Facilitators of and barriers to high-resolution anoscopy adherence among men who have sex with men: a qualitative study
Kaan Z. Apaydin A , Andy Nguyen B , Lori Panther A , Derri L. Shtasel B C , Sannisha K. Dale C D , Christina P. C. Borba E F , Christopher S. Lathan B G , Kenneth Mayer A B H and Alex S. Keuroghlian A B C I
+ Author Affiliations
- Author Affiliations
A The Fenway Institute, 1340 Boylston St., Boston, MA 02215, USA.
B Harvard Medical School, Boston, MA 02115, USA.
C Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02214, USA.
D Department of Psychology, University of Miami, Coral Gables, FL 33124, USA.
E Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA.
F Boston University School of Medicine, Boston, MA 02218, USA.
G Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
H Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
I Corresponding author. Email: akeuroghlian@partners.org
Sexual Health 15(5) 431-440 https://doi.org/10.1071/SH18029
Submitted: 23 February 2018 Accepted: 31 May 2018 Published: 24 September 2018
Abstract
Background: Anal cancer is a rare malignancy that disproportionately affects men who have sex with men (MSM) and HIV-infected people. Anal cancer is associated with human papillomavirus (HPV) in upward of 90% of cases and is preceded by pre-cancerous changes in cells of the anal canal. High-resolution anoscopy (HRA) is used for the detection, treatment and continued monitoring of anal dysplasia. Practice guidelines regarding anal cancer prevention vary by jurisdiction and institution, and patient engagement is low for high-risk populations such as MSM. The purpose of this study is to characterise perceptions among MSM of barriers to and facilitators of their adherence to HRA follow-up recommendations. Methods: Surveys and in-person focus groups with MSM who were either adherent or non-adherent to HRA follow-up recommendations at a Federally Qualified Health Centre in Boston, MA, which specialises in sexual and gender minority care, were conducted. Facilitators of and barriers to follow-up were identified by deductive content analysis. Results: Focus group participants identified the following barriers to and facilitators of HRA follow up: (1) patient-level beliefs about HPV-related disease or HRA, ability to engage in care, internalised stigma and physical discomfort; (2) provider-level knowledge and expertise, communication skills and relationship-building with patient; and (3) systems-level societal stigma and healthcare system inefficiencies. Conclusions: Reinforcing facilitators of and reducing barriers to HRA follow up may improve adherence among MSM. This includes improvements to: patient education, provider training to increase knowledge and cultural sensitivity, public awareness about HPV-related anal cancer, physical discomfort associated with HRA and systems inefficiencies.
Additional keywords: anal cancer, high-resolution anoscopy, HIV, human immunodeficiency virus; HPV, human papillomavirus, men who have sex with men.
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