Implementing an Evidence-Based, Multilevel Intervention for Primary Prevention of Anal Cancer among HIV Positive Adults

Emory University, Atlanta GA

Investigators

Linked publications & trials

Abstract

People living with HIV (PLWH) are 28 times more likely to be diagnosed with anal cancer than the general population. The PI’s preliminary data found significant delays in follow up care after an abnormal anal Pap test. Delays in follow up after an anal Pap test in the absence of national guidelines to support screening in PLWH means the incidence of anal cancer will continue to rise among PLWH, especially as this population ages. Therefore, a primary cancer prevention approach for this high-risk population is paramount. Yet, the PI’s prior work found significant gaps in knowledge and awareness of anal cancer and the risk factors associated with anal cancer (i.e., living with HIV). These findings support the next logical step to reduce the impact of anal cancer among PLWH as part of a successful cancer prevention plan. The evidence-based 4 PillarsTM Transformation Program is a multi-level intervention that has been successfully utilized to improve primary prevention strategies in the general population and is primed to be tested in the high-risk HIV population, particularly PLWH in the rural South. Guided by the RE-AIM framework, we will implement this project in three HIV clinics across the state of Georgia and enroll n=365 PLWH who are age 18-45 years from those clinics. Aim 1) Tailor and refine the 4 PillarsTM program for implementation in rural and urban HIV clinics in Georgia; Aim 2) Test the effectiveness of the 4 PillarsTM program as measured by: Aim 2.1) change in anal cancer knowledge and awareness among PLWH and providers; Aim 2.2) comparison of clinic’s baseline data and post-intervention data to assess intervention fidelity and reach; Aim 3) assessment of the sustainability of the intervention during post-intervention phase; Aim 3.1) evaluation of scalability of the program for wider implementation via a future national RCT. As an Early-Stage Investigator, the PI (Wells) has assembled an outstanding, multidisciplinary research team that brings complementary expertise to successfully execute the aims of this research proposal. The findings are anticipated to have a significant impact in the field of cancer prevention and improving cancer outcomes in a high-risk and aging HIV population.Â