17th Annual Research Articles

Abstract 27: Demographic Factors Associated with Extracutaneous Involvement in Kaposi Sarcoma

Abstract Purpose: Kaposi sarcoma (KS) is a soft tissue tumor that typically presents with red or purple skin lesions. However, extracutaneous involvement can occur in severe disease. The National Cancer Database (NCDB) compiles data from 1,400 cancer programs across the United States; to our knowledge, there has yet to be a study in the NCDB comparing demographic features and presentation of KS with cutaneous versus extracutaneous disease. Thus, there is a need to characterize the KS cohort with regards to primary site. Methods: We conducted a retrospective analysis of the NCDB from 2004 to 2019 for Kaposi sarcoma patients (n=5,587). Analysis was completed between patients with cutaneous (n=3,963) and extracutaneous (n=1,624) involvement using Pearson Chi-square and t-tests. Survival was estimated using Kaplan-Meier curves. Results: Non-cutaneous lesions made up 29.1% of diagnoses and primarily included connective/subcutaneous tissue (12.2%), as well as digestive organs (4.1%). Median survival was lower in the extracutaneous (101.7 months) cohort compared to cutaneous (131.5 months) cohort (p<0.001). Women were more likely to present with non-cutaneous lesions compared to men (37.3% versus 27.6%, p<0.001). Spanish/Hispanic subjects were less likely to have extracutaneous involvement compared to non-Spanish/Hispanic subjects (p=0.006). Patients at academic centers were less likely to have extracutaneous lesions compared to other facilities (p<0.001). Residing in the Central United States was associated with increased incidence of extracutaneous disease (p<0.001). Patients with extracutaneous disease lived further from the reporting hospital (23.95 miles) compared to patients with cutaneous (16.24 miles) involvement (p=0.004). There was no significant difference in mean age between cutaneous (58.41 years) and non-cutaneous (57.97 years) cohorts. No clear trend existed between race, insurance status, education, or income in relation to extracutaneous disease. Conclusion: To our knowledge, our study is the first to compare demographic features and trends associated with cutaneous and extracutaneous KS in the NCDB. We revealed that extracutaneous primary site is associated with poorer survival and highlighted several significant differences between the cohorts. Citation Format: Michelle Swedek, Xinxin Wu, Peter Silberstein, Victoria Vardell. Demographic Factors Associated with Extracutaneous Involvement in Kaposi Sarcoma [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 27.

Abstract 10: Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana

Abstract Purpose: Breast Cancer in Ghana is the leading type of cancer and second most common cause of cancer related death. Five-year survival in Ghana has been cited at 40-48% with most cases being stage 3 or 4 at diagnosis. Robust access to early detection and diagnostic services can lead to earlier stages of diagnosis and improved survival. The purpose of this study was to evaluate the early detection and diagnostic services available at hospital facilities nationwide in Ghana and to characterize geographic access. Methods: Trained research assistants administered a cross-sectional survey to all hospitals in Ghana from November 2020 to October 2021. Early detection and diagnostic services were characterized as having Basic, Core, or Enhanced services as per in the National Comprehensive Cancer Network (NCCN) framework for resource stratification. Availability of services were defined as available greater than 80% of the time, available less than 80%, or not at all. Results were analyzed for descriptive statistics in STATA. Results: 328 of 346 hospitals completed the survey. Of the 328 hospitals, 2 (1%) met NCCN Basic criteria alone, 11 (3%) of the hospitals met NCCN Core criteria, and none met NCCN Enhanced criteria. When including hospitals who offer services less than 80% of the year for varying circumstances, 3 (1%) met NCCN Basic criteria, 20 (6%) met NCCN Core criteria, and none met NCCN Enhanced criteria. Mammography was offered at 21 (6%) of the hospitals, 17 (5%) of which were available more than 80% of the year. Mapping and population data to estimate the percentage of population within various distances to hospital-based breast cancer early detection and diagnostic services will be done using Ghana 2021 census data in ArcGIS. Conclusion: Hospital based services for breast cancer early detection and diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care outlined by the NCCN framework, but there are only a limited number of hospitals who offer the full spectrum of services. Understanding of current availability, and geographical distribution of services, provides a framework for potential targeted expansion or identification of alternative healthcare delivery models. Citation Format: Matthew Price, Anne Rositch, Florence Dedey, Mamadou Tounkara, Kirstyn Brownson, Raymond Price, Edward Kofi Sutherland. Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 10.

Abstract 72: Socioeconomic Disparities Across the Cancer Care Continuum in Saint Lucia: A Community-Based Study

Abstract Purpose: Low socioeconomic status could contribute to insufficient access to care and the high cancer mortality in small developing island states (SIDS). However, disparities in care among cancer survivors are rarely studied in SIDS. We investigated for the first time the socioeconomic disparities across the cancer care continuum in Saint Lucia. Methods: We used purposive and snowball sampling to recruit adult cancer survivors residing in Saint Lucia. Trained field investigators interviewed survivors face-to-face with a structured questionnaire ascertaining their care experience and health services accessed. We used univariate logistic regressions to estimate odds-ratios (OR) and their 95% confidence intervals (CI) measuring the association between socioeconomic status and cancer care. Socioeconomic status was modelled as binary outcome variables: educational level, private medical insurance and hot water at home (a proxy for income in Saint Lucia). Results: We included 50 survivors (13 men, 37 women). The majority of survivors were black, and diagnosed with breast and prostate cancer. Survivors who were satisfied with the information provided during their diagnosis announcement were more likely to have hot water (OR=5.0, 95% CI=1.3-19.0). Concerning, sources of funds for treatment, private medical insurance and hot water were associated respectively with less financial contributions from family/friends (OR=0.2, 95% CI=0.1-0.9) and greater use of their own funds (OR=3.3, 95% CI=0.9-15.0). Patients who were provided with doctor’s contact information in case of concerns were more likely to have more than primary education (OR=6.3, 95% CI=1.3-31.1) and private medical insurance (OR=12.3, 95% CI=1.4-111.6). Overseas travel for cancer treatment was significantly associated with having private health insurance (OR=3.4, 95% CI=0.9-12.7) and hot water (OR=4.5, 95% CI=1.2-16.8). Having more than primary school education was associated with better perceived care experience (OR=13.5, 95% CI=2.2-84.0). Having private medical insurance was associated with greater access to supportive care services such as psychologists and physiotherapists (OR=3.6, 95% CI=0.9-14.5). Conclusion: Despite our small sample size and potential confounding, we showed some evidence of socioeconomic disparities across the cancer care continuum in Saint Lucia. Low socioeconomic status should be taken into account when considering interventions to reduce of cancer mortality in SIDS. Citation Format: Aviane Auguste, Dorothy Phillip, Owen Gabriel, James St. Catherine, Carlene Radix. Socioeconomic Disparities Across the Cancer Care Continuum in Saint Lucia: A Community-Based Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 72.

