Background Guidelines recommend annual screening for gonorrhea/chlamydia in sexually active people with HIV at multiple sites (urogenital, oropharyngeal, rectal). In the first year of multisite screening at our Ryan White HIV/AIDS Program clinic, we studied (1) sexual history documentation rate, (2) sexually transmitted infection (STI) screening rate, (3) characteristics associated with STIs, (4) the percentage of extragenital STIs that would have been missed without multisite screening. Methods Participants were ≥14 years old with ≥1 in-person medical visit at our clinic in 2019. Descriptive analyses were performed, and adjusting for number of sites tested, a log-binomial model was used to estimate the association between characteristics and STI diagnosis in men. Results In this cohort (n = 857), 21% had no sexual history recorded. Almost all STI diagnoses were among males (99.3%). 68% (253/375) received appropriate urogenital testing, 63% (85/134) received appropriate oropharyngeal testing, and 69% (72/105) received appropriate rectal testing. In male participants with ≥1 STI test (n = 347), Hispanic ethnicity and detectable HIV viral load were associated with an STI diagnosis. Of those diagnosed with an STI who had multisite testing, 96% (n = 25/26) were positive only at an extragenital site. Conclusions Screening rates were similar across all anatomical sites indicating no obvious bias against extragenital testing. In males, STIs were more frequently diagnosed in people who identify as Hispanic and those with detectable viral loads which may indicate more condomless sex in these populations. Based on infections detected exclusively at extragenital sites, our clinic likely underdiagnosed STIs prior to implementation of multisite screening.

Background Age-related chronic conditions are becoming more concerning for people with human immunodeficiency virus (PWH). We aimed to identify characteristics associated with multimorbidity and evaluate for association between multimorbidity and human immunodeficiency virus (HIV) outcomes. Methods Cohorts included PWH aged 45–89 with ≥1 medical visit at one Ryan White HIV/AIDS Program (RWHAP) Southeastern HIV clinic in 2006 (Cohort 1) or 2016 (Cohort 2). Multimorbidity was defined as ≥2 chronic diseases. We used multivariable logistic regression to assess for associations between characteristics and multimorbidity and between multimorbidity and HIV outcomes. Results Multimorbidity increased from Cohort 1 (n = 149) to Cohort 2 (n = 323) (18.8% vs 29.7%, P < .001). Private insurance was associated with less multimorbidity than Medicare (Cohort 1: adjusted odds ratio [aOR] = 0.15, 95% confidence interval [CI] = 0.02–0.63; Cohort 2: aOR = 0.53, 95% CI = 0.27–1.00). In Cohort 2, multimorbidity was associated with female gender (aOR, 2.57; 95% CI, 1.22–5.58). In Cohort 1, black participants were less likely to be engaged in care compared with non-black participants (aOR, 0.72; 95% CI, 0.61–0.87). In Cohort 2, participants with rural residences were more likely to be engaged in care compared with those with urban residences (aOR, 1.23; 95% CI, 1.10–1.38). Multimorbidity was not associated with differences in HIV outcomes. Conclusions Although PWH have access to RWHAP HIV care, PWH with private insurance had lower rates of multimorbidity, which may reflect better access to preventative non-HIV care. In 2016, multimorbidity was higher for women. The RWHAP and RWHAP Part D could invest in addressing these disparities related to insurance and gender.

Background Prevalence of anal cancer is increasing among people with HIV (PWH). Screening for anal cancer involves evaluating cytology and biopsy with high resolution anoscopy (HRA) if indicated. In this study, we sought to identify prevalence of abnormal anal cytology and biopsy-proven high-grade dysplasia, defined as anal intraepithelial neoplasia 2 and 3 (AIN2+). Methods Demographic and clinical data were collected from participants ≥30 years old with ≥1 anal Pap smear performed during the study period (12/18/2017-05/29/2021). A subgroup analysis was performed on those with ≥1 HRA. Logistic regression estimated adjusted odds ratios (aOR) for variables of interest such as age, race, gender, presence of HPV strains, and sexual practices. Results Of 317 participants, 48% (n = 152) had abnormal cytology (93% low-grade squamous intraepithelial lesion (SIL) or atypical cells of undetermined significance (ASCUS) and 7% high-grade SIL). Most with abnormal cytology proceeded to HRA (n = 136/152). Of those with HRA, 62% (n = 84/136) had AIN2 + . History of anoreceptive intercourse (aOR 4.62, 95% confidence interval (CI) 1.08-23.09, p = 0.047), HPV 16 (aOR 4.13, 95% CI 1.63-11.30, p = 0.004) and “other” high-risk HPV strains (aOR 5.66, 95% CI 2.31-14.78, p < 0.001) were significantly associated with AIN2 + . Conclusions Nearly half of those screened had abnormal cytology, highlighting the high prevalence of anal dysplasia in PWH. Though only 7% had high-grade SIL on cytology, 62% of those biopsied had AIN2 + suggesting cytology underestimates the severity of dysplasia on biopsy. HPV 16 and “other” high-risk strains were associated with AIN2 + and could be considered for risk-stratifying patients in the screening algorithm.

