PROJECT ABSTRACT Older sexual and gender minorities (SGM) living with HIV have a 100-fold higher risk for anal cancer and are more likely to be diagnosed with advanced stages of anal cancer with less favorable prognoses, highlighting the importance of engaging older SGM in anal cancer prevention programs. In Nigeria, men 45 years of age or older have some of the highest prevalences of HIV, yet they are the most difficult age demographic to recruit into our anal cancer prevention study, the Integrated Model for the Prevention of Anal Cancer using screen and Treat for HSIL (IMPACT) study. Only 15% (22/146) of SGM ≥40 years of age who provided their contact information engaged with our anal cancer prevention program since its launch 8 months ago. The IMPACT research team noted privacy concerns, socioeconomic class barriers, reluctance to engage with younger SGM at the clinic, and varying levels of health knowledge as factors contributing to low enrollment of older SGM in anal cancer screening. To ensure the success of our anal cancer prevention program, participation of older SGM—as the highest risk group that is likely to benefit the most—is crucial. To better understand how to promote anal cancer prevention among older SGM, we propose the Engaging LeaDERS (ELDERS) study to elicit the viewpoints and preferences that older Nigerian SGM living with HIV use when deciding to engage in cancer screening. We hypothesize that tailoring anal cancer prevention strategies to address culturally relevant barriers and preferences of older SGM will enhance health-seeking behavior and promote sustainability of anal cancer prevention programs among this high-risk population in Nigeria. We will use implementation research strategies to evaluate barriers and enablers to engaging with anal cancer prevention among older SGM. We will also identify preferences that contribute to the decision-making process among older SGM with respect to accessing anal cancer prevention. Our study aims will include qualitative and quantitative assessments that embrace community feedback and our strong partnerships with the SGM community in Nigeria. The information gained from ELDERS will be applied to improve the recruitment of older SGM within IMPACT as well as the development of a future Discrete Choice Experiment to improve and sustain anal cancer prevention efforts among older SGM in Nigeria more broadly.

PROJECT NARRATIVE Our ELDERS supplement will expand our capacity to support recruitment and sustainability of anal cancer prevention among older SGM living with HIV in Nigeria. Recognizing the potential challenges to investments in infrastructure and training, and the need to maintain cost-effectiveness in resource-constrained settings, it is essential to work with the community to learn how to effectively recruit this highest risk yet hardest-to-reach group to improve engagement in anal cancer screening and improve outcomes. Ultimately, a better understanding of the context and perspectives of this community will advance the implementation of innovative cancer prevention strategies.