Abstract 17: Cancer Control Through Surveillance: Harmonised Cancer Registration Guidelines for East Africa

Abstract Purpose: Implementation of evidence-based cancer control strategies requires cancer registration data. However, cancer registration in East Africa is characterized by disparities in quality and coverage; insufficient harmonisation of procedures; different laws/legislation that limit data access; lack of networking, collaboration, and participation in cancer research; and insufficient national government recognition and funding. This aimed to harmonize the cancer registration guidelines and establish a coherent framework for enhancing cancer registration in East Africa. Methods: The process of developing the “Harmonised cancer registration guidelines for East Africa” was participatory and engaged stakeholders from all the East Africa Community (EAC) member countries (Uganda, Kenya, Tanzania, Rwanda, Burundi, and South Sudan). Several strategies were used over a period of four years (2018-2021) including: 1) Partnership and leadership formation (the planning committee composed of the Ministry of Health officials and policymakers, the Steering Committee composed of experts in cancer registration, and the writing team); 2) review of relevant literature on cancer registration guidelines; 3) conducting a SWOT analysis of cancer registration in East Africa, and 4) holding three harmonisation conferences. Results: The East African Cancer Registration Guidelines were harmonised under the stewardship of the East African Center of Excellency for Oncology at the Uganda Cancer Institute (UCI) and were approved by the East African Community Sectoral Council of Ministers of Health on 10th December 2021 (EAC/SCHealth/21/Decision 003) and a directive issued to all partner countries to use the approved guidelines (EAC/SCHealth/21/Directive025). Several outcomes were achieved including Commonly agreed-upon standards and processes for establishing and operationalizing cancer registries in the region; ownership of data and easy accessibility by the member states; and improved collaboration and networking among cancer registries in the region. The process also provided learning opportunities and was a catalyst for the individual countries that are now focusing on setting up their cancer registries. Conclusion: Forging effective partnerships, wide stakeholder involvement; use of locally generated data; and locally-driven solutions are essential for generating local policies and creating a sustainable leadership structure for directing the cancer control effort in the region. Citation Format: Annet Nakaganda, Henry Wabinga, Crispin Kahesa, Francois Uwinkindi, Jonas Nsengiyumva, Valerian Mwenda, Michael Katende, Jackson Orem. Cancer Control Through Surveillance: Harmonised Cancer Registration Guidelines for East Africa [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 17.

Abstract 47: Human Papillomavirus (HPV) Cervical Cancer Screening and Secondary Prevention in Côte d’Ivoire: Time From Testing to Treatment

Abstract Purpose: Cervical cancer is both preventable and curable, yet, in Côte d’Ivoire, it is the second deadliest cancer affecting women. The Unitaid-funded SUCCESS project is supporting the Ivorian Ministry of Health (MOH) to eliminate cervical cancer through a screen-and-treat strategy with primary Human papillomavirus (HPV) DNA testing for secondary prevention. However, little is known about the challenges and opportunities of HPV-testing in Côte d’Ivoire. Here, we aimed to analyze the time elapsed between testing and results reception to highlight critical implementation steps. Methods: We analyzed preliminary cohort study data of women aged 25-49 years who underwent HPV-testing at 10 health facilities, April-November 2022. After phone-call notification of result availability, results were delivered in-person by the healthcare provider, along with counseling. Visual acetic acid inspection (VIA) followed for HPV-positive, and treatment (same-day thermal ablation (TA) or loop electrical excision procedure) for VIA-positive women. Participants were followed through each step to document the test-to-treatment process and compute the expected testing-to-treatment time. Logistic regression was used to explore factors associated with VIA completion after an HPV-positive test. Results: 1868 women (median age 37 [Inter Quartile Range: 33-41]) years were enrolled by November 2022, of whom 1712 (91.6%) preferred self-sampling. Overall, 948 (50.7%) results were available at health facility level; 240 (25.3%) within 30 days, 322 (34%) within 30-60 days and 386 (40.7%) after 60 days. There were 189 (19.9%) HPV-positive women of whom 56 (30%) underwent VIA. The average duration from testing to TA was 70.1±42.1 days, with 61.4±41.8 days from sample collection to results reception, and 27.5±29.8 days from reception to VIA. Women encountering a duration of 30-60 (OR 0.33, 95%CI: [0.16-0.68]) or more than 60 (OR 0.52, 95%CI: [0.29-0.94]) days between testing and result reception were less likely to complete VIA compared with those with less than 30 days. Conclusion: Our findings suggest that test-to-treatment completion is likely to be affected by insufficiencies in sample/result processing and return to women. Hopefully, the upcoming deployment of 07 testing platforms under the MoH’s initiative to expand laboratory coverage along with advanced strategies to improve client follow-up and treatment, will help overcome these challenges. Citation Format: Rita-Josiane Gouesse, Mathurin Dodo, Jean-Claude Kouassi, Simon Boni, Joel Setoh, Ida Zadi, Meg Bertram, Tracey Shissler, Lisa Huang, Nemdia Daceney, Innocent Adoubi, Cindy Gauvreau, Mark Kabue. Human Papillomavirus (HPV) Cervical Cancer Screening and Secondary Prevention in Côte d’Ivoire: Time From Testing to Treatment [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 47.

