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Ziegler E, Slotnes-O'Brien T, Peters MDJ. Cancer Screening and Prevention in the Transgender and Gender Diverse Population: Considerations and Strategies for Advanced Practice Nurses. Semin Oncol Nurs 2024; 40:151630. [PMID: 38622043 DOI: 10.1016/j.soncn.2024.151630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/09/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES This discussion paper presents recent evidence regarding cancer screening and prevention among the transgender and gender diverse (TGD) community and highlights where and how advanced practice nurses (APNs), particularly those in primary care, can better contribute to closing the gap between healthcare disparities between TGD and cisgendered populations. METHODS Relevant publications on the topic and professional guidelines and evidence have formed the basis for this discussion paper. RESULTS TGD individuals are a vulnerable population with unique needs. They remain at risk of cancer and might be at greater risk of developing some cancers compared to cisgendered people but are underscreened. Barriers to gender-affirming care need to be addressed to improve access to prevention and screening services and improve the cancer care experiences and outcomes of TGD people. CONCLUSION APNs can work in collaboration with TGD individuals and the healthcare system to improve access to culturally safe cancer screening and more effective prevention of cancer and poor cancer outcomes. IMPLICATIONS FOR NURSING PRACTICE APNs have the potential to improve access to cancer screening for TGD people by increasing their understanding of the needs of the population, providing culturally safe care, and advocating for more preventative care and cancer screening. With greater knowledge and understanding of the needs and preferences of TGD people both broadly and in relation to cancer screening and prevention, targeted interventions and care approaches can be implemented. APNs should also aim to conduct evaluations and research into cancer prevention and screening to build the currently limited evidence base and nursing knowledge in this important field.
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Affiliation(s)
- Erin Ziegler
- Associate Professor, Daphen Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada.
| | - Toni Slotnes-O'Brien
- Senior Lecture, UniSA Clinical & Health Science, University of South Australia, Adelaide, Australia
| | - Micah D J Peters
- Associate Professor, UniSA Clinical & Health Science, University of South Australia, Adelaide, Australia
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Welsh EF, Andrus EC, Sandler CB, Moravek MB, Stroumsa D, Kattari SK, Walline HM, Goudsmit CM, Brouwer AF. Cervicovaginal and Anal Self-Sampling for Human Papillomavirus Testing in a Transgender and Gender Diverse Population Assigned Female at Birth: Comfort, Difficulty, and Willingness to Use. LGBT Health 2024. [PMID: 38574315 DOI: 10.1089/lgbt.2023.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Purpose: Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for cervical cancer screening. At-home human papillomavirus (HPV) testing may expand access to cervical cancer screening for TGD people AFAB. This study assessed the perceptions of TGD individuals AFAB who self-collected cervicovaginal and anal samples. Methods: We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results: Of 137 consenting participants, 101 completed the sample collection and the surveys. The majority of participants reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. Conclusions: TGD individuals AFAB were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for HPV testing could expand access to cancer screening for TGD populations.
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Affiliation(s)
- Erin F Welsh
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Claire B Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daphna Stroumsa
- Department of Obstetrics and Gynecology, Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Department of Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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McIntosh RD, Andrus EC, Walline HM, Sandler CB, Goudsmit CM, Moravek MB, Stroumsa D, Kattari SK, Brouwer AF. Prevalence and Determinants of Cervicovaginal, Oral, and Anal Human Papillomavirus Infection in a Population of Transgender and Gender Diverse People Assigned Female at Birth. LGBT Health 2024. [PMID: 38530059 DOI: 10.1089/lgbt.2023.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Purpose: The human papillomavirus (HPV) causes cervicovaginal, oral, and anogenital cancer, and cervical cancer screening options include HPV testing of a clinician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face many barriers to preventive care, including cancer screening. Self-sampling options may increase access and participation in HPV testing and cancer screening. This study estimated the prevalence of HPV in self-collected cervicovaginal, oral, and anal samples from Midwestern TGD individuals AFAB. Methods: We recruited TGD individuals AFAB for an observational study, mailing them materials to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for high-risk (HR; 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and other HPV genotypes (6, 11, 66, 68, 73, 90) using a polymerase chain reaction mass array test. Prevalence ratios for HPV infection at each site as a function of participant characteristics were estimated in log-binomial models. Results: Out of 137 consenting participants, 102 completed sample collection. Among those with valid tests, 8.8% (HR = 6.6%; HPV 16/18 = 3.3%) were positive for oral HPV, 30.5% (HR = 26.8%; HPV 16/18 = 9.7%) for cervicovaginal HPV, and 39.6% (HR = 33.3%; HPV 16/18 = 8.3%) for anal HPV. A larger fraction of oral (71.4%) than anal infections (50.0%) were concordant with a cervicovaginal infection of the same type. Conclusions: We detected HR cervicovaginal, oral, and anal HPV in TGD people AFAB. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.
