HPV vaccination rates remain far below goal, leaving many adolescents unprotected against future HPV-related cancers. Starting HPV vaccine at age 9 may improve timely preteen vaccination. The "HPV ...Vax at 9" Quality Improvement intervention paired HPV vaccination with 9- and 10-year well child visits and was piloted at two pediatric clinics (
= 9 sites) in Washington between 2018 and 2022. Supporting interventions included standardized immunization schedule posters in exam rooms, electronic medical record supports, provider and staff training, strong provider recommendations, printed educational resources, and peer-to-peer champion coaching. Provider and clinic acceptance was high with HPV vaccine administration occurring at 68-86% of the 9- and 10-year well child visits. During the first year, HPV initiation rates at age 9-10 increased by 30% or more at each clinic. Sustained improvements in initiation and series completion were seen with completion at age 11-12 rising as much as 40% from 22 to 62%. Downward pressure of the COVID-19 pandemic on HPV vaccination rates was mitigated. Pairing HPV vaccine with 9- and 10-year well child visits, posting the standardized immunization schedule, and instituting EMR supports for HPV at 9 may be effective and sustainable strategies to simplify clinic workflows and increase timely HPV vaccination.
Background: HIV-positive individuals remain at risk for anal cancer and will likely benefit from research that prioritizes early detection of anal cancer and optimized screening practices. We ...assessed host deoxyribonucleic acid (DNA) methylation markers for detecting high-grade anal intraepithelial neoplasia (AIN) versus low-grade AIN or normal samples in HIV-positive individuals in Seattle, Washington.Methods: HIV-positive individuals ≥18 years of age and with assigned male sex at birth were recruited at anal cancer screening, diagnosis, or treatment visits at the Harborview Medical Center Madison Clinic in Seattle, Washington between 2015 and 2016. Anal brush sampleswere collected by an anoscopist for HPV genotyping and pyrosequencing methylation analysis. Demographic and clinical data, as well as anal cancer screening, diagnosis, and treatment results, were collected through chart abstraction and review of electronic medical record (EMR)data. The exposures were the mean percent of DNA methylation for genes ASCL1, PAX1, FMN2 and ATP10A. The primary outcome was AIN grade, dichotomized as normal/low gradeAIN and high-grade AIN, determined by clinically available histology and cytology results from the same visit. Generalized estimating equation (GEE) logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) to assess the associations between methylation and high-grade disease, adjusted for age, HIV viral load and CD4 count. The performance of a marker panel was assessed by measuring sensitivity and specificity of a model at the Youden’s index threshold using genes that were individually associated with highgrade AIN detection. A sensitivity analysis measuring high-grade disease extent was conducted using ordinal GEE logistic regression.Results: 125 samples were analyzed from 85 participants. The mean age of participants was 50.3 (SD 10.2) years, their mean CD4 count was 568 (SD 348) cells/µl and 94.2% had an undetectable HIV viral load. Methylation of ASCL1 (aOR per 1 unit increase in mean percent methylation 1.07, 95% CI 1.01, 1.13) and FMN2 (aOR per 1 unit increase in mean percent methylation 1.12, 95% CI 1.06, 1.19) were significantly associated with high-grade AIN versus low-grade AIN/normal. Mean percent methylation of PAX1 and ATP10A did not show significant associations with high-grade disease. A marker panel combining ASCL1 and FMN2 had a sensitivity of 90.4% for high-grade AIN and a specificity of 45.6%. Methylation of ASCL1 (OR 1.06, 95% CI 1.01, 1.11) and FMN2 (OR 1.07, 95% CI 1.02, 1.10) were each positively associated with increasing extent of high-grade disease, indicating a dose-response effect.Discussion: Increasing levels of DNA methylation of ASCL1 and FMN2 were positively associated with high-grade AIN detection. With further validation studies, self-sampling host gene methylation testing has promise to be an effective screening and triage tool for anal cancer.