Abstract 22: Collaboratively Adapting a Telebehavioral Mobile Platform to Enhance Patient-Provider Communication Regarding Cervical Cancer Prevention Efforts in Bluefields, Nicaragua

Abstract Purpose: Nicaragua has the highest rate of cervical cancer in Central America. Cervical cancer screening is available nationally, however substantial barriers to screening engagement persist. Azulado is a telebehavioral, patient-centered mobile platform that was culturally, linguistically, and regionally created to specifically address the cervical cancer screening and treatment needs of women in Bluefields, Nicaragua, on the Caribbean coast. The app was successfully piloted in summer 2021. In summer 2022, the research team explored healthcare provider perspectives of Azulado, collaborating with providers to design an accompanying portal for the app. Methods: The team conducted a mixed-methods, community-based participatory investigation to elicit healthcare provider perspectives to inform the design of a provider portal. Focus groups and individual interviews were conducted with providers at healthcare facilities throughout Bluefields. A tablet-based survey adapted from mHealth App Usability Questionnaire (MAUQ) and System Usability Scale (SUS) was administered. The team conducted thematic analysis and descriptive statistics. Results: Three provider focus groups (n=8) and multiple individual interviews (n=18) were conducted in six unique healthcare settings in Bluefields. Twenty participants completed the survey (15 women and 5 men). Provider years of experience ranged from 1 to 37 years (average 17.0 years, median 16.5 years). Quantitative findings demonstrated that when asked if they agreed that the app would be useful for patient health and well-being, the average response was 4.89 (SD 0.32) on a Likert scale (0= strongly disagree, 5= strongly agree). The average response for the statement “I would recommend this app” was 4.68 (SD 0.58). Emergent themes included the importance of inclusivity and representation of different regional ethnicities and situations, clarity and functionality of the app, emotional support by community or provider, ability to input clinic visit reminders, and ability to anonymously and confidentially communicate with patients. Conclusion: The study demonstrated feasibility and acceptability of the Azulado patient-provider interface. Providers gave suggestions for how to improve patient education and facilitate communication between patients and clinics. Future studies will include trialing the updated app with patients and determining its effectiveness in improving prevention and treatment efforts in Bluefields. Citation Format: Maria Geba, Katherine Hall, Anneda Rong, Michelet McLean Estrada, Rebecca Dillingham, Emma McKim Mitchell. Collaboratively Adapting a Telebehavioral Mobile Platform to Enhance Patient-Provider Communication Regarding Cervical Cancer Prevention Efforts in Bluefields, Nicaragua [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 22.

Abstract 36: Examining Policies and Guidelines to Improve the Cervical Cancer Prevention and Treatment Pathway for Patients and Health Providers in Tanzania: A Qualitative Study

Abstract Purpose: Cervical cancer is the fourth most common cancer in women around the globe. It has been identified as the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Several research studies have identified the importance of adequate and timely policies and guidelines to optimize the cervical cancer prevention and treatment pathway in the nation. However, there is scant literature on the perspectives of all stakeholders (e.g., patients, key informants, healthcare providers, and non-healthcare providers). Our study aims to better understand the recommendations from important stakeholders to inform current and upcoming policies and guidelines, and overall, improve the cervical cancer screening and treatment cascade in rural Tanzania and other African countries. Methods: We leveraged a framework for conducting a health systems assessment to identify healthcare providers’ perspectives on effective cervical cancer screening, prevention and control in Tanzania. We adapted interview topic guides for cervical cancer screening using the health systems assessment framework conceptualized by Risso-Gill and colleagues designed initially for evaluating hypertension control. Study participants (71) were interviewed between 2014-2018. This included key stakeholders, patients, healthcare providers and non-healthcare providers. Results: Through the interviews and focus group discussions that were conducted, three major themes emerged: 1) policies and guidelines, 2) burden of disease in relation to policies, and 3) treatment and follow-up. Sub-themes relating to policies and guidelines included health policies, governmental influence, data collection, and revision of HPV vaccination guidelines. Sub-themes for burden of disease included the rise in overall cases of cervical cancer. Subthemes for treatment and follow-up included quality of care, dissatisfaction with care, and patient safety and well-being. Conclusion: It is evident that significant changes must be made to existing policies and guidelines to improve many aspects of the cervical cancer screening and treatment pathway, to benefit healthcare providers and patients alike in rural Tanzania. There is also a critical need to implement new initiatives and programs to increase uptake and allow for informed-decision making among women. Citation Format: Melinda Chelva, Sanchit Kaushal, Nicola West, Erica Erwin, Prisca Dominic Marandu, Safina Yuma, Donna Shelley, Karen Yeates. Examining Policies and Guidelines to Improve the Cervical Cancer Prevention and Treatment Pathway for Patients and Health Providers in Tanzania: A Qualitative Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 36.

