Hewitt Austin J, Cherney Stafford Linda, Alagoz Esra, Sanger Cristina B
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Surgery, University of Wisconsin Surgical Outcomes Research Program, Madison, Wisconsin.
Dis Colon Rectum. 2025 Feb 1;68(2):172-179. doi: 10.1097/DCR.0000000000003512. Epub 2024 Oct 29.
Anal cancer disproportionately affects people living with HIV. The Department of Veterans Affairs is the largest single provider of health care to people living with HIV in the United States and recommends all veterans living with HIV be screened for anal cancer annually. There are barriers to developing successful anal cancer screening programs, and screenings within Veterans Affairs have been underused.
This study aims to identify facilitators to anal cancer screening programs in Veterans Affairs.
This is a qualitative study involving semistructured virtual interviews. Thematic analysis was used to identify themes in the interview data.
Study participants included Veterans Affairs infectious disease providers and colorectal surgeons who care for veterans living with HIV. Participants were asked to discuss factors that influence anal cancer screenings in Veterans Affairs.
Themes were mapped to theoretical constructs and domains related to behavioral change using the Theoretical Domains Framework.
A total of 23 Veterans Affairs providers from all major United States geographical regions were interviewed. Important facilitators identified included access to high-resolution anoscopy and colorectal surgery support. The themes for successful anal cancer screening programs were mapped to 15 behavior-influencing constructs and categorized into 6 domains: 1) knowledge, 2) skills, 3) professional role and identity, 4) goals, 5) environmental context and resources, and 6) social influences.
This study involves health care providers who are invested in caring for veterans living with HIV, and their perspectives might not be representative of all Veterans Affairs providers.
Access to a clinician with high-resolution anoscopy training and colorectal surgery support were identified as integral components of a successful anal cancer screening program. This study provides a framework for improving anal cancer screenings in veterans living with HIV by use of evidence-based interventions that incorporate the identified facilitators. See Video Abstract .
肛管癌对艾滋病病毒感染者的影响尤为严重。美国退伍军人事务部是美国为艾滋病病毒感染者提供医疗保健服务的最大单一机构，并建议所有感染艾滋病病毒的退伍军人每年接受肛管癌筛查。制定成功的肛管癌筛查项目存在障碍，退伍军人事务部内部的筛查未得到充分利用。
本研究旨在确定退伍军人事务部肛管癌筛查项目的促进因素。
这是一项定性研究，包括半结构化虚拟访谈。采用主题分析法确定访谈数据中的主题。
研究参与者包括退伍军人事务部的传染病医护人员和结直肠外科医生，他们负责照顾感染艾滋病病毒的退伍军人。参与者被要求讨论影响退伍军人事务部肛管癌筛查的因素。
使用理论领域框架将主题映射到与行为改变相关的理论结构和领域。
共采访了来自美国所有主要地理区域的23名退伍军人事务部医护人员。确定的重要促进因素包括获得高分辨率肛门镜检查和结直肠手术支持。成功的肛管癌筛查项目的主题被映射到15个影响行为的结构，并分为6个领域：1）知识，2）技能，3）职业角色和身份，4）目标，5）环境背景和资源，6）社会影响。
本研究涉及致力于照顾感染艾滋病病毒退伍军人的医护人员，他们的观点可能不代表所有退伍军人事务部医护人员。
获得经过高分辨率肛门镜检查培训的临床医生和结直肠手术支持被确定为成功的肛管癌筛查项目的重要组成部分。本研究提供了一个框架，通过采用纳入已确定促进因素的循证干预措施，改善感染艾滋病病毒退伍军人的肛管癌筛查。见视频摘要。
