Needs and Opportunities for Anal Cancer Prevention in Patients Engaged With PrEP Care: Development of Conceptual Model.

IF 3 Q1 PRIMARY HEALTH CARE
Christopher W Wheldon, Cristian L Flores, Imani Wilson-Shabazz, Caseem C Luck, Katie Singley, Sarah B Bass
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Abstract

Introduction: Populations at risk for HIV infection-including gay, bisexual, and other men who have sex with men (GBM) and transgender/gender diverse people (TGD)-are at disproportionate risk for anal cancer. Most anal cancers are caused by human papillomavirus (HPV) and are preventable with HPV vaccination and screening. Engaging at-risk populations who are already receiving HIV preventive care (eg, pre-exposure prophylaxis [PrEP]) may be an effective implementation strategy. The purpose of this study was to (1) identify the information, motivation, and behavioral skills that influence decisions about anal cancer prevention and to (2) describe the healthcare utilization patterns among PrEP users that impact their engagement in anal cancer prevention.

Methods: Using purposive sampling in the United States, we ensured diverse representation among PrEP users aged 18 to 45 across gender and ethnoracial identities. Recruitment sources included primary healthcare clinics, social media, and community venues. Semi-structured interviews were recorded, transcribed, and coded using structural, pattern, and theoretical approaches.

Results: Participants (N = 36) were mostly cisgender gay ethnoracial minority men. We identified 29 unique codes that were nested within 3 categories: individual decision-making, healthcare utilization patterns, and healthcare system influences. Participants commonly lacked essential information about HPV and anal cancer, often holding misconceptions about risks and prevention. Motivation for anal cancer prevention was driven by healthcare interactions and perceived risks, while fragmented healthcare and reliance on telemedicine were potential barriers. Many participants used telehealth services to access PrEP, described it as convenience, cost-effective, and liked the lack of provider interaction. Some participants used telehealth for PrEP and did not have a primary care provider. The importance of access to LGBTQ+-affirmative healthcare services was highlighted.

Conclusions: Integrating patient education and prevention services into ongoing PrEP management can enhance the reach and equity of anal cancer prevention. Our model underscores critical areas of misinformation, necessary systems-level changes, and unmet needs.

参与 PrEP 护理的患者预防肛门癌的需求和机遇:概念模型的开发。
导言:艾滋病病毒感染高危人群--包括男同性恋、双性恋和其他男男性行为者(GBM)以及变性人/跨性别者(TGD)--罹患肛门癌的风险更高。大多数肛门癌是由人类乳头瘤病毒 (HPV) 引起的,通过接种 HPV 疫苗和筛查是可以预防的。让已经接受艾滋病预防护理(如暴露前预防 [PrEP])的高危人群参与进来可能是一种有效的实施策略。本研究的目的是:(1) 确定影响肛门癌预防决策的信息、动机和行为技能;(2) 描述影响 PrEP 使用者参与肛门癌预防的医疗保健利用模式:方法:我们在美国采用目的性抽样,确保 18 至 45 岁的 PrEP 使用者在性别和种族身份方面具有不同的代表性。招募来源包括初级保健诊所、社交媒体和社区场所。采用结构、模式和理论方法对半结构式访谈进行记录、转录和编码:结果:参与者(N = 36)大多为少数族裔男性同性恋者。我们确定了 29 个独特的编码,这些编码被嵌套在 3 个类别中:个人决策、医疗保健利用模式和医疗保健系统影响。参与者普遍缺乏有关人乳头瘤病毒和肛门癌的基本信息,往往对风险和预防存在误解。预防肛门癌的动机来自于医疗保健互动和感知到的风险,而分散的医疗保健和对远程医疗的依赖则是潜在的障碍。许多参与者使用远程医疗服务来获得 PrEP,他们认为这样做既方便又具有成本效益,并且喜欢没有医护人员的互动。一些参与者使用远程保健服务进行 PrEP 治疗,但没有初级保健提供者。他们强调了获得 LGBTQ+ 医疗保健服务的重要性:结论:将患者教育和预防服务整合到持续的 PrEP 管理中可以提高肛门癌预防的覆盖面和公平性。我们的模型强调了错误信息的关键领域、必要的系统变革以及未满足的需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.80
自引率
2.80%
发文量
183
审稿时长
15 weeks
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