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Stull C, Bennis SL, Rosser BRS, Wilkerson JM, Zoschke IN, Jiang Z, Nyitray AG, Khariwala SS, Ross MW. Correlates of human papillomavirus vaccination intent for oropharyngeal cancer prevention among gay and bisexual men living in the United States. J Am Dent Assoc 2024; 155:26-38.e1. [PMID: 37988048 DOI: 10.1016/j.adaj.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Gay and bisexual men (GBM) are at increased risk of developing human papillomavirus (HPV)-associated oropharyngeal cancer (OPC). Vaccination may prevent OPC in GBM; however, vaccination rates are low. The authors explored the correlates associated with HPV vaccination intent for OPC prevention among GBM. METHODS The authors conducted a cross-sectional study in which they surveyed 1,700 adult GBM with a profile on 2 online dating sites. Eligibility criteria included self-identified GBM living in the United States, aged 18 through 45 years who had sex with a man in the past 5 years. Factors associated with participants' HPV vaccination status and intent to vaccinate were assessed via the online questionnaire using the Health Belief Model. RESULTS Most of the 1,108 eligible GBM had not received 1 dose or more of the HPV vaccine (54.2%), were aged 27 through 37 years (52.3%), were White (58.3%), identified as cisgender men (93.4%), were gay (79.3%), were in a monogamous relationship (99.4%), and had a bachelor's degree (29.4%) or higher college education (26.1%). Among unvaccinated GBM, 25.3% reported intent to receive the vaccine. In the multivariable model, independent associations (P < .05) were found for the Health Belief Model constructs (perceived benefits and perceived barriers) with HPV vaccine intent, after adjusting for all other predictor variables in the model. CONCLUSIONS The benefits of HPV vaccination for the prevention of OPC is associated with intent to vaccinate among GBM. Dental care providers can use this information to educate patients in this high-risk population on prevention of HPV-associated OPC. PRACTICAL IMPLICATIONS Dentists can advocate for HPV vaccination uptake among GBM patients by means of discussing the benefits of vaccination in the prevention of HPV-associated OPC.
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Wheldon CW. Psychometric Validation of the Patient Anal Cancer Knowledge Scale (PACKS) in a Cohort of Black and Hispanic/Latino Sexual and Gender Diverse Young Adults. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1925-1931. [PMID: 37648950 DOI: 10.1007/s13187-023-02362-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
Lack of anal cancer information in priority populations is a major barrier to the uptake and utilization of prevention services. A validated measure of anal cancer knowledge is needed to inform patient education and shared clinical decision-making for anal cancer prevention. The purpose of this study was to validate the Patient Anal Cancer Knowledge Scale (PACKS) in a sample of GBM, namely Black and Hispanic gay, bisexual, and other men who have sex with men (GBM) and gender expansive young adults (aged 18-30 years) living in the USA (N=188). Anal cancer knowledge was hypothesized as a 3-factor scale representing (1) risk and primary prevention (9 items), (2) symptoms (5 items), and (3) screening (3 items). Confirmatory factor analysis, internal consistency, and criterion validity were assessed. The 3-factor model demonstrated adequate fit (RMSEA=0.02; CFI=0.99). All items loaded on their respective factors (p<0.01). Scale scores indicated low to moderate anal cancer knowledge and acceptable reliability: factor 1 (M=3.5; SD=2.3; range: 0-9; α=.71), factor 2 (M=2.9; SD=1.9; range: 0-5; α=.85), and factor 3 (M=2.0; SD=1.2; range: 0-3; α=.79). History of HPV vaccination (51.3%) was positively correlated with factors 1 and 2. The PACKS demonstrated good construct validity related to knowledge of anal cancer risk, prevention, symptoms, and screening. Limited anal cancer knowledge among Black and Hispanic GBM is a potential barrier to the uptake and utilization of prevention recommendations.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA, 19122, USA.
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Mann-Barnes T, Bhimla A, Coronado M, Lin T, Duro-Aina A, Park H, Ma GX. Factors that Predict HPV Vaccination Behavior Among Young Men-Who-Have-Sex-with-Men in the Greater Philadelphia Region. J Racial Ethn Health Disparities 2023; 10:2167-2174. [PMID: 36036840 PMCID: PMC9422934 DOI: 10.1007/s40615-022-01396-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 10/31/2022]
Abstract
Human papillomavirus (HPV) is one of the most common sexually transmitted infections in the USA. HPV is acknowledged as one of the leading causes of anal cancer, with an increased risk in men who have sex with men (MSM), when compared to age-matched heterosexual men. This study highlights the various factors that influence and impede HPV vaccination uptake among a multiracial cohort of young-MSM (YMSM). A total of 444 participants aged 18 to 27 in the Greater Philadelphia region completed an online survey. Approximately 75.79% (n = 335) of participants did not receive at least one dose of the HPV vaccine. Having a healthcare provider recommendation (OR = 25.54, 95% CI: 25.54-85.42, p < 0.001) and a one unit increase in experiences of adverse effects of stigma and homophobia (OR = 1.06, 95% CI: 1.01-1.11, p = 0.044) were associated with a greater likelihood of receiving the HPV vaccine uptake. Having a greater number of sexual partners (OR = 0.85, 95% CI: 0.75-0.97, p = 0.014) and having had condomless anal sex in the past 6 months (OR = 0.31, 95% CI: 0.15-0.58, p < 0.001) were associated with a lower odds of HPV vaccine uptake. In conclusion, healthcare provider-focused interventions and educational programs are needed to increase awareness and uptake of the HPV vaccine to mitigate the risks associated with sexual behaviors among this population.
