity, a minimum aggregate of 50 non- GBM living with HIV will be recruited per the inclusion criteria.

Participants who are HRHPV negative will exit the trial, unless they have been diagnosed with possible HSIL (pHSIL) or HSIL on cytology. Participants who are tested positive for HRHPV will be referred for high-resolution anoscopy (HRA). Participants who are tested negative for HRHPV but have pHSIL or HSIL diagnosed on cytology will be referred for high-resolution anoscopy (HRA).

During the HRA, the anoscopist will take small biopsies of any tissue suspected to have abnormal cells. The biopsy samples will undergo diagnostic histology.

Participants who are not diagnosed with high-grade squamous intraepithelial lesion (HSIL), will exit the trial. Participants who are diagnosed with HSIL but undergo treatment will exit the trial. Participants who are diagnosed with HSIL and do not receive treatment will have a 12-month Follow-up HRA then exit the trial.

Tipo de estudo

Intervencional

Inscrição (Estimado)

700

Estágio

  • Não aplicável

Contactos e Locais

Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.

Contato de estudo

Estude backup de contato

Locais de estudo

  • Austrália
    • New South Wales
      • Cudgen, New South Wales, Austrália, 2487
        • North Coast Sexual Health and HIV Services, Tweed Valley Sexual Health Clinic
        • Contato:
        • Investigador principal:
          • A/Professor Vincent Cornellise, MBBS, PhD
      • Darlinghurst, New South Wales, Austrália, 2010
        • Taylor Square Private Clinic
        • Contato:
        • Investigador principal:
          • Dr Mark O'Reilly, MBBS
      • Sydney, New South Wales, Austrália, 2010
        • Holdsworth House Medical Practice
        • Contato:
        • Investigador principal:
          • Dr Mark Bloch, MBBS
      • Sydney, New South Wales, Austrália, 2010
        • St Vincent's Hospital, Sydney
        • Contato:
        • Investigador principal:
          • Prof Richard Hillman, MBChB, PhD, FRCP
      • Sydney, New South Wales, Austrália, 2000
        • Sydney Sexual Health Centre
        • Contato:
        • Investigador principal:
          • Dr Rick Varma, MB ChB, MRCP
      • Sydney, New South Wales, Austrália, 2050
        • RPA Sexual Health
        • Contato:
        • Investigador principal:
          • Dr Rachel Burdon, MBBS, MPH
      • Sydney, New South Wales, Austrália, 2010
        • Easy Sydney Doctors
        • Contato:
        • Investigador principal:
          • Dr David Baker, MBBS
      • Sydney, New South Wales, Austrália, 2150
        • Western Sydney Sexual Health Centre
        • Contato:
        • Investigador principal:
          • Prof David Lewis, MBBS, PhD
    • South Australia
      • Adelaide, South Australia, Austrália, 5000
        • Royal Adelaide Hospital
        • Contato:
        • Investigador principal:
          • Dr Michelle Thomas, MBBS, PhD
    • Victoria
      • Melbourne, Victoria, Austrália, 3053
        • Melbourne Sexual Health Centre
        • Contato:
          • Professor Jason Ong, MBBS, PhD
          • Número de telefone: +613 93416200
          • E-mail: JOng@mshc.org.au
        • Investigador principal:
          • Professor Jason Ong, MBBS, PhD

Critérios de participação

Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.

Critérios de elegibilidade

Idades elegíveis para estudo

  • Adulto
  • Adulto mais velho

Aceita Voluntários Saudáveis

Não

Descrição

Inclusion Criteria:

  1. Living with HIV.
  2. Gay, bisexual or other man who has sex with men or trans woman aged at least 35 years, or all other people aged at least 45 years.
  3. Able to commit to and undertake all study procedures.
  4. Willing and able to provide informed consent, in any of the following languages:

i. English. ii. Alternatively, use of the accredited translation service usually utilised in the participant's healthcare appointments.

Exclusion Criteria:

  1. Aged over 75 years of age at time of enrolment.
  2. Previously undergone an HRA.
  3. History of anal cancer and/or anal HSIL.
  4. Medically directed treatment (including topical treatments) to the anal canal in the preceding two weeks, which in the opinion of the consenting investigator could impact swab viability.
  5. Concurrent malignancy requiring systemic therapy, or medical conditions otherwise considered contraindicated to HRA by the delegated investigators.

Plano de estudo

Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.

Como o estudo é projetado?

Detalhes do projeto

  • Finalidade Principal: Triagem
  • Alocação: Randomizado
  • Modelo Intervencional: Atribuição cruzada
  • Mascaramento: Dobro

Armas e Intervenções

Grupo de Participantes / Braço
Intervenção / Tratamento
Experimental: Arm A: Self-collected anal swab followed by clinician-collected anal swab
Cross over
Outro: Self-collected anal swab
Each participant will be order-randomised to undergo a self-collected or clinician-collected anal swab first, with the alternate swab collected immediately afterwards. Both swab will be collected on the same day at the Baseline Visit.
Experimental: Arm B: Clinician-collected anal swab followed by self-collected anal swab
Cross over
Outro: Self-collected anal swab
Each participant will be order-randomised to undergo a self-collected or clinician-collected anal swab first, with the alternate swab collected immediately afterwards. Both swab will be collected on the same day at the Baseline Visit.

O que o estudo está medindo?

Medidas de resultados primários

Medida de resultado
Descrição da medida
Prazo
Compare the sample validity of self-collected anal swabs with clinician-collected anal swabs, for HRHPV, in the eligible cohort.
Prazo: At Baseline.
To measure the percentage of self-collected anal swabs that are valid for HRHPV testing compared with clinician-collected anal swabs, as defined by internal control positivity.
At Baseline.

