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

项目摘要 与男性发生性关系的男性(MSM)和变性女性(TGW)患肛门癌的风险更高 由于普遍存在的肛门人乳头瘤病毒(HPV)感染。男男性接触者人群中的肛门癌发病率 从每10万人中的37例增加到131例。这大约是一般肛门癌发病率的20到80倍。 人口。TGW患癌前病变的风险与MSM相似，如果不是更高的话。HPV疫苗接种 为MSM和TGW减少肛门癌差异提供了独特的机会；然而，目前的HPV 疫苗覆盖率不足。迫切需要有针对性的努力，以增加人们接种HPV疫苗 符合条件的成年男男性接触者和TGW。我们建议利用现有的艾滋病毒预防服务， 男男性接触者和TGW(例如，暴露前预防[PrEP])有助于增加HPV的覆盖面和公平性 接种疫苗。由于肛门癌风险较高，PrEP上的男男性接触者/TGW对HPV疫苗的需求增加 各种因素。然而，HPV疫苗接种不是目前PrEP启动筛查指南的一部分。长期的 本研究的目的是开发一个多层次的PrEP临床工具包，以支持共享临床决策 为预防肛门癌做出了贡献。该应用程序的目标是开发患者水平的肛门癌 针对不同种族的MSM/TGW PrEP患者的预防内容。这是一种混合养生的方法 与PrEP患者和提供者接触的沟通方法。我们将使用感知映射和 载体消息建模以创建以HPV为重点的文化响应型肛门癌预防消息 接种疫苗。这些方法由信息-动机-行为技能模型提供信息，并由 交叉框架，并在卫生交流中应用最佳做法。具体目标有三个： (1)确定男男性接触者/TGW在PrEP上的肛门癌预防信息需求和传播策略；(2) 在PrEP上为MSM/TGW制定有针对性的肛门癌预防信息；以及(3)评估可接受性， 肛门癌预防信息的相关性和可理解性，并确定实施策略。 与MSM/TGW就PrEP和PrEP提供者进行的深入定性访谈和焦点小组将提供 定性证据(目标1和3)。感知测绘调查和矢量信息建模(目标2) 用于开发肛门癌预防工具包的内容。该项目将有助于减少癌症差异。 通过改善关于肛门癌预防的医疗决策和患者与提供者的沟通。 多层次的方法解决了国家少数民族健康和健康研究所概述的差距。 差异研究框架。我们专注于行为和医疗保健系统领域的个人和 人际层面。本研究开发的内容将包括在以临床为基础的多水平PrEP中 工具包，提供患者教育、提供者消息传递和实施策略。的有效性。 关于HPV疫苗接种和决策质量结果的工具包将在未来的R01中进行测试。

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.