Access to High-Resolution Anoscopy and Colorectal Surgery Support Identified as Important Facilitators to Successful Veterans Affairs Anal Cancer Screening Programs.

Abstract

Background: Anal cancer disproportionately affects people living with HIV. The Department of Veterans Affairs is the largest single provider of health care to people living with HIV 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 Veterans Affairs have been underused.

Objective: This study aims to identify facilitators to anal cancer screening programs in Veterans Affairs.

Design: This is a qualitative study involving semistructured virtual interviews. Thematic analysis was used to identify themes in the interview data.

Settings: Study participants included Veterans Affairs infectious disease providers and colorectal surgeons who care for veterans living with HIV. Participants were asked to discuss factors that influence anal cancer screenings in Veterans Affairs.

Main outcome measures: Themes were mapped to theoretical constructs and domains related to behavioral change using the Theoretical Domains Framework.

Results: A total of 23 Veterans Affairs providers from all major United States geographical regions were interviewed. Important facilitators identified included access to high-resolution anoscopy and colorectal surgery support. The themes for successful anal cancer screening programs were mapped to 15 behavior-influencing constructs and categorized into 6 domains: 1) knowledge, 2) skills, 3) professional role and identity, 4) goals, 5) environmental context and resources, and 6) social influences.

Limitations: This study involves health care providers who are invested in caring for veterans living with HIV, and their perspectives might not be representative of all Veterans Affairs providers.

Conclusions: Access to a clinician with high-resolution anoscopy training and colorectal surgery support were identified as integral components of a successful anal cancer screening program. This study provides a framework for improving anal cancer screenings in veterans living with HIV by use of evidence-based interventions that incorporate the identified facilitators. See Video Abstract .