PrEP patient attitudes, beliefs and perceived barriers surrounding HPV vaccination: a qualitative study of semistructured interviews with PrEP patients in primary care clinics in Kansas and Missouri.

OBJECTIVES: Men who have sex with men who use pre-exposure prophylaxis (PrEP) have not traditionally been targets for human papillomavirus (HPV) vaccine programmes, despite their high risk for HPV-related cancers and HPV vaccine being approved by the U.S. Food and Drug Administration (FDA) for people up to age 45. The objective of this study was to assess attitudes and barriers towards HPV vaccine for adult PrEP users in the primary care context. METHODS: Semistructured phone interviews of 16 primary care patients taking PrEP in the Kansas City metropolitan area were conducted, with interviews assessing HPV vaccination status, and attitudes, beliefs and perceived barriers surrounding HPV vaccine. Interview notes were open-coded by student authors, and themes were generated through code review and consensus. Data were then analysed using thematic analysis. RESULTS: The results showed that most patients believed that preventative health was important and felt the HPV vaccine was important. Most patients were open to vaccination if recommended by their primary care physician and covered by insurance. Most participants believed HPV infection to be far worse in women, and there were gaps in knowledge surrounding HPV and its effects in men. CONCLUSIONS: While more research is needed to better understand facilitators of a linkage between PrEP and HPV vaccine in clinical settings for groups at high risk for HPV-related cancers, getting primary care providers involved in educating high-risk patients about the importance of HPV vaccination and actively recommending the vaccine to those patients has the potential to prevent HPV-related cancers.

Invisible Spread and Perceived Stress Amidst COVID-19.

INTRODUCTION: There are limited reports on the mental health toll associated with the fear of spreading coronavirus disease 2019 (COVID-19) and the associated stay-at-home orders. The goal of the present study was to characterize the self-reported stress of participants from the Kansas City Metropolitan Area (KCMA) and to examine the relation between potential for asymptomatic spread and perceived stress. METHODS: This prospective convenience sample study enrolled 461 participants from May 4 to May 22, 2020. Participants were consented and surveyed prior to free SARS-CoV-2 testing. Measures employed included the Perceived Stress Scale-10 and a comprehensive COVID-19 questionnaire. During the study period, testing resources were limited. In the community, only symptomatic individuals or close contacts of known positives could be tested. Our program aimed to reach those who were unable to access testing resources due to their asymptomatic status or other barriers to care. RESULTS: Worry about asymptomatic spread was associated significantly with greater perceived stress (p < 0.001). Higher stress was reported among women (p < 0.001), Hispanic/Latinx (p = 0.001), non-Black/ African American individuals (p < 0.001), and those reporting the presence of COVID-19 symptoms (p = 0.001). CONCLUSIONS: The COVID-19 pandemic has caused significant economic, social, and health disruptions around the world. Distress is significantly related to concern over unintentionally contributing to the spread of SARS-CoV-2 through asymptomatic transmission. In addition to examining outcomes like distress, future research should characterize the modifiable psychotherapeutic processes that might be targeted through intervention among those experiencing distress.

Is a Video Worth a Thousand Words? Educating Preclinical Medical Students on Sterile Scrubbing, Gowning, and Gloving Virtually and In-Person.

INTRODUCTION: Programs that offer early exposure to surgery for medical students foster interest in and positive perceptions of surgery. The COVID-19 pandemic led to suspension of these activities at our institution, the University of Kansas School of Medicine. In response to the lack of virtual alternatives, a pilot virtual surgery enrichment program was implemented for first-year students in place of in-person surgical exposure. The aim of this study was to compare the efficacy of in-person and virtual-based surgical education programs to expose preclinical medical students about the surgical realm of medicine. METHODS: First-year medical students participated in either a virtual (Group A) or in-person (Group B) week-long surgical enrichment program. Group assignments were dictated by COVID restrictions on each of our three medical school campuses: Salina, Wichita, and Kansas City. Pre- and post-surveys with a 14-question multiple-choice assessment of surgical knowledge were distributed to participants. Paired Wilcoxon Signed Rank tests and Mann-Whitney-U tests were used for statistical analysis. RESULTS: There were 14 participants in Group A and 7 participants in Group B. Both groups improved significantly from pre- to post-assessment score. (Group A, p = 0.01; Group B, p = 0.04). There was no difference between groups in the magnitude of score improvement from pre- to post-assessment (p = 0.59). CONCLUSIONS: This pilot program demonstrated that virtual platforms can be a method to provide meaningful clinical experiences in surgery to preclinical medical students restricted from clinical activities. Further development of mentorship in virtual surgical programs and assessment of subjective experience is needed.

Telemedicine for head and neck cancer surveillance in the COVID-19 era: Promise and pitfalls.

BACKGROUND: The coronavirus disease 2019 pandemic has led to increased telemedicine visits. This study examines current preferences and barriers for telemedicine among patients with head and neck cancer. METHODS: Single institution retrospective analysis of 64 patients scheduling visits with the head and neck surgical oncology clinic at a tertiary academic medical center. Data were collected detailing patient preferences and barriers regarding telemedicine appointments. Patients electing to participate in telemedicine were compared to those preferring in-person appointments. RESULTS: Most patients (68%) were not interested in telemedicine. Preference for in-person examination was the most common reason for rejecting telemedicine, followed by discomfort with or limited access to technology. Patients elected telemedicine visits to avoid infection and for convenience. CONCLUSIONS: When given a choice, patients with head and neck cancer preferred in-person visits over telemedicine. Although telemedicine may improve health care access, patient preferences, technology-related barriers, and limitations regarding cancer surveillance must be addressed moving forward.