People living with HIV (PLWH), Oral and Oropharyngeal Cancer, and Health Equity: A Qualitative Study

HIV 感染者 (PLWH)、口腔癌和口咽癌以及健康公平：定性研究

基本信息

批准号：
10762901
负责人：
Alexandra Lydia Hernandez
金额：
$ 16.19万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-10 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10762901
关键词：
Adolescent Anus Benefits and Risks Black Populations Black race Cancer Etiology Caring Categories Data Dental Care Dental Insurance Dental Offices Dentists Diagnosis Discrimination Disease Disparity Early Diagnosis Education Ethnic Origin Ethnic Population Face Focus Groups Funding Mechanisms Gender Gender Identity General Population Goals Grouping HIV HPV oropharyngeal cancer HPV-High Risk Head and Neck Cancer Health Insurance Health Personnel Healthcare High Prevalence Hispanic Hospitals Hour Human Papilloma Virus Vaccination Human Papilloma Virus Vaccine Human Papillomavirus Human papilloma virus infection Improve Access Incidence Individual Intervention Knowledge Latinx Malignant Neoplasms Mentors Minority Mouth Diseases National Health and Nutrition Examination Survey Neck Operative Surgical Procedures Oral health Oropharyngeal Squamous Cell Carcinoma Outcome Participant Perception Persons Prevalence Prevention Prevention program Prevention strategy Primary Prevention Provider Race Randomized, Controlled Trials Recommendation Research Research Personnel Risk Risk Assessment Risk Factors Screening for Oral Cancer Secondary Prevention Sexual and Gender Minorities Smoker Squamous cell carcinoma Structural Racism Suggestion Surveys Survival Rate Tongue Transportation United States Preventative Services Task Force Woman acceptability and feasibility aged anti-racism black men cis-female cis-male design ethnic identity ethnic minority population experience feasibility testing gender minority group health equity health inequalities human papilloma virus oropharyngeal squamous cell carcinoma improved innovation internalized stigma intersectionality malignant mouth neoplasm malignant oropharynx neoplasm member men mortality mouth squamous cell carcinoma nonbinary novel oral HPV infection oral care preference prevent preventive intervention programs racial diversity racial minority population racial population screening screening program sex sexual minority smoking prevalence social stigma uptake vaccine acceptance

项目摘要

Project Summary People living with HIV (PLWH) have an estimated 1.6-6.0 times increased risk of developing oropharyngeal squamous cell carcinomas (OPSCC) compared with individuals in the general population. Approximately 70% of OPSCC are caused by HPV, and PLWH also have an increased prevalence of oral HPV infection compared to the general population. While a smaller proportion of oral squamous cell carcinomas (OSCC) are attributed to HPV, PLWH also have an increased risk of developing HPV-associated OSCC. Disparities exist among racial/ethnic groups for OSCC/OPSCC outcomes and Black individuals with OPSCC and OSCC have worse survival, a later stage of diagnosis, and less frequent cancer directed treatment than other racial/ethnic groups. HPV-associated OSCC/OPSCC are potentially preventable through HPV vaccination. Although oral cancer screening is not recommended for the general population, early detection is associated with improved survival and screening may be important in racial/ethnic minority groups. Oral health care providers may be the first point of contact for OSCC/OPSCC prevention strategies. PLWH have dental insurance provided through the Ryan White Care Act. Even so, more than half of PLWH have unmet oral care needs and 58-64% do not receive regular dental care. PLWH also face stigma and/or discrimination from living with HIV, including in the dental office, and may also have other intersectionality with sexual and gender minority (SGM) groups, for which there is additional stigma. Understanding the experiences of PLWH and the barriers/facilitators of oral health, through a lens of health equity, is needed before interventions can be designed to engage PLWH with intersecting identities in OSCC/OPSCC prevention activities. As a first step, we propose to conduct a qualitative study among PLWH of diverse racial/ethnic and SGM identities to: (1) explore individual, interpersonal, and structural oral health equity factors that serve as barriers or facilitators of accessing oral health care, (2) to explore knowledge and perceptions of HPV vaccination and OSCC/OPSCC, and (3) to collect recommendations on how to increase access to oral health care and engage PLWH in OSCC/OPSCC prevention. We will conduct approximately 12-18 focus groups with 5-8 individuals grouped by common identity group. These groupings may be by race/ethnicity, gender identity, sexual preference, or a combination of identities. The results of this study will be used to: 1) inform the design of a multilevel, culturally appropriate intervention to increase engagement with oral health care and HPV- associated OSCC/OPSCC prevention activities. The PI will design a randomized controlled trial to evaluate the intervention’s impact on HPV vaccination, OSCC/OPSCC knowledge, and retention in oral health care; and 2) assess the risks and benefits of OSCC and novel OPSCC screening among PLWH from diverse racial/ethnic identity groups. Screening PLWH at high risk for HPV-associated OSCC/OPSCC and from of groups with poor 5-year survival from OSCC/OPSCC may prove beneficial in reducing cancer-related mortality.

项目摘要患有艾滋病毒（PLWH）的人估计有1.6-6.0倍的发展风险与普通人群中的个体相比，口咽鳞状细胞癌（OPSCC）。大约70％的OPSCC是由HPV引起的，PLWH的患病率也增加与普通人群相比，感染。而口服鳞状细胞癌的比例较小（OSCC）归因于HPV，PLWH的风险也增加了与HPV相关的OSCC的风险。 OSCC/OPSCC成果的种族/族裔之间存在差异，而黑人则具有OPSCC OSCC的生存率较差，诊断的后期阶段，而癌症的治疗频率低于其他种族/族裔群体。与HPV相关的OSCC/OPSCC可以通过HPV疫苗接种来预防。尽管不建议对普通人群进行口腔癌筛查，但与早期检测有关在种族/族裔少数群体中，随着生存和筛查的提高可能很重要。口腔卫生保健提供者可能是OSCC/OPSCC预防策略的第一个联系点。 PLWH拥有通过《瑞安·白护理法》提供的牙科保险。即便如此，超过一半的PLWH具有未满足的口腔护理需求和58-64％的人未接受定期的牙科护理。 PLWH还面对污名和/或歧视艾滋病毒的生活，包括在牙科诊所，也可能与性和性别少数群体（SGM）群体，对此还有其他污名。了解经验在干预之前，需要使用PLWH和口腔健康的障碍/促进者。可以设计为在OSCC/OPSCC预防活动中与相交的身份相关的身份。作为第一步，我们建议对潜水员种族/种族和SGM的PLWH进行定性研究身份：（1）探索作为障碍的个人，人际和结构性口腔健康公平因素或获得口腔保健的促进者，（2）探索HPV疫苗接种的知识和看法 OSCC/OPSCC和（3）收集有关如何增加获得口腔卫生保健和参与的建议 OSCC/OPSCC预防中的PLWH。我们将与5-8个人进行大约12-18个焦点小组由共同身份组分组。这些分组可能是通过种族/种族，性别认同，性别的偏好或身份的组合。这项研究的结果将用于：1）告知设计多层次，适当的干预措施，以增加对口腔医疗保健和HPV的参与相关的OSCC/OPSCC预防活动。 PI将设计一项随机对照试验以评估干预措施对HPV疫苗接种，OSCC/OPSCC知识和口腔保健保留的影响； 2）评估OSCC的风险和好处以及潜水员的PLWH中新颖的OPSCC筛选种族/族裔身份群体。筛选与HPV相关的OSCC/OPSCC的高风险的PLWH和 OSCC/OPSCC生存率较差的组可能证明有益于降低与癌症相关的死亡率。