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Original Research Open Access

Stakeholder-informed Strategies to Enhance Linkage to High-Resolution Anoscopy for Anal Cancer Screening in Transgender Women

  • 1University of Maryland, Baltimore, School of Medicine, Institute of Human Virology, 725 W Lombard St., Baltimore, MD 21201, USA
  • 2University of Maryland, Baltimore, School of Social Work, 525 W. Redwood Street, Baltimore, MD 21201, USA
  • 3Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
  • 4HIPS organization, 906 H St., Washington, DC 20002, USA
+ Affiliations - Affiliations

Corresponding Author

Omar Harfouch, oharfouch@ihv.umaryland.edu

Received Date: June 06, 2026

Accepted Date: August 18, 2026

Abstract

Transgender women (TW) experience high rates of anal cancer, yet linkage to high-resolution anoscopy (HRA) following abnormal anal cancer screening (AACS) remains low. This study identifies stakeholder-informed interventions to improve linkage to HRA among TW.

We interviewed eight stakeholders: 4 healthcare professionals involved in ACS in the Mid-Atlantic US and 4 TW community leaders in Washington DC. Interviews elicited recommendations for intervention strategies targeting previously identified barriers and facilitators to HRA among TW. Transcripts were analyzed using rapid qualitative methods.

Stakeholders identified three key intervention targets: 1) educational sessions for TW with AACS, 2) provider education, and 3) integration of HRA into gender-affirming care clinics. Educational sessions to TW should be led by trusted sources such as TW peers, case managers, or clinicians, and use accessible language. Provider education should focus on screening guidelines, communication skills, and trust-building. Integration of HRA into gender-affirming care clinics may enhance comfort and continuity of care, though feasibility is limited by a shortage of trained HRA providers.

Stakeholder perspectives highlight the need to incorporate peer support, provider training, and structural integration of services to improve linkage to HRA among TW and close the gap in anal cancer prevention. Such interventions would require piloting to test their acceptability and feasibility in real-world settings.

Keywords

Sexual and gender minorities, HPV, Cancer prevention and control, Sexual health, Qualitative evaluation, Behavior change, HIV co-infections

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