Temple University, Philadelphia, PA, USA.
Fox Chase Cancer Center, Philadelphia, PA, USA.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241295914. doi: 10.1177/21501319241295914.
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.
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.
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.
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.
包括男同性恋、双性恋和其他与男性发生性关系的男性（GBM）以及跨性别/性别多样化人群（TGD）在内的感染艾滋病毒风险人群，肛门癌的风险不成比例。大多数肛门癌是由人乳头瘤病毒（HPV）引起的，可以通过 HPV 疫苗接种和筛查来预防。针对已经接受艾滋病毒预防保健（例如，暴露前预防[PrEP]）的高危人群，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 用户参与肛门癌预防的保健利用模式。
我们在美国采用目的性抽样，确保在性别和族裔身份方面，18 至 45 岁的 PrEP 用户具有多样化的代表性。招募来源包括初级保健诊所、社交媒体和社区场所。使用结构、模式和理论方法对半结构化访谈进行记录、转录和编码。
参与者（N=36）主要是顺性别男同性恋少数族裔男性。我们确定了 29 个独特的代码，这些代码嵌套在 3 个类别中：个体决策、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 HPV 和肛门癌的基本信息，常常对风险和预防存在误解。肛门癌预防的动机来自于医疗保健互动和感知风险，而医疗保健碎片化和对远程医疗的依赖是潜在的障碍。许多参与者使用远程医疗服务来获取 PrEP，他们认为远程医疗服务方便、具有成本效益，并且喜欢没有提供者互动。一些参与者使用远程医疗来获取 PrEP，并且没有初级保健提供者。获得 LGBTQ+肯定的医疗保健服务的重要性得到了强调。
将患者教育和预防服务纳入正在进行的 PrEP 管理可以增强肛门癌预防的覆盖面和公平性。我们的模型强调了关键的信息错误领域、必要的系统层面的变化和未满足的需求。
