Division of Colon and Rectal Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Surgery, W. S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin, USA.
AIDS Patient Care STDS. 2023 Sep;37(9):436-446. doi: 10.1089/apc.2023.0144.
People living with human immunodeficiency virus (HIV) are at high risk for anal cancer. Anal cancer screenings are recommended annually for US veterans with HIV. Screenings can identify treatable precursor lesions and prevent cancer development. In a previous study, we found screening rate to be only 15%. Semistructured interviews were conducted with Veterans Affairs (VA) providers who treat veterans living with HIV. Participants described their experiences with anal cancer screenings. Researchers developed a codebook based on Theoretical Domains Framework (TDF) and coded data using thematic analysis to identify barriers to anal cancer screenings. Twenty-three interviews were conducted with VA providers representing 10 regions. Barriers identified corresponded with five targetable TDF domains: Knowledge, Skills, Environmental Context/Resources, Professional Roles/Identities, and Social Influence. Many providers lacked knowledge of screening protocols. Knowledgeable providers often lacked needed resources, including swabs, clinic space, reliable pathology, access to high-resolution anoscopy, or leadership support to implement a screening program. Providers mentioned competing priorities in the care of veterans with HIV infection and lack of skilled/trained personnel to perform the tests. It was often unclear which provider specialty should "own" screening responsibilities. Additional factors included patient discomfort with screening exams. Anal cancer screening protocols are recommended but not widely adopted in VA. There is a critical need to address barriers to anal cancer screenings in veterans. The TDF domains identified align with five intervention domains to target, including education, training, resource/environment, delineation of provider roles, and improved counseling efforts. Targeting these barriers may help improve the uptake of anal cancer screenings within VA.
人免疫缺陷病毒（HIV）感染者患肛门癌的风险很高。美国退伍军人事务部（VA）建议每年对 HIV 感染者进行肛门癌筛查。筛查可以发现可治疗的癌前病变，并预防癌症的发展。在之前的一项研究中，我们发现筛查率仅为 15%。对治疗 HIV 感染者的 VA 医护人员进行了半结构式访谈。参与者描述了他们在肛门癌筛查方面的经验。研究人员根据理论领域框架（TDF）制定了代码本，并使用主题分析对数据进行编码，以确定肛门癌筛查的障碍。对来自 10 个地区的 23 名 VA 医护人员进行了访谈。确定的障碍与五个可针对的 TDF 领域相对应：知识、技能、环境/资源、专业角色/身份和社会影响。许多医护人员缺乏筛查方案的知识。有知识的医护人员往往缺乏所需的资源，包括拭子、诊所空间、可靠的病理学、获得高分辨率肛门镜的途径，或实施筛查计划的领导力支持。医护人员提到在 HIV 感染者的护理中存在竞争优先级，以及缺乏熟练/培训人员来进行测试。通常不清楚哪个提供者的专业知识应该“拥有”筛查责任。其他因素包括患者对筛查检查的不适。VA 推荐但未广泛采用肛门癌筛查方案。迫切需要解决退伍军人肛门癌筛查的障碍。确定的 TDF 领域与五个干预领域相对应，包括教育、培训、资源/环境、明确提供者的角色以及改进咨询工作。针对这些障碍可能有助于提高 VA 内肛门癌筛查的接受率。
