Utilization of Anal Cytology Screening among Sexual and Gender Minority Populations in Pennsylvania

Background: Despite the risk of anal cancer in sexual and gender minority (SGM) populations, anal cancer screening remains infrequent and inconsistent in these populations. The objective of this analysis was to identify factors associated with anal cancer screenings among SGM populations using the Andersen's behavioral model of health services use. Methods: Secondary analyses of two cross-sectional surveys from the 2020 (N = 1,125) and 2022 (N = 630) Pennsylvania LGBTQ Health Needs Assessment. Multiple logistic regression analyses were used to identify correlates of anal cytology screening. Results: Average age was 37.7 (SD = 13.3) and 39.7 (SD = 13.6) in 2020 and 2022, respectively. Approximately 16% to 18% reported living with human immunodeficiency virus (HIV). A minority of respondents reported past year screening (14.0%, 2020 and 13.6%, 2022). Enabling and need-based factors consistently associated with screening included sexually transmitted infection treatment, living with HIV, preexposure prophylaxis use, and multiple sex partners. Robust factors associated with ever being screened were age and living with HIV. Conclusions: Anal cytology screening is being done in Pennsylvania at a small but not insignificant rate. In accordance with existing guidelines, SGM populations living with HIV were most likely to be screened, but still at a low rate. Predictive factors associated with screening in this study can inform future interventions to implement guideline-specific anal cancer prevention. Impact: Factors that reflect consistent connection to healthcare are associated with increased rates of screening via anal cytology testing, indicating there are opportunities to implement anal cancer screening as part of a larger, more comprehensive SGM-focused care pathway.