A mixed-methods assessment of decisional needs and development of health communication intervention for anal cancer screening among people with HIV - PROJECT SUMMARY People with HIV (PWH) have a disproportionately high anal cancer risk. As a result of the recent success of the national Anal Cancer–HSIL Outcomes Research (ANCHOR), several health organizations and specialty societies have developed anal cancer screening guidelines for PWH and have prioritized implementation of the screening guidelines. However, from patients’ perspective, the provision of anal cancer screening can be complex due to a lack of understanding of the screening modalities and algorithms and the potential benefits versus side effects. Furthermore, limited knowledge about the screening algorithms, provider beliefs, and limited availability of screening resources may restrain HIV healthcare providers from adequately discussing screening options with PWH. These patient- and provider-related constraints may further limit opportunities for PWH to make informed decisions about screening participation. To address this knowledge gap, the proposed project will obtain patient and provider perspectives to understand the decisional needs for anal cancer screening and create anal cancer screening communication intervention for healthcare providers to facilitate effective screening communication with PWH. The K99 phase of this project will include two aims: 1) Determine decisional needs (knowledge deficits, sources of decisional conflicts, values, expectations, and resources) for anal cancer screening among PWH, and 2) Examine the perspectives of HIV care providers on current anal cancer screening practices and barriers and facilitators to anal cancer screening implementation in HIV clinics. The R00 phase of the project will include the development of a screening communication intervention for healthcare providers and pre-testing the intervention to evaluate its acceptability, feasibility, complexity, fidelity, and usability. This K99/R00 award will not only create the first communication intervention designed for anal cancer screening, but it will also equip Dr. Garg with the necessary skills and training to complete the proposed research and transition to research independence. She will advance her training in four key areas: 1) qualitative and mixed methods design and analysis, 2) intervention designing, 3) intervention mapping and implementation science, and 4) professional skills development. She will complete her training and the proposed research with the full support of her mentors (Drs. Ashish Deshmukh, Katherine Sterba, and Eric Meissner). At the end of her R00 phase, Dr. Garg will submit an R01 application to test the effectiveness of the communication intervention in a hybrid effectiveness- implementation trial. This K99/R00 plan will enable Dr. Garg to achieve her goal of pursuing high-impact research in this crucial and understudied area of anal cancer screening implementation in PWH and equip her for a successful transition as an independent investigator, with emphasis on health disparities, early detection, and implementation science.