Abstract 14: Barriers to Effective Safe Handling of Chemotherapeutic Drugs Among Healthcare Workers in Vietnam: Needs Assessment by Electronic Survey

Abstract Purpose: To identify barriers and facilitators of effective safe handling of chemotherapeutic drugs among healthcare workers in hospitals across Vietnam. Methods: We used Qualtrics to design a 45-question structured questionnaire in English and Vietnamese survey to assess the safe handling of chemotherapeutic drugs. This questionnaire was distributed as an anonymous online survey through the e-mail listserv of the Vietnam Pediatric Oncology Association in August 2022. Survey instruments included years of practice, types of prior training, knowledge, personal practice, and organizational factors. Respondents were asked whether they used specific personal protective equipment (PPE) in the steps of preparation, administration, and disposal of chemotherapeutic drugs. Results: The survey was distributed to 310 healthcare workers at 14 children’s hospitals. Sixty-two healthcare workers from 13 hospitals completed the survey (response rate 20%). Among those who completed the survey, diverse occupations were represented (39 nurses, 21 physicians, and 2 pharmacists). Forty-six had received prior training in the safe handling of chemotherapeutic drugs, and 25 had longer than ten years of practice. Forty-two workers reported involvement in the administration of chemotherapy, and 17 reported wearing chemotherapy gloves (compliant group) while 25 wore other types of gloves or no gloves at all (non-compliant group). Thirty-six workers (86%) reported the availability of chemotherapy gloves, and 38 (90%) were aware that not all gloves provide the same level of protection. In the compliant group, 71% (n = 12) were aware of institutional policies at their workplaces, while only 36% of the non-compliant group (n = 9) reported awareness of the institutional policies. When stratified according to the availability of institutional policy, long years of practice were more common in the compliant group. Conclusion: Overall, respondents reported having supplies of gloves and knowledge of glove use. Those who used chemotherapy gloves were generally aware of institutional policies and had longer years of practice. The next step will involve reviewing institutional policy at each institution and studying how long years of practice influence the practice of safe handling. Citation Format: Cham Nguyen, Linda Abramovitz, Kim Lien Nguyen, Bao Truong, Michelle Hermiston. Barriers to Effective Safe Handling of Chemotherapeutic Drugs Among Healthcare Workers in Vietnam: Needs Assessment by Electronic Survey [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 14.

Abstract 30: Development of a Breast Cancer Survivorship Health System Needs Assessment Questionnaire (BSH-Q) for Malaysian Health Institutions

Abstract Purpose: There is a need to develop and implement a Breast Cancer Survivorship Care Plan in Malaysia based on the available healthcare resources and services. The objective of the study is to develop a Breast Cancer Survivorship Health System Needs Assessment Questionnaire (BSH-Q) using the Delphi method. Methods: The three rounds of e-Delphi surveys were conducted from November, 2020 to April, 2021. Development of BSH-Q was accomplished amongst key stakeholders (multidisciplinary healthcare professionals involved in cancer care in public hospitals, NGOs and breast cancer survivors). The first Delphi round was intended to explore the barriers, facilitators and needs of healthcare providers focused on five main survivorship care domains. The questions were open ended, allowing expert participants to brainstorm their ideas. Delphi round two involved a ranking exercise of the newly developed questionnaire based on the first Delphi round. A five point Likert scale was used to rate the importance of each item. This was followed with a pilot study to determine the feasibility of the research process, and face validity of the questionnaire. The pilot study was tested on healthcare providers working in University Malaya Medical Centre representing the five respective domains: Rehabilitation, life-style, psychosocial, financial, and genetic counselling. The participants were selected based on their involvement in managing the healthcare issues related to the five domains. Results: A total of 55 participants responded to the Delphi survey. Following the first Delphi survey, a total of 95 questions were developed in the domains of psychosocial, lifestyle, financial, rehabilitation, genetic counselling, cancer surveillance and management. In the second Delphi survey, 39 participants responded, they selected a total of 196 questions as important and finally 182 relevant questions were developed for the final BSH-Q version. The newly developed BSH-Q underwent a pilot study with no major modifications to the questionnaire. Conclusion: The Delphi survey method is suitable to develop the BSH-Q questionnaire. The newly developed BSH-Q is a valuable tool for Malaysia to analyse existing services in the country to provide a needs assessment too for the development of an implementation framework cancer survivorship care in Malaysia. Citation Format: Tania Islam, Syahidatul Akmal Azmi, Suniza Jamarish, Fatiha Hana Shaharuddin, Julia Patrick Engkasan, Nur Aishah Taib. Development of a Breast Cancer Survivorship Health System Needs Assessment Questionnaire (BSH-Q) for Malaysian Health Institutions [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 30.

Abstract 56: Integrated Breast and Cervical Cancer Prevention: What is the Cost of Cost Reduction?

Abstract Purpose: coupling of breast and cervical cancer prevention has been proposed as a possible low hanging fruit to accelerate simultaneous reduction in burden of both cancers in low resource settings but unfortunately the evidence on effectiveness of such strategy is limited. We have therefore documented and compared the implementation processes of 2 intervention programs in low resource settings with the aim of catalyzing further research into the effectiveness of coupling prevention of breast and cervical cancer in low resource settings. Methods: Action research model was adopted in the implementation of coupling of breast cancer prevention strategies onto cervical cancer screening programs that End Cervical Cancer Nigeria Initiative (ECCNI) is involved in. This study compared the implementation processes and outcomes of leveraging two cervical cancer screening programs to prevent breast cancer in Kebbi State of Nigeria. Budget impact of the programs was projected and compared. Results: Two thousand four hundred and sixty-six (2,466) women were screened for cervical cancer across 10healthcare facilities under the WHO/CHAI/MCF supported pilot HPV screening in Kebbi State while the number of women who had clinical breast examination could not be ascertained. At the police cottage hospital, 125 women were screened for cervical cancer using VIA and 131 women had clinical breast examination within the reporting period. The estimated financial cost of implementation (excluding economic cost) per center was $4,550 for cervical cancer screening and $1,850 for clinical breast examination-based prevention program. The implementation cost for the integrated breast and cervical cancer screening at the police cottage hospital was $4,550, implying that no additional funding is required to leverage clinical breast examination on budgeted cervical cancer screening at the primary healthcare level. Conclusion: Integrated breast and cervical cancer prevention is a confirmed cost reducing strategy but further research is needed to determine cost effectiveness of the strategy. Citation Format: Ishak Lawal, Zainab Shinkafi-Bagudu, Nuhu Koko, Jamilu Mohammad, Abdullahi Bala Rano, Kabir Aliyu Suleiman. Integrated Breast and Cervical Cancer Prevention: What is the Cost of Cost Reduction? [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 56.