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Affiliation(s)
- Tyrell Mann-Barnes
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Aisha Bhimla
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Michael Coronado
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Timmy Lin
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Adebola Duro-Aina
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Hemi Park
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Fox Chase Cancer Center, Temple University, Philadelphia, PA, USA.
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Wheldon CW, Sykes KJ, Ramaswamy M, Bass SB, Collins BN. Integrating HPV Vaccination Within PrEP care Delivery for Underserved Populations: A Mixed Methods Feasibility Study. J Community Health 2023; 48:640-651. [PMID: 36894796 PMCID: PMC10492896 DOI: 10.1007/s10900-023-01202-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/11/2023]
Abstract
Human Papillomavirus (HPV) vaccination is effective at preventing anal cancer, which disproportionally impacts gay/bisexual men (GBM) and transgender women (TGW). Vaccine coverage among GBM/TGW is insufficient to reduce anal cancer disparities. Federally qualified health centers (FQHCs) can increase reach and uptake of HPV vaccination by integrating and promoting HPV vaccination in ongoing HIV preventive care (e.g., Pre-exposure Prophylaxis [PrEP]). The purpose of the current study was to assess the feasibility and potential impact of integrating HPV vaccination with PrEP care. We conducted a mixed methods study of PrEP providers and staff (qualitative interviews, N = 9) and PrEP patients (quantitative survey, N = 88) at an FQHC in Philadelphia, Pennsylvania. Qualitative thematic analysis of PrEP provider/staff interviews was informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify and describe barriers and facilitators to HPV vaccination implementation. Quantitative analysis of PrEP patient survey was informed by the Information-Motivation-Behavioral Skills Model. Quantitative interviews resulted in 16 themes related to characteristics of the inner and outer clinic context. Barriers among providers included lack of focus on HPV in PrEP management guidelines, in metrics mandated by funding agencies, and in electronic medical record templates. Lack of anal cancer specific knowledge and motivation was identified in both PrEP patients and providers/staff. Providing HPV vaccination during routine PrEP visits was highly acceptable to both patients and providers. Based on these findings, we recommend several multi-level strategies to increase HPV vaccine uptake among PrEP patients.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA.
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas School of Medicine, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA
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Magana K, Strand L, Love M, Moore T, Peña A, Ito Ford A, Vassar M. Health inequities in human papillomavirus prevention, diagnostics and clinical care in the USA: a scoping review. Sex Transm Infect 2023; 99:128-136. [PMID: 36396174 DOI: 10.1136/sextrans-2022-055587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) represents the most common STI in the USA. HPV inequities in prevention, diagnostics and clinical care persist. We define inequities as systematic, avoidable and unfair differences in health outcomes. OBJECTIVES The objectives of this scoping review are to chart existing data on HPV-related inequities, identify gaps in existing literature and guide future research to reduce these inequities. METHODS We completed a scoping review following guidelines from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping reviews extension. We performed a literature search on PubMed and Ovid Embase in July 2022 for articles pertaining to HPV and evaluating populations within the USA. We included English language publications from 2018 to 2022 evaluating at least one health inequity outlined by the National Institutes of Health. General publication characteristics and health inequity data were charted in a masked, duplicate fashion using a pilot-tested Google Form. We analysed frequencies of health inequities and summarised main findings from included studies. RESULTS Our final sample included 170 publications. The most common inequities examined were race/ethnicity (140 studies), sex or gender (97 studies), and income (69 studies). Many historically marginalised racial/ethnic groups had lower rates of HPV-related knowledge, vaccination and worse overall outcomes related to HPV. Compared with women, men had lower rates of HPV vaccination and provider recommendation, and higher rates of HPV-infection. Results regarding income were largely conflicting. CONCLUSION Findings from our review demonstrate clear gaps in HPV-related inequity research. Vaccine completion, provider recommendation and intersectionality should continue to be evaluated to implement targeted interventions.