People living with HIV (PLWH) are at highest risk of anal cancer and will benefit from optimized screening for early disease detection. We compared host DNA methylation markers in high‐grade squamous ...intraepithelial lesions (HSIL) versus samples negative for intraepithelial lesions (NILM) or low‐grade intraepithelial lesions (LSIL) in PLWH. We recruited PLWH identifying as male aged ≥18 years undergoing high‐resolution anoscopy (HRA) in Seattle, Washington, 2015–2016. Anal brush samples were collected for HPV detection, genotyping, and pyrosequencing methylation (host genes ASCL1, PAX1, FMN2, and ATP10A); clinical data were ed from medical records. We assessed associations between methylation and presence and extent of HSIL using generalized estimating equation logistic regression, adjusting for age, CD4 count and HIV viral load. Marker panels using HPV DNA and methylation were also evaluated to predict prevalent HSIL. We analyzed 125 samples from 85 participants (mean age 50.1; standard deviation 11.0 years). ASCL1 (adjusted odds ratio aOR per 1 unit increase mean percent methylation: 1.07, 95% CI: 1.01–1.13) and FMN2 (aOR per 1 unit increase mean percent methylation: 1.14, 95% CI: 1.08–1.20) methylation were significantly associated with HSIL versus NILM/LSIL. ASCL1 (aOR: 1.06, 95% CI: 1.01–1.11) and FMN2 (aOR: 1.13, 95% CI: 1.08–1.17) methylation were positively associated with increasing HSIL extent. A panel combining methylation (ASCL1 and FMN2) and HPV DNA (HPV16, HPV18, and HPV31) demonstrated best balance of sensitivity (78.2%) and specificity (73.9%) for HSIL detection compared with methylation or HPV alone. Increasing levels of DNA methylation of ASCL1 and FMN2 were positively associated with HSIL detection in PLWH. Host gene methylation testing shows promise for HSIL screening and triage.
What's New?
People living with HIV are at highest risk of anal cancer and would benefit from optimized screening practices for early disease detection. However, evidence to inform clinical guidelines for anal cancer screening and diagnosis remains sparse. Here, the authors compared host DNA methylation markers in high‐grade squamous intraepithelial lesions versus low‐grade intraepithelial lesions or samples negative for intraepithelial lesions in people living with HIV. They also evaluated marker panels using HPV DNA and methylation to predict prevalent high‐grade squamous intraepithelial lesions. The study supports the promise of host gene methylation testing for high‐grade squamous intraepithelial lesion screening and triage.
Androgen deprivation therapy (ADT) increases the risk of metabolic adverse effects among patients with prostate cancer. The transformative impact of mobile health (mHealth) apps may benefit men ...managing activity and nutrition at home.
This study aimed to evaluate the usability and patient experience of a newly developed mHealth app among prostate cancer patients on ADT and physicians' beliefs about the potential benefits of using this app.
This study took place over 2 months, beginning in March 2019. A sample of 5 patients (age 45-75 years) initiating ADT participated in a semistructured focus group discussion with a facilitator. The study participants also included 5 specialist physicians who provided in-depth interviews. An institutional review board-approved script was used to guide both the focus group and physician interviews. Usability was tested through specific scenarios presented to the patients, including downloading the mHealth app, entering information on physical activity and meals, and navigating the app. The focus group and interviews were audio recorded and transcribed. Content analysis was used to analyze the transcripts iteratively and exhaustively. Thematic discrepancies between reviewers were resolved through consensus.
The mean age of the patients was 62 years. This group included 4 White and 1 Latin American patients. The physician specialists included 2 urologists, 2 medical oncologists, and 1 radiation oncologist. Analyses revealed that the patients appreciated the holistic care enabled by the app. Difficulties were observed with registration of the app among 60% (3/5) of the patients; however, all the patients were able to input information about their physical activity and navigate the options within the app. Most patients (4/5, 80%) were able to input data on their recent meal. Among the health care physicians, the dominant themes reflected in the interviews included undermining of patients ability to use technology, patients' fear of technology, and concern for the ability of older patients to access technology.
The patients reported an overall positive experience of using an mHealth app to record and track diet and exercise. Usability was observed to be an important factor for adoption and was determined by ease of registration and use, intuitive appearance of the app, and focus on holistic cancer care. The physicians believed that the app was easy to use but raised concerns about usability among older men who may not typically use smartphone apps.
HPV vaccination rates remain far below goal, leaving many adolescents unprotected against future HPV-related cancers. Starting HPV vaccine at age 9 may improve timely preteen vaccination. The "HPV ...Vax at 9" Quality Improvement intervention paired HPV vaccination with 9- and 10-year well child visits and was piloted at two pediatric clinics (n = 9 sites) in Washington between 2018 and 2022. Supporting interventions included standardized immunization schedule posters in exam rooms, electronic medical record supports, provider and staff training, strong provider recommendations, printed educational resources, and peer-to-peer champion coaching. Provider and clinic acceptance was high with HPV vaccine administration occurring at 68-86% of the 9- and 10-year well child visits. During the first year, HPV initiation rates at age 9-10 increased by 30 percentage points or more at each clinic. Sustained improvements in initiation and series completion were seen with completion at age 11-12 rising as much as 40 percentage points from 22 to 62%. Downward pressure of the COVID-19 pandemic on HPV vaccination rates was mitigated. Pairing HPV vaccine with 9- and 10-year well child visits, posting the standardized immunization schedule, and instituting EMR supports for HPV at 9 may be effective and sustainable strategies to simplify clinic workflows and increase timely HPV vaccination.
PDF