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Affiliation(s)
- Ryan D McIntosh
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Claire B Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Molly B Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Department of Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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McIntosh RD, Andrus EC, Walline HM, Sandler CB, Goudsmit CM, Moravek MB, Stroumsa D, Kattari SK, Brouwer AF. Prevalence and determinants of cervicovaginal, oral, and anal HPV infection in a population of transgender and gender diverse people assigned female at birth. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.15.23294129. [PMID: 37645745 PMCID: PMC10462201 DOI: 10.1101/2023.08.15.23294129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Introduction HPV causes oral, cervicovaginal, and anogenital cancer, and cervical cancer screening options include HPV testing of a physician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face discrimination and stigma in many healthcare settings; are believed to be a lower risk for cervical cancer by many physicians; are less likely to be up to date on preventive health care services such as pelvic health exams; and are more likely to have inadequate results from screening tests. Self-sampling options may increase access and participation in HPV testing and cancer screening. Methods We recruited 137 TGD individuals AFAB for an observational study, mailing them a kit to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for HPV genotypes 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73 and 90 using a PCR mass array test. Results 102 participants completed the study. Among those with valid tests, 8.8% were positive for oral HPV, 30.5% were positive for cervicovaginal HPV, and 39.6% were positive for anal HPV. A large fraction of anal (50.0%) and oral (71.4%) infections were concordant with a cervicovaginal infection of the same type. Conclusions HPV infection in TGD people AFAB may be just as high, if not higher, than in cisgender women. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.
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Affiliation(s)
- Ryan D. McIntosh
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Emily C. Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Heather M. Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Claire B. Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Molly B. Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States
| | - Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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5
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Welsh EF, Andrus EC, Sandler CB, Moravek MB, Stroumsa D, Kattari SK, Walline HM, Goudsmit CM, Brouwer AF. Cervicovaginal and anal self-sampling for HPV testing in a transgender and gender diverse population assigned female at birth: comfort, difficulty, and willingness to use. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.15.23294132. [PMID: 37645965 PMCID: PMC10462238 DOI: 10.1101/2023.08.15.23294132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for HPV and cervical cancer screening. Self-sampling options may expand access to HPV testing for TGD people AFAB. Methods We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at-home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results The majority of the 101 participants who completed the study reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. About 70% of participants who reported negative experiences with either self-swab were still willing to use that swab in the future. Conclusions TGD AFAB individuals were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for cancer screening could expand access to HPV screening for TGD AFAB populations.
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Affiliation(s)
- Erin F Welsh
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Emily C. Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Claire B. Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Molly B. Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States
| | - Heather M. Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | | | - Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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Carroll R, Tan KKH, Ker A, Byrne JL, Veale JF. Uptake, experiences and barriers to cervical screening for trans and non-binary people in Aotearoa New Zealand. Aust N Z J Obstet Gynaecol 2023. [PMID: 37005094 DOI: 10.1111/ajo.13674] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
Little is known about experiences and barriers for trans and non-binary (TGNB) people eligible for cervical screening in Aotearoa New Zealand. AIMS To identify uptake, barriers and reasons for delaying cervical cancer screening among TGNB people in Aotearoa. MATERIALS AND METHODS The 2018 Counting Ourselves data on TGNB people assigned female at birth aged 20-69 years who had ever had sex, were analysed to report on experiences of those who were eligible for cervical screening (n = 318). Participants answered questions about whether they had taken part in cervical screening and reasons behind any delays in receiving the test. RESULTS Trans men were more likely than non-binary participants to report that they did not require cervical screening or were unsure if they needed it. For those who had delayed cervical screening, 30% did so due to feeling worried about how they would be treated as a trans or non-binary person and 35% due to another reason. Other reasons for delay related to general and gender-related discomfort, previous traumatic experiences, anxiety or fear of the test and pain. Material barriers to access included cost and lack of information. CONCLUSIONS The current cervical screening program in Aotearoa does not consider the needs of TGNB people, leading to delayed and reduced uptake of cervical screening. Health providers require education on the reasons TGNB people delay or avoid cervical screening in order to provide appropriate information and affirmative healthcare environments. The human papillomavirus self-swab may address some of the existing barriers.
