Skip to main content

Advertisement

SpringerLink
Log in

Primary Care Provider Practices and Perceptions Regarding HPV Vaccination and Anal Cancer Screening at a Boston Community Health Center

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Human papillomavirus (HPV) vaccination and anal cancer screening are valuable, yet underutilized, tools in prevention of HPV-related cancers among sexual and gender minority (SGM) populations. The aim of this study was to characterize primary care providers’ (PCPs) practices and perceptions pertaining to HPV vaccination and anal cancer screening. A survey assessing self-reported practice characteristics related to HPV vaccination and anal cancer screening, as well as perceived barriers to vaccination and anal cancer screening at the patient-, provider-, and system-level was distributed to PCPs at a Federally-Qualified Health Center that specializes in care for SGM populations in the greater Boston area. A total of 33 PCPs completed the survey. All PCPs strongly recommended HPV vaccination to their patients by emphasizing that the vaccine is extremely important or very important. Most PCPs told their patients that the HPV vaccine prevents cervical cancer (96.9%), anal cancer (96.9%), oropharyngeal cancer (72.7%), penile cancer (57.5%), and genital warts (63.6%). There is substantial variability among providers regarding recommendations for anal cancer screening and follow-up. Most PCPs perceived that patient-level factors such as poverty, mental illness, and substance use disorders were barriers to HPV vaccination and anal cancer screening. Systems-level barriers such as lack of clinical time with each patient and lack of staffing were also described as barriers to vaccination and screening. Patient-, provider- and systems-level improvements are important to increase HPV vaccination and anal cancer screening rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jowett, A., & Peel, E. (2009). Chronic illness in non-heterosexual contexts: An online survey of experiences. Feminism and Psychology, 19(4), 454–474. https://doi.org/10.1177/0959353509342770.

    Article  Google Scholar 

  2. Gates, G. J. (2011). How many people are lesbian, gay, bisexual, and transgender ? Williams Inst. https://doi.org/10.1080/13691058.2012.673639.

    Article  Google Scholar 

  3. Quinn, G. P., Sanchez, J. A., Sutton, S. K., et al. (2015). Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. Cancer Sex Minor, 65(5), 384–400. https://doi.org/10.3322/caac.21288.

    Article  Google Scholar 

  4. Kobayashi, T., Sigel, K., & Gaisa, M. (2017). Prevalence of anal dysplasia in human immunodeficiency virus–infected transgender women. Sexually Transmitted Disease, 44(11), 714–716. https://doi.org/10.1097/OLQ.0000000000000673.

    Article  Google Scholar 

  5. Silverberg, M. J., Lau, B., Justice, A. C., et al. (2012). Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America. Clinical Infectious Disease, 54(7), 1026–1034. https://doi.org/10.1093/cid/cir1012.

    Article  Google Scholar 

  6. McNamara, M., Batur, P., Walsh, J. M. E., & Johnson, K. M. (2016). HPV update: vaccination, Screening, and associated disease. Journal of General Internal Medicine, 31(11), 1360–1366. https://doi.org/10.1007/s11606-016-3725-z.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Meites, E., Kempe, A., & Markowitz, L. E. (2016). Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the advisory committee on immunization practices. MMWR Morbidity and Mortality Weekly Report, 65(49), 1405–1408. https://doi.org/10.15585/mmwr.mm6549a5.

    Article  PubMed  Google Scholar 

  8. Iversen, O.-E., Miranda, M. J., Ulied, A., et al. (2016). Immunogenicity of the 9-valent HPV vaccine using 2-dose regimens in girls and boys vs a 3-dose regimen in women. JAMA, 316(22), 2411. https://doi.org/10.1001/jama.2016.17615.

    Article  PubMed  CAS  Google Scholar 

  9. Markowitz LE, Dunne EF, Saraiya M, et al. Human Papillomavirus vaccination recommendations of the advisory committee on immunization practices (ACIP). MMWR Recommendation Reports. 2014;63(1):1–30. http://www.scopus.com/inward/record.url?eid=2-s2.0-84907813308&partnerID=tZOtx3y1.

