Background: Despite significant progress in HIV treatment and prevention, people living with HIV (PLWH) continue to face a myriad of health challenges, including an increased risk of developing certain cancers and experiencing poorer cancer-related prognoses. Timely cancer screening can potentially improve health outcomes for PLWH, yet there is limited research on screening access among PLWH.

Methods: To address this gap, cross-sectional analyses using data from the All of Us research program were conducted to estimate the prevalence of prostate and breast cancer screening among PLWH. For both screening outcomes, an analytic sample was defined based on USPSTF guidelines for screening ages. Descriptive statistics and chi-square tests were used to identify sociodemographic differences between PLWH who did and did not receive screenings. Multivariable logistic regression was utilized to further examine factors associated with screening.

Results: The breast cancer screening sample included 1,458 women (50% received screening) and the prostate cancer screening sample included 1,563 men (33.33% received screening). In a multivariable model, Hispanic/Latina ethnicity (aOR:2.03; 95%CI:1.27-3.23) and being dually insured with Medicaid and Medicare (aOR: 2.03; 95%CI:1.09-3.65) were associated with higher odds of breast cancer screening, while being a lesbian/bisexual woman (aOR:0.39; 95%CI: 0.25-0.63) and having a household income <$10,000 (aOR:0.16; 95%CI:0.06-0.36) were associated with lower odds. In another multivariable model, being married (aOR:2.96; 95%CI:1.70-5.25) and being dually insured (aOR:9.25; 95%CI:3.92-23.33) were associated with higher odds of prostate screening. Hispanic/Latino ethnicity (aOR:0.21;95%CI:0.06-0.58), having a household income <10,000 (aOR:0.16; 95%CI:0.06-0.36), and reporting less than a high school education (aOR:0.08;95%CI:0.01-0.29) were associated with lower odds.

Conclusion: In this population-based sample of PLWH, there were differences in breast and prostate cancer screening by key sociodemographic characteristics. These findings can inform prevention and intervention efforts to increase equity in access to timely cancer screening among older PLWH, for whom general preventative services require greater attention.

Background:

The Rural Appalachian Lung Cancer Screening Initiative is a unique collaboration between the Association of Community Cancer Centers (ACCC), the Appalachian Community Cancer Alliance, and patient advocacy partners. This multi-year initiative, recognized by the Cancer Moonshot, seeks to improve lung cancer screening rates by identifying and addressing social and structural barriers that impede eligible Appalachian residents from accessing screening.

Methods:

A targeted scan was conducted in 2022 to gather epidemiological data (state and county-level) for the 13 states which make up Appalachia, as well as to identify current best practices at the individual, community, and societal level to improve lung cancer screening.

Results:

The U.S. age-adjusted incidence rate (2015-2019) for lung & bronchus cancer is 56.3 per 100,000; with some of the highest rates found in Appalachia. Kentucky has the highest incidence rate nationally (87.1) followed by West Virginia (77.9). Kentucky has the highest mortality rate in the nation, as well, followed by West Virginia. Again, most Appalachian states have higher lung cancer mortality than the national rate. When stratifying rates by race/ethnicity, Black men have the highest incidence rates and mortality burden in all 13 states. Common promising practices and lessons learned emerged through the landscape analysis, including evidence-based methods to increase lung cancer screening and how to optimize lung cancer screening retention. Many of the strategies identified were used concurrently to improve outcomes.

Conclusion:

The Rural Initiative has identifieda 10-county region where there are significant structural barriers and other factors that contribute to low-uptake of screening resulting in high disease burden. The next phase of the initiative is to work with community members in this region to further understand patients’ and providers’ needs and local care coordination patterns and then, in partnership, pilot expansion of a targeted lung cancer screening program for at-risk patients in rural Appalachia.

Background: The American Cancer Society (ACS) vision is to end cancer as we know it, for everyone. Screening for cancer increases opportunities to prevent, detect, treat, and survive cancer; yet, screening rates remain below national targets. ACS partnered with healthcare systems on a nationwide quality improvement (QI) program designed to increase access and rates of breast, cervical, colorectal, and lung cancer screening.

Methods: ACS created a 12-month multipronged-approach program for healthcare systems that included tailored resources for implementing multi-component interventions through QI framework and technical assistance support from a trained and dedicated team of local and national ACS experts. We created a structured data collection tool to collect and evaluate system's program processes and outcomes data, EBIs, QI tools, screening rates, and other project-related data, at baseline, midpoint, and endline. We analyzed changes in processes and cancer screening rates.

Results: The 114 participating healthcare system partners reached over 1.1 million screening-eligible people. Partners included community clinics, hospitals, and integrated delivery systems, with 32% having clinic sites in rural areas. Healthcare systems implemented both client- and provider-focused EBIs, with the most common interventions being client reminders (73%), navigation to screening (64%), and provider prompts/reminders (54%). The most used QI tools were plan-do-study-act cycles (55%) and process mapping (51%). On average, cancer screening rates increased by 7 percentage points (pp) from baseline to endline, with variability by cancer type (breast: 7pp, cervical: 9pp, colorectal: 7pp, lung: 6pp). Over 347,000 cancer screenings were completed and over 6,000 cancers were detected during the project period.

Discussion: Results support the program’s positive impact on healthcare system capacity to implement QI and EBIs to improve health equity in early cancer detection and cancer screening rates across the country. This initiative offers promising solutions and lessons learned that can support other safety-net healthcare systems.

Introduction: In response to disproportionately high regional rates of liver cancer, Hepatitis Viral Infection and Systematic Treatment Alliance (HepVISTA) was developed. HepVISTA was a bilingual Hepatitis C Virus (HCV) patient education and navigation program for an urban public hospital in Bexar county, Texas (n=839) from 2017-2022. HepVISTA was integrated into clinics, offering HCV education, screening and treatment. This study evaluated program cost-effectiveness, patient knowledge and satisfaction, and clinic staff attitudes.

Methods: Cost-effectiveness was evaluated using program data and building a validated microsimulation model. The natural progression of HCV, liver disease, liver cancer and program impact were then simulated. Patient knowledge and perceived susceptibility of liver cancer were assessed using pre-post patient surveys conducted throughout the program; data were analyzed using SPSS and paired two-sample t-tests. Patient satisfaction was assessed using Likert scale, post-only patient satisfaction surveys administered via phone; data were analyzed using uni-variate and bi-variate analyses. In 2021, interviews using Likert-scale questions were conducted with staff to assess program satisfaction. Staff interview data were analyzed in Excel using uni-variate and bi-variate analyses.

Results: The program was cost-effective relative to no intervention, costing $8957 per quality-adjusted life-year gained among program patients. There was a statistically significant increase from pre-program patient liver cancer knowledge responses (mean=2.35, SD=2.11) to post-survey responses (mean=4.41, SD=2.15;t(431)=1.96, p=0.025), and pre-post beliefs that untreated HCV could cause liver cancer [Pre=63%(n=279);Post=93%(n=408)]. Patient satisfaction surveys (n=267; response rate=57%) reported high satisfaction with HepVISTA navigation (M=4.9 on 5-point scale). Analysis of staff interviews (n=20) revealed 100% reported “strongly agree” that HepVISTA effectively educated patients about liver cancer and 100% reported “strongly agree” that HepVISTA effectively prevented liver cancer in target population.

Conclusion: HCV screening, treatment and patient navigation programs targeting underserved patients may be cost-effective, increase patient knowledge about liver cancer, and result in satisfied patients and staff.