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Affiliation(s)
- Rona Carroll
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Kyle K H Tan
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
| | - Alex Ker
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Jack L Byrne
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Jaimie F Veale
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
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7
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Zschaebitz E, Bradley A, Olson S, Casey C, Britz J. Primary Care Practice for Gender-Diverse Patients Using Gender-Affirming Hormone Therapy. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.104526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Dartibale CB, Prado GDC, Carobeli LR, Meirelles LEDF, Damke GMZF, Damke E, Morelli F, Souza RP, da Silva VRS, Consolaro MEL. Recent HPV self-sampling use for cervical cancer screening in Latin America and Caribbean: a systematic review. Front Oncol 2022; 12:948471. [PMID: 36338730 PMCID: PMC9627290 DOI: 10.3389/fonc.2022.948471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/03/2022] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Cervical cancer is one of the deadliest cancers among women in Latin America and Caribbean (LAC), where most of the countries have not been successful in implementing population-level cytology-based screening programs. An increasing body of evidence supports the validity of self-sampling as an alternative to clinician collection for primary Human papillomavirus (HPV) screening. Therefore, this work aims to summarize recent HPV self-sampling approaches in LAC. METHOD We performed a systematic review to identify studies focused on "Self-sampling", and "Human Papillomavirus DNA test" and "Latin America" in PubMed, Embase, Web of Science, Cochrane library and SCOPUS databases for publications dating between 01 January 2017 and 15 March 2022 based on the Preferred Reporting Items for systematic reviews and meta-analysis (PRISMA) statement. Additionally, the references of the articles were carefully reviewed. RESULTS Of the 97 records selected, 20 studies including 163,787 participants, with sample sizes for individual studies ranging from 24 to 147,590 were included in this review. Studies were conducted in 10 LAC countries (18.5%), most with upper medium-income economies (70%). The range of age was 18 to ≥65 years. The vast majority of the studies (85%) addressed the HPV self-sampling strategy for primary cervical cancer screening with overall success for all women including under/never screened and those from special populations (rural, indigenous and gender minorities). Women generally found HPV self-sampling highly acceptable regardless of age, setting of collection, target population or country of residence. CONCLUSIONS HPV self-sampling is a promising strategy to overcome the multiple barriers to cervical cancer screening in LAC settings and increasing attendance in underscreened women in countries/territories with well-established screening programs. Furthermore, this strategy is useful even in LAC countries/territories without organized cervical cancer screening and in special populations such as indigenous, rural and transgender women. Therefore, the information generated by the recent initiatives for HPV self-sampling approach in LAC can be beneficial for decision-making in both new and existing programs in the region.
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Kattari SK, Gross EB, Harner V, Andrus E, Stroumsa D, Moravek MB, Brouwer A. "Doing it on my own terms": Transgender and nonbinary adults' experiences with HPV self-swabbing home testing kits. WOMEN'S REPRODUCTIVE HEALTH (PHILADELPHIA, PA.) 2022; 10:496-512. [PMID: 38105788 PMCID: PMC10720596 DOI: 10.1080/23293691.2022.2094737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/19/2022] [Indexed: 12/19/2023]
Abstract
The human papillomavirus (HPV) carries a significant health risk for people with a cervix. Among transgender and nonbinary people, however, testing and treatment for HPV can pose difficulties, and even be traumatic at times. This current study is part of a larger mixed methods study conducted in Michigan in 2020, and it explores the experiences of transmasculine and nonbinary people with at-home self-swabbing HPV test kits and knowledge of HPV transmission/screenings. Phenomenological methods were used by conducting virtual qualitative interviews with ten transmasculine and nonbinary individuals with cervixes, ages 23-59. Interviews were independently coded by members of the research team and a tabletop theming method was used. Four themes were generated from the data: 1) Multilevel barriers; 2) "Get it done, so I know that I am safe"; 3) Contrasting preferences for care; and 4) Community calls for change. The discussion focuses on the implications of these findings for improving sexual health care for the transgender and nonbinary community, along with directions for further research.
