PROJECT SUMMARY In the US, people with HIV (PWH) experience elevated mortality and morbidity due to cancer compared to the general population. In fact, PWH diagnosed with non-AIDS defining cancers including lung, breast, and colorectal cancers, are more likely to die due to their cancer diagnosis compared to those without HIV. Factors contributing to the disproportionate burden of poor cancer outcomes among PWH are likely multi-factorial, including inter- connected clinical and social factors, such as advanced stage at cancer diagnosis and barriers to cancer screening for timely diagnosis. It is known that PWH are more likely to be diagnosed with advanced stage at cancer diagnosis compared to those without HIV. Inequities in access to cancer screening among PWH are likely a key contributor to lower cancer-specific survival rates among PWH. However, limited research exists comparing trends in non-AIDS defining cancer screening recommendations. Breast, colorectal, and lung cancers each have screening recommendations outlined and are preventable with routine, timely, guideline-adherent screening. Detecting these cancers at later stage leads to more complex treatment trajectories and poorer cancer-related outcomes. It is urgent to understand trends in cancer screening uptake and follow-up in the general population of PWH to facilitate intervention development. However, existing research on cancer screening trends on PWH focuses on populations engaged in routine HIV care visits, which may not reflect the real-world barriers to screening PWH in the US face. We therefore propose to leverage data from the All of Us Research Program to carry out the following aims: (Aim 1) Compare serial cross-sectional screening prevalence for breast, colorectal, and lung cancers by HIV status, stratified by age, sex, and race/ethnicity; (Aim 2) Evaluate time to follow-up after an abnormal cancer screening results by HIV status, stratified by age, sex, and race/ethnicity; and (Aim 3) Estimate associations of multi-level social determinants of health (SDoH) with cancer screening behaviors among PWH. The All of Us Research Program is an ideal data source to conduct this study given the national recruitment efforts, the diverse study population, the recruitment of patients who are largely served by federally qualified health centers (FQHCs), the unique linkage of electronic health record data as well as in-depth survey data to obtain SDoH information at an individual level, and the availability of zip code to link to contextual SDoH. The linkage of electronic health record data is particularly critical given we will have access to HIV disease and care/treatment status, and detailed information regarding cancer screening behaviors as well as treatment for any abnormal findings. The present proposal will lead to two important outcomes: (1) insights on real-world trends into cancer screening and prevention behaviors among PWH to facilitate intervention development tailored to ...