Anal cancer screening among women with HIV: provider experiences and system-level challenges

ABSTRACT

Women living with HIV (WLWH) are at increased risk of anal cancer compared to women without HIV, often due to persistent human papillomavirus (HPV) infections. This paper describes current practices and challenges conducting anal cancer screening for WLWH at an urban integrated safety-net system and a non-profit community-based HIV clinic. We conducted 25 semi-structured interviews with clinical and administrative stakeholders to assess knowledge, clinic practices and procedures, and experiences with anal cancer screening. Interview transcripts and fieldnotes were thematically analyzed using an iterative deductive and inductive coding scheme. Findings were organized by the Consolidated Framework for Implementation Research (CFIR) domains and constructs. Provider-level barriers to conducting anal cancer screening included limited knowledge of guidelines. System-level barriers included: structural characteristics such as lack of coordination between clinics to discern provider roles and responsibilities; and limitations in available resources such as configuration of electronic health records and infrastructure to manage referrals of abnormal anal Pap results. We conclude that anal cancer screening and follow-up for WLWH requires organization and coordination between multiple care teams, updated clinical information systems to facilitate communication and support anal Pap ordering and result documentation, and infrastructure that includes policies and protocols for management of abnormal results.

KEYWORDS:

• Human papillomavirus (HPV)
• dysplasia
• safety-net
• Papanicolaou (Pap) test
• qualitative
• risk perception

Acknowledgments

The authors are grateful to the participants for generously donating their time and sharing their perspectives.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Declaration of interests

The authors declare they have no conflicts of interest.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study was supported by the National Center for Advancing Translational Sciences under Grant UL1TR00105; the Agency for Healthcare Research and Quality under Grant HS022418; the President’s Program for the Development and Evaluation of Model Community Health Initiatives in Dallas at the University of Texas Southwestern Medical Center (PI: Barnes); and the University of Texas Health Science Center at Houston, School of Public Health–National Cancer Institute Cancer Control Research Training Program under Grant T32/CA057712 (Fernandez).