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

HIV 感染者 (PLWH)、口腔癌和口咽癌以及健康公平：定性研究

• 批准号: 10762901
• 负责人: Alexandra Lydia Hernandez
• 金额: $ 16.19万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762901
• 关键词: Adolescent; Anus; Benefits and Risks; Black Populations; Black race; Cancer Etiology; Caring; Categories; Data; Dental Care; Dental Insurance; Dental Offices; Dentists; Diagnosis; Discrimination; Disease; Disparity; Early Diagnosis; Education; Ethnic Origin; Ethnic Population; Face; Focus Groups; Funding Mechanisms; Gender; Gender Identity; General Population; Goals; Grouping; HIV; HPV oropharyngeal cancer; HPV-High Risk; Head and Neck Cancer; Health Insurance; Health Personnel; Healthcare; High Prevalence; Hispanic; Hospitals; Hour; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Human papilloma virus infection; Improve Access; Incidence; Individual; Intervention; Knowledge; Latinx; Malignant Neoplasms; Mentors; Minority; Mouth Diseases; National Health and Nutrition Examination Survey; Neck; Operative Surgical Procedures; Oral health; Oropharyngeal Squamous Cell Carcinoma; Outcome; Participant; Perception; Persons; Prevalence; Prevention; Prevention program; Prevention strategy; Primary Prevention; Provider; Race; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Screening for Oral Cancer; Secondary Prevention; Sexual and Gender Minorities; Smoker; Squamous cell carcinoma; Structural Racism; Suggestion; Surveys; Survival Rate; Tongue; Transportation; United States Preventative Services Task Force; Woman; acceptability and feasibility; aged; anti-racism; black men; cis-female; cis-male; design; ethnic identity; ethnic minority population; experience; feasibility testing; gender minority group; health equity; health inequalities; human papilloma virus oropharyngeal squamous cell carcinoma; improved; innovation; internalized stigma; intersectionality; malignant mouth neoplasm; malignant oropharynx neoplasm; member; men; mortality; mouth squamous cell carcinoma; nonbinary; novel; oral HPV infection; oral care; preference; prevent; preventive intervention; programs; racial diversity; racial minority population; racial population; screening; screening program; sex; sexual minority; smoking prevalence; social stigma; uptake; vaccine acceptance

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.

项目摘要 据估计，艾滋病毒感染者（PLWH）患艾滋病的风险增加1.6-6.0倍。 口咽鳞状细胞癌（OPSCC）与一般人群中的个体相比。 大约70%的OPSCC是由HPV引起的，PLWH的口腔HPV患病率也有所增加。 与普通人群相比，而口腔鳞状细胞癌中 （OSCC）归因于HPV，PLWH也具有发展HPV相关OSCC的增加的风险。 OSCC/OPSCC结局的种族/民族群体和OPSCC黑人个体之间存在差异 和OSCC相比， 其他种族/民族。HPV相关的OSCC/OPSCC可能通过HPV疫苗接种来预防。 虽然口腔癌筛查不推荐用于一般人群，但早期发现与 在种族/少数民族群体中，提高生存率和筛查可能是重要的。 口腔卫生保健提供者可能是OSCC/OPSCC预防策略的第一接触点。 PLWH有通过瑞安白色护理法案提供的牙科保险。即便如此，一半以上的艾滋病毒携带者 口腔护理需求未得到满足，58-64%的人没有定期接受牙科护理。艾滋病毒/艾滋病感染者还面临耻辱和/或 艾滋病毒感染者的歧视，包括在牙科诊所，也可能有其他交叉性， 性和性别少数群体，对他们来说，还有更多的耻辱。了解经验 在采取干预措施之前，需要通过健康公平的透镜， 可以设计成使具有交叉身份的PLWH参与OSCC/OPSCC预防活动。 作为第一步，我们建议在不同种族/族裔和SGM的艾滋病毒携带者和艾滋病患者中进行定性研究， 身份：（1）探索个人，人际关系和结构性口腔健康公平因素，作为障碍 或获得口腔保健的促进者，（2）探索HPV疫苗接种的知识和看法， OSCC/OPSCC，以及（3）收集关于如何增加口腔保健的可及性的建议， PLWH在OSCC/OPSCC预防中的作用。我们将进行大约12-18个焦点小组，5-8个人 按共同身份组分组。这些分组可能是按种族/民族、性别认同、性取向、性别认同、性别 偏好或身份的组合。本研究的结果将用于：1）为设计提供信息 多层次、文化上适当的干预措施，以增加对口腔保健和HPV的参与- 相关OSCC/OPSCC预防活动。主要研究者将设计一项随机对照试验， 干预措施对HPV疫苗接种、OSCC/OPSCC知识和口腔保健保留率的影响; 和2）评估OSCC和新的OSCC筛查在PLWH中的风险和益处， 种族/民族身份群体。筛查HPV相关OSCC/OPSCC高危PLWH， OSCC/OPSCC 5年生存率低的人群可能有助于降低癌症相关死亡率。