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Affiliation(s)
- Shanna K. Kattari
- School of Social Work & Department of Women’s
and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Emma B. Gross
- School of Social Work, Department of Psychology,
University of Michigan, Ann Arbor, MI, USA
| | - Vern Harner
- School of Social Work, University of Washington, Seattle,
WA, USA
| | - Emily Andrus
- School of Public Health, Department of Epidemiology,
University of Michigan, Ann Arbor, MI, USA
| | - Daphna Stroumsa
- Medical School, Department of Obstetrics and Gynecology
& Institute for Healthcare Policy and Innovation, University of Michigan, Ann
Arbor, MI, USA
| | - Molly B. Moravek
- Medical School, Department of Obstetrics and Gynecology,
University of Michigan, Ann Arbor, MI, USA
| | - Andrew Brouwer
- School of Public Health, Department of Epidemiology,
University of Michigan, Ann Arbor, MI, USA
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Ferguson L, Narasimhan M, Gutierrez J, Jardell W, Gruskin S. Law, human rights and gender in practice: an analysis of lessons from implementation of self-care interventions for sexual and reproductive health. Sex Reprod Health Matters 2022; 29:2105284. [PMID: 35975874 PMCID: PMC9387312 DOI: 10.1080/26410397.2022.2105284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Self-care interventions for health are becoming increasingly available, and among the preferred options, including during the COVID-19 pandemic. This research assessed the extent of attention to laws and policies, human rights and gender in the implementation of self-care interventions for sexual and reproductive health (SRH), to identify where additional efforts to ensure an enabling environment for their use and uptake will be useful. A literature review of relevant studies published between 2010 and 2020 was conducted using PubMed, Scopus and Web of Science. Relevant data were systematically abstracted from 61 articles. In March–April 2021, semi-structured interviews were conducted with 10 key informants, selected for their experience implementing self-care interventions for SRH, and thematically analysed. Laws and policies, rights and gender are not being systematically addressed in the implementation of self-care interventions for SRH. Within countries, there is varied attention to the enabling environment including the acceptability of interventions, privacy, informed consent and gender concerns as they impact both access and use of specific self-care interventions, while other legal considerations appear to have been under-prioritised. Operational guidance is needed to develop and implement supportive laws and policies, as well as to ensure the incorporation of rights and gender concerns in implementing self-care interventions for SRH.
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Affiliation(s)
- Laura Ferguson
- Associate Professor of Population and Public Health Sciences, Director of Research, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
| | - Jose Gutierrez
- Student, University of Southern California, Los Angeles, CA, USA
| | - William Jardell
- Project Specialist, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Professor of Population and Public Health Sciences and Law, Director, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
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Nyitray AG, Schick V, Swartz MD, Giuliano AR, Fernandez ME, Deshmukh AA, Ridolfi TJ, Ajala C, Brzezinski B, Sandoval M, Nedjai B, Smith JS, Chiao EY. Rationale and design of the Prevent Anal Cancer Self-Swab Study: a protocol for a randomised clinical trial of home-based self-collection of cells for anal cancer screening. BMJ Open 2021; 11:e051118. [PMID: 34187833 PMCID: PMC8245463 DOI: 10.1136/bmjopen-2021-051118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Squamous cell carcinoma of the anus is a common cancer among sexual minority men, especially HIV-positive sexual minority men; however, there is no evidenced-based national screening protocol for detection of anal precancers. Our objective is to determine compliance with annual anal canal self-sampling or clinician-sampling for human papillomavirus (HPV) DNA. METHODS AND ANALYSIS This is a prospective, randomised, two-arm clinical study to evaluate compliance with annual home-based versus clinic-based HPV DNA screening of anal canal exfoliated cells. The setting is primary care community-based clinics. Recruitment is ongoing for 400 HIV-positive and HIV-negative sexual minority men and transgender persons, aged >25 years, English or Spanish speaking, no current use of anticoagulants other than nonsteroidal anti-inflammatory drugs and no prior diagnosis of anal cancer. Participants are randomised to either receive a swab in the mail for home-based collection of an anal canal specimen at 0 and 12 months (arm 1) or attend a clinic for clinician collection of an anal canal specimen at 0 and 12 months (arm 2). Persons will receive clinic-based Digital Anal Rectal Examinations and high-resolution anoscopy-directed biopsy to assess precancerous lesions, stratified by study arm. Anal exfoliated cells collected in the study are assessed for high-risk HPV persistence and host/viral methylation. The primary analysis will use the intention-to-treat principle to compare the proportion of those who comply with 0-month and 12-month sampling in the home-based and clinic-based arms. The a priori hypothesis is that a majority of persons will comply with annual screening with increased compliance among persons in the home-based arm versus clinic-based arm. ETHICS AND DISSEMINATION The study has been approved by the Medical College of Wisconsin Human Protections Committee. Results will be disseminated to communities where recruitment occurred and through peer-reviewed literature and conferences. TRIAL REGISTRATION NUMBER NCT03489707.
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Affiliation(s)
- Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vanessa Schick
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Insitute, Tampa, Florida, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Timothy J Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher Ajala
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bridgett Brzezinski
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Micaela Sandoval
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Belinda Nedjai
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Jennifer S Smith
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Elizabeth Y Chiao
- Department Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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