  10. Machalek, D. A., Poynten, M., Jin, F., et al. (2012). Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: A systematic review and meta-analysis. Lancet Oncology, 13(5), 487–500. https://doi.org/10.1016/S1470-2045(12)70080-3.

    Article  PubMed  Google Scholar 

  11. Daling, J. R., Madeleine, M. M., Johnson, L. G., et al. (2004). Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer, 101(2), 270–280. https://doi.org/10.1002/cncr.20365.

    Article  PubMed  Google Scholar 

  12. Meites, E., Markowitz, L. E., Paz-Bailey, G., et al. (2014). HPV vaccine coverage among men who have sex with men—National HIV Behavioral Surveillance System, United States, 2011. Vaccine, 32(48), 6356–6359. https://doi.org/10.1016/j.vaccine.2014.09.033.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Reiter, P. L., McRee, A.-L., Katz, M. L., & Paskett, E. D. (2015). Human papillomavirus vaccination among young adult gay and bisexual men in the United States. American Journal of Public Health, 105(1), 96–102. https://doi.org/10.2105/AJPH.2014.302095.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cummings, T., Kasting, M. L., Rosenberger, J. G., Rosenthal, S. L., Zimet, G. D., & Stupiansky, N. W. (2015). Catching up or missing out? Human papillomavirus vaccine acceptability among 18- to 26-year-old men who have sex with men in a US national sample. Sexually Transmitted Disease, 42(11), 601–606. https://doi.org/10.1097/OLQ.0000000000000358.

    Article  CAS  Google Scholar 

  15. Gorbach, P. M., Cook, R., Gratzer, B., et al. (2017). Human papillomavirus vaccination among young men who have sex with men and transgender women in 2 US cities. Sexually Transmitted Disease, 44(7), 436–441. https://doi.org/10.1097/OLQ.0000000000000626.

    Article  Google Scholar 

  16. Medical Advisory Secretariat. (2007). Anal dysplasia screening: An evidence-based analysis. Vol 7, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3377578&tool=pmcentrez&rendertype=abstract.

  17. New York State Department of Health AIDS Institute (2007). Anal dysplasia and cancer. Retreived June 23, 2017 from http://www.hivguidelines.org/adult-hiv/preventive-care-screening/anal-dysplasia-cancer/.

  18. Palefsky, J. (2001). Screening for anal and cervical dysplasia in HIV-infected patients. PRN Notebook, 6(3), 24–31.

    Google Scholar 

  19. Goldie, S. J. (1999). The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. JAMA, 281(19), 1822. https://doi.org/10.1001/jama.281.19.1822.

    Article  PubMed  CAS  Google Scholar 

  20. D’Souza, G., Rajan, S. D., Bhatia, R., et al. (2013). Uptake and predictors of anal cancer screening in men who have sex with men. American Journal of Public Health, 103(9), 88–95. https://doi.org/10.2105/AJPH.2013.301237.

    Article  Google Scholar 

  21. D’Souza, G., Cook, R. L., Ostrow, D., Johnson-Hill, L. M., Wiley, D., & Silvestre, T. (2008). Anal cancer screening behaviors and intentions in men who have sex with men. Journal of Genernal Internal Medicine, 23(9), 1452–1457. https://doi.org/10.1007/s11606-008-0698-6.

    Article  Google Scholar 

  22. Mayer, K., Appelbaum, J., Rogers, T., Lo, W., Bradford, J., & Boswell, S. (2001). The evolution of the fenway community health model. American Journal of Public Health, 91(6), 892–894.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Fenway Health Annual Report. (2016) Boston, MA.

  24. Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata driven methodology and workflow process for providing translational research informatict support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.Research.

    Article  PubMed  Google Scholar 

  25. Gilkey, M. B., Malo, T. L., Shah, P. D., Hall, M. E., & Brewer, N. T. (2015). Quality of physician communication about human papillomavirus vaccine: Findings from a National Survey. Cancer Epidemiology and Prevention Biomarkers, 24(11), 1673–1679. https://doi.org/10.1158/1055-9965.EPI-15-0326.

    Article  Google Scholar 

  26. Gerend, M. A., Madkins, K., Phillips, G., & Mustanski, B. (2016). Predictors of human papillomavirus vaccination among young men who have sex with men. Sexually Transmitted Disease, 43(3), 185–191. https://doi.org/10.1097/OLQ.0000000000000408.

