Facilitator and barrier perspectives on learning and implementing high-resolution anoscopy in Abuja, Nigeria: a qualitative study

Abstract

Background: Early detection and treatment of anal precancer via high resolution anoscopy (HRA) is paramount to prevent anal cancer, particularly for populations at heightened risk like sexual minority men (SMM) living with HIV. Successful training and sustainability of cancer screening requires attention to local contexts, best captured by qualitative research. Using the Consolidated Framework for Implementation Research (CFIR), this study investigated factors that challenged or fostered learning and implementing HRA across a variety of stakeholder groups in Abuja, Nigeria. Methods: Using in-depth qualitative methodology, nineteen semi-structured interviews were conducted in September 2023 with stakeholders - patients who underwent HRA, HRA providers, and health system representatives in Nigeria. Thematic analysis, guided by CFIR, was employed to identify key themes related to the barriers and facilitators to practicing HRA as guided by the International Anal Neoplasia Society. Results: Eight themes were identified across three domains. Barriers included low knowledge and understanding of HRA, with participants explicitly noting the need for more research in low resource settings to garner local acceptance. Participants were concerned about financial costs for the clinic and the patients. Facilitators included organizational buy-in, SMM social networks, and a safe clinic environment to support HRA engagement. Facilitators important for sustainability included acceptance of the research evidence for HRA and recognition of the health benefits. Overall, participants from all stakeholder groups welcomed HRA as a new evidence-based intervention as part of HIV care services. Conclusions: Our study highlighted the need for localized research, cultural sensitivity, and resource allocation to improve the adoption of HRA in a Nigerian HIV care setting. Organizational buy-in, community engagement, and safe healthcare environments facilitated trust and patient engagement and would promote long term sustainability. Overall, the study provided perspectives from various stakeholders that strengthen clinical proficiency and sustainability of anal cancer screening in Nigeria.