QS141 - Access to HRA and Colorectal Surgery Support Identified as Important Facilitators to a Successful Veterans Affairs Anal Cancer Screening Program

Purpose/Background: Anal cancer disproportionately affects people living with HIV (PLWH). The Department of Veterans Affairs (VA) is the largest single provider of healthcare to PLWH in the United States and recommends all veterans living with HIV be screened for anal cancer annually. There are barriers to developing successful anal cancer screening programs and screenings within VA have been underutilized. A recently completed randomized controlled trial demonstrated treatment of high-grade anal neoplasia compared to monitoring alone led to a reduction of anal cancer in PLWH. These findings highlight the need to identify neoplastic lesions, which can be accomplished through screening. We hypothesized that there are healthcare provider perceived facilitators that can increase the uptake of VA anal cancer screening programs.

Methods/Interventions: VA providers who care for veterans living with HIV were invited to participate in 30-minute, semi-structured virtual interviews. Study participants included infectious disease providers and colorectal surgeons. Providers were asked to discuss factors that influence anal cancer screenings in VA. Three researchers collaboratively reviewed interview transcripts and used thematic analysis to identify patterns in the data. Using the Theoretical Domains Framework (TDF), an established implementation science framework, the main themes in our data were mapped to TDF domains and characterized as facilitators to adopting anal cancer screening programs in VA.

Results/Outcomes: A total of 23 providers (21 infectious disease providers, 2 colorectal surgeons) were interviewed with representation from all major geographical regions in the United States and 11 of 18 VA regional systems of care. The facilitators (themes) to successful screening programs that emerged from participant interview data were mapped to 15 unique behavior-influencing constructs and categorized into six TDF domains: (1) Environmental Context and Resources, (2) Professional Role and Identity, (3) Goals, (4) Knowledge, (5) Skills, and (6) Social Influences. Important facilitators included access to high resolution anoscopy (HRA), colorectal surgery support, and continuity of care. Providers identified being or having an advocate with programmatic goals that are supported by buy-in from institutional leadership and collaborating clinics as being critical. Establishing clear provider roles regarding who is responsible for overseeing anal cancer screenings and having or obtaining the appropriate knowledge and skills related to screening were also identified as important. Providers discussed having the interpersonal skills and confidence to normalize “uncomfortable” conversations related to anal cancer screening when counseling patients as helpful facilitators to programmatic success.

Conclusion/Discussion: Our study demonstrates facilitators identified by providers significant to successful anal cancer screening programs within VA. Identified facilitators map to six TDF domains including environment/resources, professional roles, goals, knowledge, skills, and social factors. Access to HRA and colorectal surgeons are identified as integral components of a successful program. The results of this study provide a framework for improving anal cancer screenings using evidenced-based interventions incorporating the facilitators identified and highlights the importance of colorectal surgeons to VA.