MADISON, WI — Because human immunodeficiency virus (HIV) patients are at high risk for anal cancer, screenings are recommended annually for U.S. veterans with HIV.
“Screenings can identify treatable precursor lesions and prevent cancer development,” according to researchers from the University of Wisconsin School of Medicine and Public Health and the W.S. Middleton Memorial Veterans’ Hospital, both in Madison. The study team advised that it previously had determined the yearly anal screening rate to be only 15%.
In response, the investigators conducted semi-structured interviews with VA providers who treat veterans diagnosed with HIV. Participants described their experiences with anal cancer screenings.
A total of 23 interviews were conducted with VA providers representing 10 regions. Barriers identified corresponded with five targetable Theoretical Domains Framework (TDF) domains: Knowledge, Skills, Environmental Context/Resources, Professional Roles/Identities and Social Influence. The results were published in AIDS Patient Care STDS.1
“Many providers lacked knowledge of screening protocols,” the researchers pointed out. “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.”
During the interviews, providers also mentioned competing priorities in the care of veterans with HIV infection and lack of skilled/trained personnel to perform the tests. Other factors included patient discomfort with screening exams.
“It was often unclear which provider specialty should ‘own’ screening responsibilities,” according to the researchers.
The study concluded that 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,” according to the study authors. “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.”
- Sanger CB, Kalbfell E, Cherney-Stafford L, Striker R, Alagoz E. A Qualitative Study of Barriers to Anal Cancer Screenings in US Veterans Living with HIV. AIDS Patient Care STDS. 2023 Sep;37(9):436-446. doi: 10.1089/apc.2023.0144. PMID: 37713286.