Background Care cascades can inform providers about differences in engagement and retention in care between patient populations thereby improving participation by targeting interventions more effectively. The objective of this study was to assess the uptake and retention of participants along the anal cancer screening algorithm within a single HIV clinic. Methods Retrospective procedural and demographic data were collected within a Ryan White HIV/AIDS Program clinic from 18 December 2017 to 29 May 2021. A care cascade was constructed among eligible participants who engaged and were retained in the anal cancer screening algorithm. Engagement was defined as having at least one anal Pap smear. Retention was defined as having a follow-up anal Pap smear, and/or high resolution anoscopy, as indicated. Risk ratios (RR) were calculated to reveal factors associated with initiation and retention in screening. Results Of 821 eligible participants, 312 (38%) engaged in screening and 205 (66%) were retained in care. Anoreceptive intercourse was positively associated with engagement (RR 2.81, 95% confidence interval [CI] 2.05–3.90, p<0.001), whereas male gender was negatively associated (RR 0.26, 95% CI 0.20–0.33, p<0.001). Abnormal cytology results on Pap smear were associated with retention (RR 1.39, 95% CI 1.03–1.86, p=0.03). Conclusions Overall engagement in anal cancer screening is low within our clinic, particularly among men, but retention in the screening program is notably better, especially among those with abnormal cytology. Target populations have been identified to increase awareness, and qualitative studies are underway to understand perceptions and barriers to engagement in anal cancer screening.

Purpose: Nicaragua has the highest rate of cervical cancer in Central America. Cervical cancer screening is available nationally, however substantial barriers to screening engagement persist. Azulado is a telebehavioral, patient-centered mobile platform that was culturally, linguistically, and regionally created to specifically address the cervical cancer screening and treatment needs of women in Bluefields, Nicaragua, on the Caribbean coast. The app was successfully piloted in summer 2021. In summer 2022, the research team explored healthcare provider perspectives of Azulado, collaborating with providers to design an accompanying portal for the app. Methods: The team conducted a mixed-methods, community-based participatory investigation to elicit healthcare provider perspectives to inform the design of a provider portal. Focus groups and individual interviews were conducted with providers at healthcare facilities throughout Bluefields. A tablet-based survey adapted from mHealth App Usability Questionnaire (MAUQ) and System Usability Scale (SUS) was administered. The team conducted thematic analysis and descriptive statistics. Results: Three provider focus groups (n=8) and multiple individual interviews (n=18) were conducted in six unique healthcare settings in Bluefields. Twenty participants completed the survey (15 women and 5 men). Provider years of experience ranged from 1 to 37 years (average 17.0 years, median 16.5 years). Quantitative findings demonstrated that when asked if they agreed that the app would be useful for patient health and well-being, the average response was 4.89 (SD 0.32) on a Likert scale (0= strongly disagree, 5= strongly agree). The average response for the statement “I would recommend this app” was 4.68 (SD 0.58). Emergent themes included the importance of inclusivity and representation of different regional ethnicities and situations, clarity and functionality of the app, emotional support by community or provider, ability to input clinic visit reminders, and ability to anonymously and confidentially communicate with patients. Conclusion: The study demonstrated feasibility and acceptability of the Azulado patient-provider interface. Providers gave suggestions for how to improve patient education and facilitate communication between patients and clinics. Future studies will include trialing the updated app with patients and determining its effectiveness in improving prevention and treatment efforts in Bluefields. Citation Format: Maria Geba, Katherine Hall, Anneda Rong, Michelet McLean Estrada, Rebecca Dillingham, Emma McKim Mitchell. Collaboratively Adapting a Telebehavioral Mobile Platform to Enhance Patient-Provider Communication Regarding Cervical Cancer Prevention Efforts in Bluefields, Nicaragua [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 22.