Abstract 81: The Introduction of a High Risk HPV DNA Test for the Cervical Cancer Screening Among Mongolian Women

Abstract Purpose: A global strategy developed by the World Health Organization aims to reduce cervical cancer burden by screening 70% of women with high performance tests at least twice during their lifetime. While Mongolia has implemented a PAP test-based cervical cancer screening program over the past few decades, cervical cancer remains the leading cause of death in the country. Therefore, it is necessary to introduce high-risk HPV DNA detection tests in cervical cancer screening program. Methods: Cervical screening was conducted in 6 districts of the UB and in 4 regional provinces between March 01 and July 01, 2019. A high risk HPV DNA test was conducted on all women using the careHPV test, and then all positive samples were double-tested using the PAP test. All positive women were followed by HPV genotyping test and colposcopy with direct biopsy or endocervical curettage as necessary. Results: A total of 2725 women were screened for HPV DNA, with 8.5%(239) of these detecting high risk HPV DNA, and 61% (138) of positive results having a negative result for intraepithelial neoplasia as determined by PAP tests. It was determined that 10% of samples contained atypical squamous cells of undetermined significance, 4% contained atypical squamous cells of unknown significance, and cannot exclude high grade, 17% of the samples contained low grade squamous intraepithelial lesions, and 10% contained high grade squamous intraepithelial lesions. A colposcopy examination was performed on 181 women who were high-risk HPV DNA positive. An abnormal colonoscopy result was observed in 18% of the women, for which biopsies were taken. A total of 31% of them were confirmed with CIN I, 31% with CIN II, 9% with CIN III, 11% with CIS, and 6% with SCC. Additionally, 105 high-risk HPV DNA-positive samples were genotyped for HPV. There were 25.7% of individuals who were found to have HPV genotype 16, 4.7% who were found to have HPV genotype 18, and 69.6% who were found to have other high-risk genotypes. Conclusion: By incorporating high-risk HPV DNA tests into cervical cancer screening program, its coverage and effectiveness could be increased. Citation Format: Enkhjargal Bayarsaikan. The Introduction of a High Risk HPV DNA Test for the Cervical Cancer Screening Among Mongolian Women [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 81.

Abstract 12: Barriers in Delivery of Results and Treatment of Women Tested Positive for HPV in Burkina Faso

Abstract Purpose: Cervical cancer is the third most common cancer among women in Burkina Faso. As part of the global effort to eliminate cervical cancer, the ministry of health supported by the Unitaid-funded SUCCESS project, is implementing Human Papillomavirus screening and services associated with treatment when needed. However, effective implementation in a Burkinabé context remains unknown. The SUCCESS project is studying the integration of this approach into existing women’s health services. Methods: Study data were collected from April to October 2022 in 10 health facilities in Burkina Faso, where voluntary HPV testing is integrated into routine services. Women enrolled in the study were contacted by health providers by phone to inform them of the availability of results and the need to return to the health center; results were not delivered over the phone. A second contact was made with HPV-positive women to evaluate and propose treatment. To overcome difficulties in reaching women with poor access to telephone networks in rural areas, the study team engaged with local resource persons like community health workers. Quantitative and qualitative data collection (surveys and clinical records) covered all components of this implementation research. Descriptive analysis was conducted. Results: 2,227 women participated in the study, of whom 1,960 (88%) received their results. Of these, 212 (11%) HPV-positive women received treatment by October 2022. 37% of these women were married. The median time from receipt of results by health providers to treatment was 10 days (IQR 16-27). Women were primarily contacted by telephone, with the majority of women or one member of the household having at least one telephone. lack of information on the importance of early treatment, the two-week period without sexual intercourse during treatment and the difficulty of accessing the telephone network for rural women are the main challenges. Conclusion: The relatively short time between receipt of results and treatment shows that the integration of HPV services in Burkina Faso requires complementary action with all health system actors. Comprehensive methods of communicating results and husband involvement for early treatment of HPV-positive women should be considered when expanding services, especially for women living in rural areas. Key words: Cervical Cancer, Human Papilloma Virus testing, implementation research, feasibility, Women, Burkina Faso Citation Format: Gountante Kombate, Linda Troare, Blami Dao, Andre Koné, Youssouf Zongo, Emmanuelle Zoure, Tracey Shissler, Lisa Huang, Nemdia Daceney, Mathurin Dodo, Cindy Gauvreau, Mark Kabue. Barriers in Delivery of Results and Treatment of Women Tested Positive for HPV in Burkina Faso [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 12.

Abstract 52: Implementation of a Hospital-Based Peer Support Intervention Model for Cancer Patients: Results From a Pilot Study in Vietnam

