People living with HIV (PLWH), Oral and Oropharyngeal Cancer, and Health Equity: A Qualitative Study

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Project Summary People living with HIV (PLWH) have an estimated 1.6-6.0 times increased risk of developing oropharyngeal squamous cell carcinomas (OPSCC) compared with individuals in the general population. Approximately 70% of OPSCC are caused by HPV, and PLWH also have an increased prevalence of oral HPV infection compared to the general population. While a smaller proportion of oral squamous cell carcinomas (OSCC) are attributed to HPV, PLWH also have an increased risk of developing HPV-associated OSCC. Disparities exist among racial/ethnic groups for OSCC/OPSCC outcomes and Black individuals with OPSCC and OSCC have worse survival, a later stage of diagnosis, and less frequent cancer directed treatment than other racial/ethnic groups. HPV-associated OSCC/OPSCC are potentially preventable through HPV vaccination. Although oral cancer screening is not recommended for the general population, early detection is associated with improved survival and screening may be important in racial/ethnic minority groups. Oral health care providers may be the first point of contact for OSCC/OPSCC prevention strategies. PLWH have dental insurance provided through the Ryan White Care Act. Even so, more than half of PLWH have unmet oral care needs and 58-64% do not receive regular dental care. PLWH also face stigma and/or discrimination from living with HIV, including in the dental office, and may also have other intersectionality with sexual and gender minority (SGM) groups, for which there is additional stigma. Understanding the experiences of PLWH and the barriers/facilitators of oral health, through a lens of health equity, is needed before interventions can be designed to engage PLWH with intersecting identities in OSCC/OPSCC prevention activities. As a first step, we propose to conduct a qualitative study among PLWH of diverse racial/ethnic and SGM identities to: (1) explore individual, interpersonal, and structural oral health equity factors that serve as barriers or facilitators of accessing oral health care, (2) to explore knowledge and perceptions of HPV vaccination and OSCC/OPSCC, and (3) to collect recommendations on how to increase access to oral health care and engage PLWH in OSCC/OPSCC prevention. We will conduct approximately 12-18 focus groups with 5-8 individuals grouped by common identity group. These groupings may be by race/ethnicity, gender identity, sexual preference, or a combination of identities. The results of this study will be used to: 1) inform the design of a multilevel, culturally appropriate intervention to increase engagement with oral health care and HPV- associated OSCC/OPSCC prevention activities. The PI will design a randomized controlled trial to evaluate the intervention’s impact on HPV vaccination, OSCC/OPSCC knowledge, and retention in oral health care; and 2) assess the risks and benefits of OSCC and novel OPSCC screening among PLWH from diverse racial/ethnic identity groups. Screening PLWH at high risk for HPV-associated OSCC/OPSCC and from of groups with poor 5-year survival from OSCC/OPSCC may prove beneficial in reducing cancer-related mortality.