Module 1 

HPV Background (Epidemiology, Pathogenesis and Anatomy)

Objectives: 

• Apply knowledge of lower genital HPV infection, including natural history, to the anal canal
• Describe anal canal and perianal anatomy
• Define and identify histopathological and cytopathological features of anal squamous intraepithelial lesions and anal cancer

1.    Introduction to HPV: General Epidemiology - 30 mins

2.    Epidemiology of Anal Cancer and Squamous Intraepithelial Lesions (SIL) – 31 mins

3.    Anal Anatomy – 10 mins

4.    Pathology 1: Anal Squamous Intraepithelial Lesions and Cancer – 24 mins

5.    Pathology 2: Interpretation of Anal Cytology – 14 mins

Total time: approximately 109 minutes 

Module 2

Introduction to HRA and Related Procedures

Objectives:

• Understand and define terminology related to HRA
• Interpret the normal features encountered during HRA with respect to the transformation zone and anal/perianal anatomy
• Learn the steps of performing an HRA exam and related procedures

1.    HRA Terminology – 26 mins

2.    HRA: Features of the Normal Anal Transformation Zone – 17 mins

3.    HRA Procedures/Skills – 40 mins

4.    Putting it together: HRA Video – 20 mins 

Total time: approximately 103 minutes

Module 3

HRA Pattern Recognition

Objectives:

• Identify and differentiate Low-grade (L)SIL and High-grade (H)SIL within the anal canal and perianus
• Recognize features of invasive disease

1.    HRA: Identification of LSIL – 14 mins

2.    HRA: Identification of HSIL – 21 mins 

3.    HRA: Identification of Perianal Lesions – 28 mins

4.    HRA: Identification of Cancer – 33 mins

5.    Tips to improving HRA skills – 31 mins 

Total time: approximately 127 minutes

Module 4

Treatment of ASIL

Objectives:

• Summarize current treatment options for Anal SIL including topical, ablative and excisional methods
  
• Describe their mode of action, benefits and complications 
• Requirements for anesthesia associated with different treatment modalities

1.    Principles of Treatment – 16 mins

2.    Topical Therapies – 25 mins 

3.    Ablative Therapies: Technique – 24 mins

Total time: approximately 65 minutes 

Module 5

Screening for HPV-associated Lesions

Objectives: 

• Summarize the key principles of screening
  
• Recognize how current screening criteria are used in anal cancer screening and anal cancer precursor screening 
• Identify high-risk groups appropriate for screening

1.    Judging who to screen for prevention of anal cancer: where do we stand today - 39 mins

2.    Screening tests for anal cancer: Current approaches and future directions – 30 mins

3.     Screening for anal cancer: IANS Consensus Guidlines – 18 mins 

Total time: approximately 87 minutes 

Module 6

Management and Counseling

Objectives: 

• Outline appropriate management for anal SIL including treatment in the operating room, and follow-up post-treatment
  
• Understanding the impact of anal neoplasia on patients

1.    Treatment Triage: Cases – 44 mins

2.    HRA in the Operating Room – 17 mins

3.    Messaging: Counseling the Patient with HPV-associated Disease – 28 mins

4.    The Patient’s Perspective – 32 mins

Total time: approximately 121 minutes

Module 7

Practicalities for Establishing an HRA Practice

Objectives:

• Define components of an HRA practice 
  
• Recognize practice metrics, practice standards and international guidelines
• Describe the indications for HPV vaccination

1.    Essential Equipment for HRA – 21 mins

2.    Documentation for HRA – 22 mins

3.    Guidelines for Creating a New HRA Practice – 21 mins

4.    HRA Practice Metrics – 18 mins

Total time: approximately 82 minutes 

Module 8

Anal Neoplasia in Context

Objectives: 

• Expand knowledge to that of other specialty areas that overlap with management of lower anogenital tract disorders

1.    Non-infectious Disease of the Anus and Perianus – 39 mins

2.    Sexually Transmitted Infections, Testing and Treatment – 24 mins

3.    Dermatologic conditions – 26 mins

Total time: approximately 89 minutes 

Module 9

Optional Content

This content contains material relevant to all HRA practices which may be familiar to providers specializing in those fields and unfamiliar to others.  You may choose to complete all lectures, but you are not required.  The number of CME credits will be determined based on all completed lectures.  You will be able to claim up to 15.5 CME.

1.    Coding and Billing (US based providers)  – 20 mins

2.    HRA and Cervical Colposcopy: Differences  – 23 mins

3.    Incorporating research into clinical practice  – 11 mins

4.    Anal Cancer Treatment - 31 mins 

5. HRA Following cancer - 14 mins

6.     Vulvar Disease – 31 mins

7.    Diseases of the Colon and Rectum – 29 mins

8. HPV Vaccination for prevention – 28 mins

Total time: approximately 187 minutes