Abstract Purpose: Provision of mental health psychosocial support can reduce psychological distress experienced by cancer patients, which can in turn improve their treatment adherence and outcomes. In this study, we present the results from the pilot trial of Stronger Together, a culturally adapted peer-to-peer support program, conducted in Vietnam. Methods: We recruited eligible women from four hospitals in Vietnam (K3 National Cancer Hospital, Hue Central Hospital Oncology Center, Can Tho Oncology Hospital, and Hung Vong Women’s Hospital Oncology Unit). Participants were newly diagnosed with breast or gynecologic cancers, and self-selected into either the control (usual care) or intervention arm (mentees who were matched up with trained peer mentors). Validated questionnaires were administered at baseline (0), 2-, 4-, and 6-months. We conducted a difference-in-difference (DID) analysis for the primary outcomes (assessed by the Depression, Anxiety, and Stress Scale [DASS-21]), comparing the difference in scores from baseline to 6 months and between intervention arms (mentees vs. usual care). Results: The analytic sample included n=186 participants (mentees: 91; usual care: 95), with the majority having breast cancer (85.5%), followed by cervical cancer (7.5%) and ovarian cancer (7.0%). There were no statistically significant differences between study arms in demographic and cancer characteristics (cancer type and stage). DID analyses showed that compared to usual care participants, mentees (those who received peer support) showed greater reductions in depression, anxiety, and stress scores between baseline and 6 months. Adjusting for age, education, marital status, and cancer stage, statistically significant reductions in stress scores (β=-1.47; 95%CI: [-2.9,-0.02]; p=0.047) were observed. Among breast cancer patients only, adjusted models showed significant reductions in depression scores (β=-1.80; 95%CI: [-3.0,-0.48]; p=0.007) and stress scores (β=-1.9; 95%CI: [-3.3,-0.37; p=0.015). Conclusion: The Stronger Together pilot study study shows that utilizing peer cancer survivors is a promising strategy to address the psychosocial needs of newly diagnosed cancer patients in low-resource settings. Future research should test this intervention model in larger samples or other similar populations and settings. Citation Format: PhuongThao Le, Carolyn Taylor, Rachel Monahan, Mai Do, Linh Nguyen, Minh Tri Phan, Cong Wang, Huong Tran, Ophira Ginsburg. Implementation of a Hospital-Based Peer Support Intervention Model for Cancer Patients: Results From a Pilot Study in Vietnam [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 52.

Abstract 35: Examining Levels of Awareness, Barriers and Enablers Regarding the Cervical Cancer Prevention and Treatment Pathway for Patients and Health Providers in Tanzania: A Qualitative Study

Abstract Purpose: Cervical cancer is the fourth most common cancer in women around the globe. It has been identified as the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Several research studies have identified lack of awareness, low screening uptake and several other barriers as significant contributors to the striking number of deaths in the nation. While prior studies on the effects of both awareness levels and barriers/enablers in rural Tanzania have been explored, there is scant literature on the perspectives across all stakeholders (e.g., patients, key informants, healthcare providers, and non-healthcare providers). Our study aims to better understand the cervical cancer screening cascade in rural Tanzania to inform relevant policies and guidelines and overall, improve health outcomes. Methods: We leveraged a framework for conducting a health systems assessment to identify healthcare providers’ perspectives on effective cervical cancer screening, prevention and control in Tanzania. We adapted interview topic guides for cervical cancer screening using the health systems assessment framework conceptualized by Risso-Gill and colleagues designed initially for evaluating hypertension control. Study participants (71) were interviewed between 2014-2018. This included key stakeholders, patients, healthcare providers and non-healthcare providers. Results: Through the interviews and focus group discussions that were conducted, three major themes emerged: 1) awareness, 2) barriers, and 3) enablers. Awareness sub-themes included education (healthcare providers), education (patients), beliefs on cervical cancer screening, traditional medicine, risk factors, and symptoms and signs. Barriers sub-themes included access to seeking care, stigma, fear of seeking care, transportation methods, lack of communication between healthcare providers, lack of resources for patients, and disadvantaged populations. Enablers sub-themes included previous use of services, use of referrals, mass screening programs, and family support (including male involvement). Conclusion: It is evident that there is a low level of awareness of cervical cancer amongst patients and healthcare providers in rural Tanzania and a multitude of barriers and enablers that alter the prevention and treatment cascade. There is a critical need to implement more initiatives and programs to increase uptake and allow for informed-decision making among women. Citation Format: Sanchit Kaushal, Melinda Chelva, Nicola West, Erica Erwin, Prisca Dominic Marandu, Safina Yuma, Donna Shelley, Karen Yeates. Examining Levels of Awareness, Barriers and Enablers Regarding the Cervical Cancer Prevention and Treatment Pathway for Patients and Health Providers in Tanzania: A Qualitative Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 35.

Abstract 9: Association Between HMOX1 (GT)n Promoter Microsatellite and Prostate Cancer Prognosis

Abstract Purpose: Heme Oxygenase 1 (HO-1), the rate-limiting enzyme in heme degradation encoded by HMOX1 gene, has a strong anti-tumoral effect in prostate cancer (PCa). HMOX1 expression levels are modulated by the length of a dinucleotide (GT)n microsatellite polymorphism mapping in its promoter region. PCa is the second most frequent cancer and the sixth leading cause of cancer-related deaths in men worldwide. One of the strongest predictors for newly diagnosed PCa is the International Society of Urological Pathology (ISUP) grade, a histopathology-based classification system, which presents diverse limitations due to tumoral heterogeneity. Consequently, the identification of novel biomarkers is important to optimize PCa prognosis. In this study we genotyped the HMOX1 (GT)n promoter polymorphism and analyze its association with PCa clinico-pathological parameters. Methods: We collected 108 peripheral blood samples from PCa patients from Hospital de Clínicas “Jose de San Martín”, Buenos Aires, Argentina. Genomic DNA was isolated and the (GT)n was genotyped by fluorescent PCR and capillary electrophoresis. Randomly selected samples were cloned and sequenced by Sanger to determine the length of the microsatellite and validate the results. We considered a statistically significant difference between groups if p≤0.05. Results: The length of the (GT)n ranged from 11 to 40 repeats. HMOX1 alleles were dichotomized as “Long (l)” (≥30 repeats) or “Short (s)” (<30 repeats) based on the median length; and genotypes were categorized as homozygous “HMOX1ss, homozygous “HMOX1ll”, or heterozygous “HMOX1sl”. We found an association between the “HMOX1ss” genotype and higher serum prostate specific antigen (sPSA) levels among patients with <10 ng/mL sPSA (p<0.01). Furthermore, the proportion of “HMOX1ss” patients increased with the ISUP grade, whereas “HMOX1ll” or “HMOX1sl” genotypes were more frequent in lower ISUP grades (ptrend<0.05). Finally, “HMOX1ss” patients had 4-fold higher risk of biochemical relapse (HR=4.03, p<0.05). Conclusion: “HMOX1ss” patients present more aggressive phenotypes compared with the other genotypes. HMOX1 polymorphism has the potential to classify patients in different groups to predict the severity of PCa tumors, thus evidencing potential to support clinicians on the decision making and improving clinical management of PCa at an early stage through a non-invasive sample. Citation Format: Gaston Pascual, Agustina Sabater, Rocio Seniuk, Ines Achinelli, Pamela Freiria, Carlos Scorticati, Osvaldo Mazza, Ayelen Toro, Elba Vazquez, Geraldine Gueron, Javier Cotignola. Association Between HMOX1 (GT)n Promoter Microsatellite and Prostate Cancer Prognosis [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 9.

