Development and user testing of a culturally targeted anal cancer prevention decision tool

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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.