    Article  Google Scholar 

  27. Hendry, M., Pasterfield, D., Gollins, S., et al. (2017). Talking about human papillomavirus and cancer: Development of consultation guides through lay and professional stakeholder coproduction using qualitative, quantitative and secondary data. British Medical Journal Open, 7(6), e015413. https://doi.org/10.1136/bmjopen-2016-015413.

    Article  Google Scholar 

  28. Brewer, N. T., Ng, T. W., McRee, A. L., & Reiter, P. L. (2010). Men’s beliefs about HPV-related disease. Journal of Behavioral Medicine, 33(4), 274–281. https://doi.org/10.1007/s10865-010-9251-2.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ylitalo, K. R., Lee, H., & Mehta, N. K. (2013). Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US national immunization survey. American Journal of Public Health, 103(1), 164–169. https://doi.org/10.2105/AJPH.2011.300600.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gilkey, M. B., Calo, W. A., Moss, J. L., Shah, P. D., Marciniak, M. W., & Brewer, N. T. (2016). Provider communication and HPV vaccination: The impact of recommendation quality. Vaccine, 34(9), 1187–1192. https://doi.org/10.1016/j.vaccine.2016.01.023.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Krantz, L., Ollberding, N. J., Beck, A. F., & Carol Burkhardt, M. (2017). Increasing HPV vaccination coverage through provider-based interventions. Clinical Pediatrics (Phila). https://doi.org/10.1177/0009922817722014.

    Article  Google Scholar 

  32. Mcree, A., Katz, M. L., Paskett, E. D., & Reiter, P. L. (2014). HPV vaccination among lesbian and bisexual women: Findings from a national survey of young adults. Vaccine, 32(37), 4736–4742. https://doi.org/10.1016/j.vaccine.2014.07.001.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Keuroghlian, A., Ard, K., & Makadon, H. Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments. Sex Health. 2017:119–122. https://doi.org/10.1071/SH16145.

  34. Reisner, S. L., Bradford, J., Hopwood, R., et al. (2015). Comprehensive transgender healthcare: The gender affirming clinical and public health model of fenway health. Journal of Urban Health, 92(3), 584–592. https://doi.org/10.1007/s11524-015-9947-2.

    Article  PubMed  PubMed Central  Google Scholar 

  35. HPV vaccine, adolescents, 2008–2012. Retrieved January 3, 2018 from https://www.healthypeople.gov/2020/topics-objectives/national-snapshot/hpv-vaccine-adolescents-2008-2012.

  36. Clark, C. R., Baril, N., Hall, A., et al. (2011). Case management intervention in cervical cancer prevention: The Boston REACH Coalition Women’s Health Demonstration Project. Progress in Community Health Partnership, Fall(5(3), 235–247.

    Article  Google Scholar 

  37. Fontenot, H. B., Lee-St. John, T., Vetters, R., Funk, D., Grasso, C., & Mayer, K. H. (2016). The association of health seeking behaviors with human papillomavirus vaccination status among high-risk urban youth. Sexually Transmitted Disease, 43(12), 771–777. https://doi.org/10.1097/OLQ.0000000000000521.

    Article  Google Scholar 

  38. Sussman, A. L., Helitzer, D., Bennett, A., Solares, A., Lanoue, M., & Getrich, C. M. (2015). Catching up with the HPV vaccine: Challenges and opportunities in primary care. Annals of Family Medicine, 13(4), 354–360. https://doi.org/10.1370/afm.1821.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Farmar, A.-L. M., Love-Osborne, K., Chichester, K., Breslin, K., Bronkan, K., & Hambidge, S. J. (2016). Achieving high adolescent HPV vaccination coverage. Pediatrics, 138(5), e20152653. https://doi.org/10.1542/peds.2015-2653.

    Article  PubMed  Google Scholar 

  40. Fontenot, H. B., Fantasia, H. C., Vetters, R., & Zimet, G. D. (2016). Increasing HPV vaccination and eliminating barriers: Recommendations from young men who have sex with men. Vaccine, 34(50), 6209–6216. https://doi.org/10.1016/j.vaccine.2016.10.075.

