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）和跨性别女性（TGW）患肛门癌的风险增加 因为肛门人乳头瘤病毒（HPV）感染很普遍。MSM人群肛门癌发病率 从每10万人37例降至131例。这大约是一般肛门癌发病率的20到80倍 人口TGW有类似的，如果不是更大的癌症前肛门病变的风险比MSM。HPV疫苗接种 提供了一个独特的机会，以减少肛门癌的差距男男性接触者和TGW;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HPV疫苗的吸收， 符合条件的成年MSM和TGW。我们建议利用现有的艾滋病毒预防服务， MSM和TGW（例如，暴露前预防[PrEP]）可以帮助增加HPV的覆盖范围和公平性 预防针PrEP的MSM/TGW增加了对HPV疫苗接种的需求，因为肛门癌风险率很高 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 本研究的目的是开发一个多层次的PrEP临床工具包，以支持共享的临床决策 有助于预防肛门癌本申请的目的是发展患者水平的肛门癌 针对不同种族MSM/TGW PrEP患者的预防内容。这是一个混合方法的健康 沟通方法，使PrEP患者和提供者参与。我们将使用感知映射， 矢量信息建模，以创建文化响应的肛门癌预防信息，重点是HPV 预防针这些方法以信息-动机-行为技能模型为基础， 在这方面，我们的工作重点是建立一个跨部门框架，并在卫生宣传方面采用最佳做法。有三个具体目标： (1)确定MSM/TGW对PrEP的肛门癌预防信息需求和信息传递策略;（2） 为MSM/TGW制定有针对性的肛门癌预防信息;（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。 深入的定性访谈和焦点小组与MSM/TGW对PrEP和PrEP供应商将提供 质量证据（目标1和3）。感知映射调查和矢量信息建模（目标2）将 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 通过改善医疗决策和患者-提供者关于肛门癌预防的沟通。 国家少数民族健康和保健研究所概述了多层次办法解决差距的问题。 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。本研究中开发的内容将纳入基于临床的多层次PrEP 工具包，提供患者教育、提供者信息和实施策略。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R 01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.