Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS, USA.
J Community Health. 2023 Aug;48(4):640-651. doi: 10.1007/s10900-023-01202-y. Epub 2023 Mar 10.
Human Papillomavirus (HPV) vaccination is effective at preventing anal cancer, which disproportionally impacts gay/bisexual men (GBM) and transgender women (TGW). Vaccine coverage among GBM/TGW is insufficient to reduce anal cancer disparities. Federally qualified health centers (FQHCs) can increase reach and uptake of HPV vaccination by integrating and promoting HPV vaccination in ongoing HIV preventive care (e.g., Pre-exposure Prophylaxis [PrEP]). The purpose of the current study was to assess the feasibility and potential impact of integrating HPV vaccination with PrEP care. We conducted a mixed methods study of PrEP providers and staff (qualitative interviews, N = 9) and PrEP patients (quantitative survey, N = 88) at an FQHC in Philadelphia, Pennsylvania. Qualitative thematic analysis of PrEP provider/staff interviews was informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify and describe barriers and facilitators to HPV vaccination implementation. Quantitative analysis of PrEP patient survey was informed by the Information-Motivation-Behavioral Skills Model. Quantitative interviews resulted in 16 themes related to characteristics of the inner and outer clinic context. Barriers among providers included lack of focus on HPV in PrEP management guidelines, in metrics mandated by funding agencies, and in electronic medical record templates. Lack of anal cancer specific knowledge and motivation was identified in both PrEP patients and providers/staff. Providing HPV vaccination during routine PrEP visits was highly acceptable to both patients and providers. Based on these findings, we recommend several multi-level strategies to increase HPV vaccine uptake among PrEP patients.
人乳头瘤病毒（HPV）疫苗接种可有效预防肛门癌，而同性恋/双性恋男性（GBM）和跨性别女性（TGW）受肛门癌影响不成比例。GBM/TGW 人群中的疫苗接种率不足以减少肛门癌的差异。合格的联邦卫生中心（FQHC）可以通过整合和推广 HPV 疫苗接种来增加预防艾滋病毒的护理（例如，暴露前预防[PrEP]）来增加 HPV 疫苗接种的覆盖面。本研究的目的是评估在 PrEP 护理中整合 HPV 疫苗接种的可行性和潜在影响。我们对宾夕法尼亚州费城的一家 FQHC 的 PrEP 提供者和工作人员（定性访谈，N=9）以及 PrEP 患者（定量调查，N=88）进行了一项混合方法研究。对 PrEP 提供者/工作人员访谈的定性主题分析以探索、准备、实施、维持（EPIS）框架为指导，以确定和描述实施 HPV 疫苗接种的障碍和促进因素。对 PrEP 患者调查的定量分析以信息-动机-行为技能模型为指导。定量访谈得出了 16 个与内部和外部诊所环境特征相关的主题。提供者面临的障碍包括在 PrEP 管理指南、资金机构规定的指标以及电子病历模板中缺乏对 HPV 的关注。在 PrEP 患者和提供者/工作人员中都发现了缺乏针对肛门癌的具体知识和动力。在常规 PrEP 就诊期间提供 HPV 疫苗接种对患者和提供者都非常受欢迎。基于这些发现，我们建议采取一些多层次的策略来提高 PrEP 患者的 HPV 疫苗接种率。