Abstract 20: Clinical and Non-Clinical Determinants of Cervical Cancer Mortality: A Retrospective Cohort Study in Lagos, Nigeria

Abstract Purpose: Cervical cancer (CCa) is the fourth most frequent and a common cause of cancer mortality in women, the majority of whom live in low- and middle-income countries. Data on CCa mortality and its determinants have been poorly studied in Nigeria, resulting in a paucity of information that can assist patient management and cancer control policy. The purpose of this study was to assess the mortality rate among CCa patients in Nigeria as well as the major factors influencing CCa mortality. Methods: Data from the medical records of 343 CCa patients seen at the Lagos University Teaching Hospital and NSIA-LUTH Cancer Center from 2015 to 2021 were used in a retrospective cohort analysis. The hazard ratios (HR) and confidence intervals (CI) associated with the exposure variables and CCa mortality were calculated using Cox proportional hazard regression. Results: The CCa mortality rate was 30.5 per 100 women-years after 2.2 years of median follow-up. Clinical factors such as HIV/AIDS (adjusted HR [aHR]: 11.9; 95% CI: 4.6, 30.4), advanced clinical stage (aHR: 2.7; 95% CI: 1.5, 4.7), and anemia at presentation (aHR: 1.8; 95% CI: 1.1, 3.0) were associated with a higher mortality risk, as were non-clinical factors such as age at diagnosis >50 years (aHR: 1.4; 95% CI: 1.0, 1.9) and family history of CCa (aHR: 3.5; 95%CI: 1.1, 11.1) Conclusion: CCa has a high mortality rate in Nigeria. Incorporating these clinical and non-clinical factors into CCa management and control policies may improve women’s outcomes. Citation Format: Idris Ola, Adebola Okunowo, Muhammad Habeebu, Junmei Miao Jonasson. Clinical and Non-Clinical Determinants of Cervical Cancer Mortality: A Retrospective Cohort Study in Lagos, Nigeria [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 20.

Abstract 65: Oral Health Inequalities Among Tobacco Users in the Tea Plantation Workers, Nilgiri Hills, Tamilnadu, India

Abstract Purpose: Tea is an important agro-industry of India, which contributes immensely to the countries economy. Poor socio-economic conditions, ignorance due to illiteracy, over-crowded and unhygienic living conditions in the residential colonies make tea garden population vulnerable. Hence this study was contemplated with an aim to assess the oral health status, tobacco use and cancer awareness among tea plantation workers, Nilgiri Hills, Tamil Nadu, India. Methods: A cross-sectional descriptive study was conducted to assess the prevalence of head and neck cancers among tobacco use and cancer awareness among tea plantation workers, Nilgiri Hills. Data was collected using a pretested Questionnaire, which included Demographic data, tobacco habits, its frequency and form. Oral examination for potentially malignant and cancerous lesions was done by the examiner. The data collected was analysed using SPSS version 21. Results: Results showed that among 900 study population, 57% had no formal education, 64.5% had indigenous brushing habits. Of those who had the habit of smoking, 26% smoked beedi, 10.9% smoked cigarette, 65% chewed raw tobacco, 18% chewed Hans and 28% had a combination of smoking and smokeless tobacco usage. 52% of oral mucosal and potentially malignant lesions, 6% oral cancers were observed. Prevalence of oral mucosal lesions in the study population was due to tobacco usage and lack of awareness regarding the deleterious effects of the products used. Conclusion: The dangers from smoking and chewing tobacco are well documented within the literature but the public’s lack of knowledge of the risks is a concern. Health professionals are encouraged to ensure that the public is made aware of these risks, especially those within high-risk groups. Citation Format: Delfin Lovelina Francis. Oral Health Inequalities Among Tobacco Users in the Tea Plantation Workers, Nilgiri Hills, Tamilnadu, India [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 65.

Abstract 18: Cervical Cancer Prevention and Control in the Pacific: A Comprehensive Systems Based Approach in Yap State, Federated States of Micronesia

Abstract Purpose: The US Affiliated Pacific Islands, is composed of 3 US Territories (Guam, American Samoa, Commonwealth of the Northern Marianas) and 3 Sovereign Nations (Federated States of Micronesia (FSM), Republic of the Marshall Islands, Republic of Palau. The cervical cancer incidence in several of these island nations are amongst the highest globally. This project is designed to implement a sustainable comprehensive cervical cancer (CC) control program to eliminate CC in the island nations. Yap State, FSM an LMIC is a current project site. Planning, over 7 years, was through the Cancer Council of the Pacific Islands. Funding is primarily through a CDC Prevention and Control Capacity Building Grant, and other grant funds. To eliminate cervical cancer in Yap State, FSM through enhanced evidence based public health practices. The primary objective is to increase sustainable capacity to control cervical cancer. Methods: This non-research project is guided by the principles of community-based participatory development/engagement (CBPE), implementation science, transdisciplinary approach, and capacity building. The team is composed of 4 working cores, coordinated and led by an implementation core. The 4 cores are 1.) medical protocol and laboratory support 2.) community engagement and outreach 3.) data and informatics 4.) medical modeling and micro-costing. Capacity building through training and infrastructure development is a key component. Each core works synergistically and interfaces with the Yap Community Advisory Board, which has decision making authority. Results: Working towards cervical cancer control in a small island LMIC nation, with human resource and health infrastructure limitations, geographic challenges require flexibility and patience. The project processes involve multiple iterations, are culturally/geographically nuanced, and requires constant adjustment to national and international agency and medical regulatory bodies. Strong partnerships with health policy leaders, vaccination programs, clinicians is essential. Modelling projections to understand potential outcomes is necessary. Conclusions: Cervical Cancer Prevention and Control in Yap State, FSM an LMIC can be done with close and trusting community engagement that is participatory and capacity building. Building strong relationships with local, national, and international programs necessary. Citation Format: Neal Palafox, James Edilyong, Martina Reichhardt. Cervical Cancer Prevention and Control in the Pacific: A Comprehensive Systems Based Approach in Yap State, Federated States of Micronesia [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 18.