    Article  PubMed  Google Scholar 

  41. Reed, A. C., Reiter, P. L., Smith, J. S., Palefsky, J. M., & Brewer, N. T. (2010). Gay and bisexual men’s willingness to receive anal papanicolaou testing. American Journal of Public Health, 100(6), 1123–1129. https://doi.org/10.2105/AJPH.2009.176446.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Pitts, M. K., Fox, C., Willis, J., & Anderson, J. (2007). What do gay men know about human papillomavirus? Australian gay men’s knowledge and experience of anal cancer screening and human papillomavirus. Sexually Transmitted Disease, 34(3), 170–173. https://doi.org/10.1097/01.olq.0000230436.83029.ce.

    Article  Google Scholar 

  43. Siekas, L. L., & Aboulafia, D. M. (2009). Establishing an anal dysplasia clinic for HIV-infected men: initial experience. AIDS Read, 19(5), 178–186.

    PubMed  Google Scholar 

  44. Schochet, E. (2011). You want to stick that where?: A guide to the anal pap smear before, during, and after. Journal of the Association of Nurses in AIDS Care, 22(6), 502–504.

    Article  PubMed  Google Scholar 

  45. Walker, C. M., Likes, W., Bernard, M., Kedia, S., & Tolley, E. (2016). Risk of anal cancer in people living with HIV: Addressing anal health in the HIV primary care setting. Journal of the Association of Nurses in AIDS Care, 27(5), 563–573. https://doi.org/10.1016/j.jana.2016.02.012.

    Article  PubMed  Google Scholar 

  46. Taylor, S., Bunge, E., Bakker, M., & Castellsagué, X. (2016). The incidence, clearance and persistence of non-cervical human papillomavirus infections: A systematic review of the literature. BMC Infectious Diseases, 16(1), 293. https://doi.org/10.1186/s12879-016-1633-9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  47. Lee, E. Q., & Goldstone, S. E. (2011). Predictors of anal dysplasia in men who have sex with men with benign cytology. Diseases of the Colon Rectum, 54(3), 347–351. https://doi.org/10.1007/DCR.0b013e3181f46dc4.

    Article  PubMed  Google Scholar 

  48. Scott, H., Khoury, J., Moore, B. A., & Weissman, S. (2008). Routine anal cytology screening for anal squamous intraepithelial lesions in an urban HIV clinic. Sexually Transmitted Disease, 35(2), 197–202. https://doi.org/10.1097/OLQ.0b013e31815aba8c.

    Article  Google Scholar 

  49. Gee, R. (2006). Primary care health issues among men who have sex with men. Journal of American Academy Nurse Practice, 18(4), 144–153. https://doi.org/10.1111/j.1745-7599.2006.00117.x.

    Article  Google Scholar 

Download references

Funding

Dr. Alex S. Keuroghlian is supported by the Trefler Practitioner Program for Cancer Equity at the Kraft Center for Community Health Leadership. Dr. Holly Fontenot is supported by Grant R21AI130447 from the National Institute of Allergy and Infectious Diseases.

Author information

Authors and Affiliations

  1. The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA

    Kaan Z. Apaydin, Holly B. Fontenot, Kenneth H. Mayer & Alex S. Keuroghlian

  2. W.F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA

    Holly B. Fontenot

  3. Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA

    Derri L. Shtasel, Kenneth H. Mayer & Alex S. Keuroghlian

  4. Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Derri L. Shtasel & Alex S. Keuroghlian

  5. Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA

    Kenneth H. Mayer

Authors
  1. Kaan Z. Apaydin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Holly B. Fontenot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Derri L. Shtasel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenneth H. Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alex S. Keuroghlian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alex S. Keuroghlian.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Apaydin, K.Z., Fontenot, H.B., Shtasel, D.L. et al. Primary Care Provider Practices and Perceptions Regarding HPV Vaccination and Anal Cancer Screening at a Boston Community Health Center. J Community Health 43, 792–801 (2018). https://doi.org/10.1007/s10900-018-0486-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-018-0486-0

Keywords

Search

Navigation