Are gynecologists prepared to offer anal cancer prevention services?: a qualitative study of barriers to implementation in the United States.

Objectives: Training in anal cancer prevention (ACP) techniques is crucial to respond to increasing anal cancer rates in women. We explored what is necessary for gynecologists, specialists in lower genital tract and experts in HPV-related disease prevention, to incorporate ACP into routine practice. Methods: In 2022, we interviewed thirteen gynecologists practicing across three states (Florida, Georgia, Maryland) about current prevention practices, provider perceptions, and support needed to incorporate ACP into practice. We employed thematic content analysis to understand issues of implementation and categorized these themes following the Consolidated Framework for Implementation Research. Results: Key themes included a need to demonstrate the importance of ACP to gynecologists; key barriers to ACP implementation focused on the lack of clinical guidelines and resulting uncertainty about value of these tests, need for additional training, already limited time with patients, logistical concerns related to laboratory capacity and insurance/billing and current reliance on referrals to other providers for ACP. Conclusion: Building on gynecologists' existing training to enhance their ability to conduct ACP and extending training to other providers is important to increase early intervention and reduce rates of anal cancer among women; pairing this with efforts to address systems-based barriers can facilitate widespread ACP adoption.