Medidas de resultados secundários

Medida de resultado
Descrição da medida
Prazo
To evaluate sample quality for cytology of self-collected ana swabs compared with clinician-collected anal swabs, in the eligible cohort.
Prazo: At Baseline.
To measure the proportion of self-collected anal swabs that have satisfactory sample quality for cytology, compared with the proportion of clinician-collected anal swabs that have satisfactory sample quality.
At Baseline.
To compare the HRHPV findings of self-collected anal swabs compared with clinician-collected anal swabs, in the eligible cohort.
Prazo: At Baseline.
To measure between self-collected and clinician-collected swabs, the level of agreement between HRHPV testing results.
At Baseline.
To compare the HRHPV findings of self-collected anal swabs compared with clinician-collected anal swabs, in the eligible cohort.
Prazo: At Baseline.
To measure between self-collected and clinician-collected swabs, prevalence of any HRHPV.
At Baseline.
To compare the HRHPV findings of self-collected anal swabs compared with clinician-collected anal swabs, in the eligible cohort.
Prazo: At Baseline.
To measure between self-collected and clinician-collected swabs, prevalence of HPV16.
At Baseline.
To compare the cytology findings of self-collected anal swabs compared with clinician-collected anal swabs, according to the modified Bethesda criteria in the eligible cohort.
Prazo: At Baseline.
To measure between self-collected and clinician-collected swabs according to modified Bethesda criteria, the level of agreement between cytology testing results.
At Baseline.
To compare the cytology findings of self-collected anal swabs compared with clinician-collected anal swabs, according to the modified Bethesda criteria in the eligible cohort.
Prazo: At Baseline.
To measure between self-collected and clinician-collected swabs according to modified Bethesda criteria, prevalence of any cytological abnormality.
At Baseline.
To compare the cytology findings of self-collected anal swabs compared with clinician-collected anal swabs, according to the modified Bethesda criteria in the eligible cohort.
Prazo: At Baseline.
To measure between self-collected and clinician-collected swabs according to modified Bethesda criteria, prevalence of cytological HSIL.
At Baseline.

Outras medidas de resultado

Medida de resultado
Descrição da medida
Prazo
To evaluate participant perception of self-collected anal swabs as an alternative to clinician-collected anal swabs.
Prazo: At Baseline.
To measure distribution of participant responses on the acceptability and feasibility of self-collected anal swabs in future screening, measured via the Participant Reported Experience Measures instrument.
At Baseline.
To evaluate participant self-reported awareness of anal cancer, acceptability and willingness to complete self-collected swab for screening.
Prazo: At Baseline.
Interview data will be evaluated using standard qualitative analysis, including thematic analysis.
At Baseline.
To evaluate use of methylation testing, compared with anal cytology as a triage test for anal HSIL.
Prazo: At Baseline.
To compare sensitivity and specificity of methylation testing compared with anal cytology, for predicting histologically confirmed HSIL.
At Baseline.
To evaluate anal HSIL persistence at 12-month follow-up HRA, compared with Diagnostic HRA by Baseline anal swab methylation status.
Prazo: From Baseline through to Month 15.
To measure the proportion of participants diagnosed with HSIL at Diagnostic HRA who have persistent HSIL at 12-month follow-up HRA, stratified by Baseline anal swab methylation status.
From Baseline through to Month 15.
To evaluate long-term anal cancer outcomes, for participants that consent to data linkage.
Prazo: From Baseline until 5 years after the completion of the initial trial.
Evaluation of anal cancer diagnoses against HRHPV status, histological findings and methylation testing results.
From Baseline until 5 years after the completion of the initial trial.

Colaboradores e Investigadores

É aqui que você encontrará pessoas e organizações envolvidas com este estudo.

Patrocinador

Kirby Institute

Investigadores

  • Cadeira de estudo: Dr Isobel Mary Poynten, MBBS, MPH, DCH PhD, The Kirby Institute, University of New South Wales Sydney, Australia
  • Investigador principal: Scientia Prof Andrew Grulich, MBBS, PhD, FAFPHM, FAAHMS, The Kirby Institute, University of New South Wales Sydney, Australia

Datas de registro do estudo

Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados ​​pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.

Datas Principais do Estudo

Início do estudo (Estimado)

1 de novembro de 2026

Conclusão Primária (Estimado)

31 de agosto de 2030

Conclusão do estudo (Estimado)

31 de dezembro de 2030

Datas de inscrição no estudo

Enviado pela primeira vez

20 de agosto de 2026

Enviado pela primeira vez que atendeu aos critérios de CQ

25 de agosto de 2026

Primeira postagem (Real)

27 de agosto de 2026

Atualizações de registro de estudo

Última Atualização Postada (Real)

27 de agosto de 2026

Última atualização enviada que atendeu aos critérios de controle de qualidade

25 de agosto de 2026

Última verificação

1 de agosto de 2026

Mais Informações

Termos relacionados a este estudo

Palavras-chave

Termos MeSH relevantes adicionais

Outros números de identificação do estudo

  • HEPP 202601
  • APP2047111 (Número de outro subsídio/financiamento: National Health and Medical Research Council, Australia)

Informações sobre medicamentos e dispositivos, documentos de estudo

Estuda um medicamento regulamentado pela FDA dos EUA

Não

Estuda um produto de dispositivo regulamentado pela FDA dos EUA

Não

Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .

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