Volpi Connor R, Chama John, Mansfield Megan E, Adebiyi Ruxton, Mitchell Andrew, Aigoro Jumoke A, Bawa Yerima Jibrin, Kolawole Kazeem E, Ononaku Uchenna, Jibrin Paul, Olaomi Oluwole, Agbo Francis, Bentzen Soren M, Goldstone Stephen E, Dakum Patrick, Palefsky Joel M, Knott Cheryl, Adebajo Sylvia, Nowak Rebecca G
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Institute of Human Virology Nigeria, Abuja, Nigeria.
PLOS Glob Public Health. 2025 Jul 2;5(7):e0004616. doi: 10.1371/journal.pgph.0004616. eCollection 2025.
Anal cancer poses a significant risk for sexual minority males (SMM) living with HIV, with a 100-fold higher incidence compared to the general population. Despite success in high-income settings, training on anal cancer prevention in Africa faces challenges due to limited resources and lack of trained practitioners. We evaluated adapting training using an implementation science framework in a Nigerian SMM-friendly clinic. The Consolidated Framework for Implementation Research (CFIR) Card Game assessed barriers to training on anal cancer prevention. Stakeholders ranked the importance of different CFIR constructs. Sessions were conducted separately for internal stakeholders, external stakeholders, and patients. Facilitators identified barriers using culturally adapted text and a hybrid format for consensus discussion. Potential strategies to overcome the barriers were identified with the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool. The CFIR card game was conducted in August 2023 with 20 participants (Internal: 4, External: 8, Patients: 8). Internal stakeholders identified adaptability, cost, and the absence of external change agents. External stakeholders highlighted adaptability, design quality, and financial burden, proposing advocacy and local discussions. Patients expressed concerns about adaptability and external policies affecting trust and acceptance, emphasizing strategic adaptations and local involvement. The CFIR-ERIC Matching Tool recommended identifying champions and altering incentives as strategies. Incorporating champion roles, local adaptations, policy enforcement, and financial support can enhance training on anal cancer prevention in Nigeria. The findings stress the importance of cultural sensitivity and engagement with local stakeholders to support training practitioners in anal cancer prevention.
肛门癌对感染艾滋病毒的性少数男性（SMM）构成重大风险，其发病率比普通人群高100倍。尽管在高收入环境中取得了成功，但由于资源有限和缺乏训练有素的从业者，非洲的肛门癌预防培训面临挑战。我们评估了在尼日利亚一家对SMM友好的诊所中使用实施科学框架调整培训的情况。实施研究综合框架（CFIR）纸牌游戏评估了肛门癌预防培训的障碍。利益相关者对不同CFIR结构的重要性进行了排名。分别为内部利益相关者、外部利益相关者和患者举办了会议。主持人使用文化适应文本和混合形式进行共识讨论，以确定障碍。通过CFIR实施变革专家建议（ERIC）匹配工具确定了克服障碍的潜在策略。CFIR纸牌游戏于2023年8月进行，有20名参与者（内部：4名，外部：8名，患者：8名）。内部利益相关者指出了适应性、成本以及缺乏外部变革推动者的问题。外部利益相关者强调了适应性、设计质量和经济负担，提出了宣传和本地讨论的建议。患者对影响信任和接受度的适应性和外部政策表示担忧，强调战略调整和本地参与。CFIR-ERIC匹配工具建议将确定倡导者和改变激励措施作为策略。纳入倡导者角色、本地调整、政策执行和财政支持可以加强尼日利亚的肛门癌预防培训。研究结果强调了文化敏感性以及与当地利益相关者合作以支持肛门癌预防培训从业者的重要性。
