Development and user testing of a culturally targeted anal cancer prevention decision tool - Project Summary
Men who have sex with men (MSM) and transgender women (TGW) are at increased risk of anal cancer
because of prevalent anal human papillomavirus (HPV) infections. Anal cancer incidence among MSM ranges
from 37 to 131 cases per 100,000. That is roughly 20 to 80 times higher than anal cancer rates in the general
population. TGW have similar if not greater risk of precancerous anal lesions than MSM. HPV vaccination
provides a unique opportunity to decrease anal cancer disparities for MSM and TGW; however, current HPV
vaccine coverage is inadequate. Targeted efforts are urgently needed to increase HPV vaccine uptake among
eligible adult MSM and TGW. We propose that leveraging existing HIV prevention services already utilized by
MSM and TGW (e.g., pre-exposure prophylaxis [PrEP]) can help to increase the reach and equity of HPV
vaccination. MSM/TGW on PrEP have increased need for HPV vaccination given high rates of anal cancer risk
factors. However, HPV vaccination is not part of current screening guidelines for PrEP initiation. The long-term
objective of this research is to develop a multilevel PrEP clinic-based toolkit to support shared clinical decision
making for anal cancer prevention. The objective of this application is to develop patient-level anal cancer
prevention content targeted to ethnoracially diverse MSM/TGW PrEP patients. This is a mixed methods health
communication approach that engages PrEP patients and providers. We will use perceptual mapping and
vector message modeling to create culturally responsive anal cancer prevention messaging focused on HPV
vaccination. The methods are informed by the information-motivation-behavioral skills model, guided by an
intersectionality framework, and applies best practices in health communication. There are three specific aims:
(1) Determine anal cancer prevention information needs and messaging strategies for MSM/TGW on PrEP; (2)
Develop targeted anal cancer prevention messages for MSM/TGW on PrEP; and (3) Assess the acceptability,
relevance, and comprehensibility of anal cancer prevention messages and identify implementation strategies.
In-depth qualitative interviews and focus groups with MSM/TGW on PrEP and PrEP providers will provide
qualitative evidence (aims 1 and 3). Perceptual mapping surveys and vector message modeling (aim 2) will be
used to develop content for the anal cancer prevention toolkit. This project will help reduce cancer disparities
by improving medical decision making and patient-provider communication regarding anal cancer prevention.
The multi-level approach addresses gaps as outlined in the National Institute on Minority Health and Health
Disparities Research Framework. We focus on behavioral and healthcare system domains at individual and
interpersonal levels. The content developed in this study will be included in a multilevel PrEP clinic-based
toolkit, providing patient education, provider messaging, and implementation strategies. The effectiveness of
the toolkit on HPV vaccine uptake and decisional quality outcomes will be tested in a future R01.