Abstract 86: The Status of Government-Funded Radiotherapy Centres in Nigeria

Abstract Purpose: Access to radiotherapy (RT) is now one of the stark examples of global cancer inequities. Over 800,000 new cancer cases require potentially curative or palliative RT services in Africa, arguably less than 15% of these patients currently have access to this important service. For a population of over 200 million, Nigeria requires a minimum of 280 RT machines for the increasing number of cancer cases. Painfully the country has only 8 government-funded radiotherapy machines. This study aimed to evaluate the status of the eight (8) Government-funded RT centres in Nigeria regarding RT equipment, workforce and infrastructure to quantify their ability to deliver effective RT to their patients. Methods: A survey addressing ten (10) critical areas was used to assess the eight (8) Government-funded RT centres in Nigeria. Results: Unfortunately, 6 of the 8 centres (75%) surveyed have not treated patients with RT over the last 2 years because they do not have functioning teletherapy machines. Only 2 RT centres have the capability of treating patients using advanced RT techniques. There is no PET-CT scan in any of the Government-funded RTcentres. The workforce capacity and infrastructure across the 8 centres are limited. All of the centres lack residency training programmes for medical physicists and radiation therapy technologists (RTTs) resulting in very few well-trained staff. Conclusion: As the Nigeria government plans for the new National Cancer Control Plan, there is an urgent need to scale up access to radiotherapy by upgrading the RT equipment, workforce and infrastructure to meet the current needs of Nigerian cancer patients. While the shortfall is apparent from a variety of radiotherapy-capacity data bases, this detailed analysis provides essential information for an implementation plan involving solutions from within Nigeria and with global partners. Citation Format: Runcie C.W. Chidebe, Chinedu S. Aruah, Tochukwu C. Orjiakor, Fatima Uba, Uchechukwu N Shagaya, Charles Ugwanyi, Aisha A Umar, Taofeeq Ige, Obinna C. Asogwa, Oiza T Ahmadu, Musa Ali-Gombe, Alabi Adewumi, Vitalis C. Okwor, Mutiu A Jimoh, Basheer Bello, Lucy O. Eriba, Yusuf A. Ahmed, Awwal Bisalla, Ukamaka Itanyi, Ramatallah A Balogun, Suleiman Alabi, David Pistenmaa, Coleman C. Norman, Dosanjh Manjit. The Status of Government-Funded Radiotherapy Centres in Nigeria [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 86.

Abstract 64: Multilevel Barriers and Facilitators of Smoking Cessation in People Living With HIV in Vietnam: A Qualitative Analysis

Abstract Purpose: In Vietnam, tobacco smoking is highly prevalent among people living with HIV (PLWH) and increases their risk of cancer, cardiovascular disease, and life-threatening opportunistic infections. However, research on effective tobacco use treatment (TUT) for PLWH is lacking. To fill this gap, we aimed to identify multilevel barriers and facilitators (B&Fs) of smoking cessation and their implications for TUT implementation for PLWH in Hanoi, Vietnam. Methods: We conducted individual in-depth interviews with 24 patients and 13 healthcare providers at three HIV outpatient clinics (OPCs) in Hanoi to explore B&Fs of smoking cessation at the patient, provider, and system level. Two coders carried out a two-phase abductive thematic analysis using Atlas.ti and guided by the Theoretical Domains Framework. Results: Participants described several patient-level barriers to smoking cessation: limited knowledge, misperceptions about smoking harms, lack of familiarity with cessation aids, exposure to environments in which smoking is common, emotional issues (i.e., stress/depression), substance use, and social norms that promote male smoking and tie smoking to masculinity. Both patients and providers described self-determination to quit as a major facilitator of smoking cessation (Everything can be overcome if there is determination). Patients reported that strong determination to quit is influenced by concerns about the harms of smoking; family support and pressure to quit; and the potential for improving health of themselves and their family and for reducing tobacco-related expenses from tobacco purchases. Provide-reported barriers included a lack of resources and capabilities to assess and intervene on smoking behaviour at the OPCs, and at the system level affordable and accessible tobacco products. However, providers endorsed the importance of supporting patients to quit and were optimistic about tailoring and integrating TUT into OPCs if they were equipped with training, personnel, and financial support. Trust and patient-provider solid relationships were potential facilitators of cessation. Conclusion: The study suggested the need to intervene at patient, provider, and system levels to increase engagement among PLWH in smoking cessation treatment. Provider training, patient education and resources are needed to facilitate treatment. Findings also suggest a need to tailor existing treatment options developed in other contexts to this population and setting. Citation Format: Thanh Hoang, Claire VT Nguyen, Gloria Guevera Alvarez, Trang Nguyen, Nam Nguyen, Louise Adermark, Nawi Ng, Donna Shelley, Mari Armstrong-Hough. Multilevel Barriers and Facilitators of Smoking Cessation in People Living With HIV in Vietnam: A Qualitative Analysis [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 64.