3389 - Barriers and Facilitators to Anal Cancer Screening and Treatment for Patients with HIV: Physician Perceptions and Practices

Purpose/Objective(s): A lack of awareness of anal cancer and stigma associated with anal cancer are striking impediments to improving early cancer detection and treatment, especially among people with HIV (PWH). This qualitative study engaged physicians in the primary care setting as well as oncologists who serve PWH to assess their perspectives of patient facilitators and barriers to anal cancer screening and treatment, including perceptions of stigma.

Materials/Methods: Fifteen individual interviews were held between May-Dec 2024 with infectious disease (ID) physicians (n=5) and oncologists (n=10) who treat PWH. Oncologists included colorectal surgeons, medical oncologists, and radiation oncologists. Interviews were held virtually and lasted on average about 60 minutes. Standard content analysis was applied to the qualitative data to generate salient themes regarding facilitators and barriers to screening, treatment, and stigma.

Results: Most physician participants identified as male (67%), white (40%), and in practice 6 years or more (67%). While all physicians serve PWH, most oncologists (60%) treat a low number of anal cancer patients (between 6-10 annually), and these are primarily patients with non-metastatic anal cancer (Stages I-III). Physicians who worked within integrated health systems reported more facilitators to care for their patients, noting better coordination of care, shorter wait times for appointments, and more comprehensive support services than those who practiced in community sites. Anal cancer screening services are facilitated by same-day appointments, on-site anal cancer clinics, and dedicated ID physicians who serve high-risk populations. Barriers to care were reported particularly among physicians who serve low-income and uninsured patients in safety-net settings. These patient barriers included structural barriers to care (e.g., long wait times, poor coordination of care, financial/insurance barriers) as well as individual barriers (e.g., homelessness, lack of transportation, poor health literacy/awareness). Additionally, ID physicians noted that some patients express hesitancy toward anal cancer screening and discomfort with the procedure. Oncologists noted that cancer treatment for PWH can be delayed if HIV is not well controlled. As such, reluctance toward screening and stigma regarding anal cancer have contributed to delays in care for PWH, which is important since there was no consensus regarding anal cancer screening in PWH until 2024.

Conclusion: Identifying facilitators and barriers to care for anal cancer patients with HIV can be critical steps to strategize education campaigns to increase awareness, correct misconceptions, and break down barriers to patient access to anal cancer care. Findings also suggest potential opportunities to engage with patients, the community, and public health leaders to decrease stigma at the community level outside of healthcare environments.