Strengthening anal cancer prevention in Abuja, Nigeria: Identifying barriers and potential strategies to improve training

Anal cancer poses a significant risk for sexual minority males (SMM) living with HIV, with a 100-fold higher incidence compared to the general population. Despite success in high-income settings, training on anal cancer prevention in Africa faces challenges due to limited resources and lack of trained practitioners. We evaluated adapting training using an implementation science framework in a Nigerian SMM-friendly clinic. The Consolidated Framework for Implementation Research (CFIR) Card Game assessed barriers to training on anal cancer prevention. Stakeholders ranked the importance of different CFIR constructs. Sessions were conducted separately for internal stakeholders, external stakeholders, and patients. Facilitators identified barriers using culturally adapted text and a hybrid format for consensus discussion. Potential strategies to overcome the barriers were identified with the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool. The CFIR card game was conducted in August 2023 with 20 participants (Internal: 4, External: 8, Patients: 8). Internal stakeholders identified adaptability, cost, and the absence of external change agents. External stakeholders highlighted adaptability, design quality, and financial burden, proposing advocacy and local discussions. Patients expressed concerns about adaptability and external policies affecting trust and acceptance, emphasizing strategic adaptations and local involvement. The CFIR-ERIC Matching Tool recommended identifying champions and altering incentives as strategies. Incorporating champion roles, local adaptations, policy enforcement, and financial support can enhance training on anal cancer prevention in Nigeria. The findings stress the importance of cultural sensitivity and engagement with local stakeholders to support training practitioners in anal cancer prevention.