A mixed methods study examining early onset anal cancer and current screening practices, attitudes, and perceived risk among people living with and without HIV in the Deep South

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PROJECT SUMMARY/ABSTRACT The purpose of the proposed F31 application is to support Ms. Anna Junkins (PI) in research training and development during her PhD training in Epidemiology on her trajectory to becoming an independent cancer researcher. The primary goals of the proposed research are 1) to identify predictors of early onset anal cancer (<50 years of age at diagnosis), and 2) utilize a mixed methods research (MMR) approach to identify and explain factors associated with anal cancer screening uptake among men living with HIV (MLHIV) and their providers in the Deep South. The first Aim will identify predictors of early onset anal cancer who have received care at the University of Alabama at Birmingham (UAB) Hospital. Electronic health records (EHR) at UAB provide detailed demographic, clinical, and socio-behavioral data which will be used in the statistical analyses to predict early onset cancer. Next, using a MMR approach, Aim 2 and Aim 3 will identify and explain barriers and facilitators to anal cancer screening, and explore attitudes about screening and perceived risk among MLHIV and their healthcare providers. The quantitative part of the MMR approach (Aim 2) will include analysis of survey data from UAB’s 1917 Clinic cohort database to identify predictors of screening. Following the data analysis in Aim 2, an in-depth interview (IDI) guide will be developed to explain predictors of screening uptake in Aim 3. This qualitative Aim will include IDI among a subpopulation of patients whose data was analyzed in Aim 2, and healthcare providers (physicians and nurse practitioners) at the UAB 1917 Clinic. The IDIs will aim to further explore attitudes about screening, history of screening, barriers and facilitators to screening, and perceived risk. The long-term goal of the proposed research is to improve the lives of people living with HIV (PLHIV) and those most at risk for early onset anal cancer by informing national anal cancer screening guidelines through 1) identifying risk factors of early onset anal cancer; and 2) identifying and explaining patient-level and provider- level facilitators and barriers to screening among PLHIV in the Deep South. The primary training goals include: 1) increase knowledge and experience in the utilization of EHR to answer complex research questions regarding early onset anal cancer; 2) gain certification in applied MMR in early detection and screening of anal cancer among PLHIV in the South; and 3) increase expertise and independence in cancer prevention and control research. The overall goal of the proposed training is to prepare Ms. Anna Junkins with a strong foundation for independent research in early detection of cancer among PLHIV. .