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Affiliation(s)
- Kimberly Magana
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Laura Strand
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Mitchell Love
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Ty Moore
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Andriana Peña
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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King LM, Lewnard JA, Niccolai LM. Clinical and Public Health Considerations for HPV Vaccination in Midadulthood: A Narrative Review. Open Forum Infect Dis 2023; 10:ofad004. [PMID: 36726535 PMCID: PMC9887268 DOI: 10.1093/ofid/ofad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/10/2022] [Indexed: 01/13/2023] Open
Abstract
Human papillomavirus (HPV) is an important cause of anogenital and oropharyngeal cancers, anogenital warts, and recurrent respiratory papillomatosis. Beginning in 2019, US guidelines recommended shared clinical decision-making (SCDM) for HPV vaccination among midadults (27-45 years). We conducted a narrative review of existing literature on HPV vaccination in midadults. The available evidence demonstrates that HPV vaccination in midadults is safe, efficacious, and likely to benefit both HPV-naïve midadults and those with previous infections. However, gaps in knowledge related to HPV vaccination have been identified among clinicians and midadult patients. Universal midadult HPV vaccination in the United States could avert 20 934-37 856 cancer cases over 100 years, costing $141 000-$1 471 000 per quality-adjusted life-year gained. Wide variation in these estimates reflects uncertainties in sexual behavior, HPV natural history, and naturally acquired immunity. Greater awareness among clinicians and midadult patients and broad implementation of SCDM may accelerate progress toward eliminating HPV-associated cancers and other diseases.
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Affiliation(s)
- Laura M King
- Correspondence: Laura M. King, MPH, 2121 Berkeley Way, Berkeley, CA 94704 (); or Joseph A. Lewnard, PhD, 2121 Berkeley Way, Berkeley, CA 94704 ()
| | - Joseph A Lewnard
- Correspondence: Laura M. King, MPH, 2121 Berkeley Way, Berkeley, CA 94704 (); or Joseph A. Lewnard, PhD, 2121 Berkeley Way, Berkeley, CA 94704 ()
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Wheldon CW, Eaton LA, Watson RJ. Predisposing, Enabling, and Need-Related Factors Associated with Human Papillomavirus Vaccination Intentions and Uptake Among Black and Hispanic Sexual and Gender Diverse Adults in the USA. J Racial Ethn Health Disparities 2023; 10:237-243. [PMID: 34981465 PMCID: PMC8722661 DOI: 10.1007/s40615-021-01214-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
The purpose of the current study was to identify predisposing, enabling, and need-based factors associated with human papillomavirus (HPV) or HPV vaccination intentions among ethnoracial minority men who have sex with men (MSM) and gender expansive natal males. This was a secondary analysis of survey data from 299 Black and Hispanic MSM and gender expansive young (aged 18-30 years) adults living in the USA. Variable selection was informed by Anderson's model of healthcare utilization. Outcomes were self-reported HPV vaccination and vaccine intentions. Less than half of the sample (45.5%) reported initiating (i.e., receiving at least 1 dose) HPV vaccination. Hierarchical multiple regression was used to identify relevant theoretical predictors. Among those who were unvaccinated, 14.2% were unlikely, 56.3% were undecided, and 29.4% likely to initiate HPV vaccination within the next 12 months. More favorable vaccine attitudes (adjusted prevalence ratio [aPR] = 1.55; 95% CI: 1.12-2.15), past year routine check-up (aPR = 1.50; 95% CI: 1.14-1.97), and ever being diagnosed with anogenital warts (aPR = 1.55; 95% CI: 1.12-2.15) were independently associated with the probability of HPV vaccination. Several enabling factors (e.g., testing for sexually transmitted infections) were not associated with HPV vaccination, suggesting routine missed opportunities. There were no associations between predictor variables and HPV vaccine intentions. Targeted efforts are needed to decrease anal cancer disparities experienced by ethnoracial minority MSM. Leveraging enabling factors already present this population (e.g., STI testing and pre-exposure prophylaxis use) are potential targets for interventions to increase the reach of HPV vaccination.
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Affiliation(s)
- Christopher W. Wheldon
- grid.264727.20000 0001 2248 3398Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA USA
| | - Lisa A. Eaton
- grid.63054.340000 0001 0860 4915Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT USA
| | - Ryan J. Watson
- grid.63054.340000 0001 0860 4915Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT USA
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Meites E, Wilkin TJ, Markowitz LE. Review of human papillomavirus (HPV) burden and HPV vaccination for gay, bisexual, and other men who have sex with men and transgender women in the United States. Hum Vaccin Immunother 2022; 18:2016007. [PMID: 35294325 PMCID: PMC8993076 DOI: 10.1080/21645515.2021.2016007] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gay, bisexual, and other men who have sex with men (MSM) and transgender women, particularly those who are living with HIV, are disproportionately affected by human papillomavirus (HPV). For this narrative review of HPV health outcomes and vaccination for gay, bisexual, and other MSM and transgender women in the United States, we highlighted 71 publications regarding 1) burden of HPV infections and related diseases; 2) HPV vaccine efficacy; 3) HPV vaccination recommendations; 4) HPV vaccination coverage; 5) real-world vaccine effectiveness and health impacts; and 6) HPV vaccination acceptability. Vaccination is effective at reducing HPV infections among MSM; in the United States, routine HPV vaccination is recommended for all adolescents at age 11-12 years and for all persons through age 26 years. Efforts are ongoing to increase vaccination coverage and monitor health impacts of vaccination. Increasing vaccination coverage before sexual exposure to HPV is expected to reduce the burden of HPV-related disease.
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Affiliation(s)
- Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Timothy J Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Pleuhs B, Walsh JL, Quinn KG, Petroll AE, Nyitray A, John SA. Uptake of Human Papillomavirus Vaccination by HIV Status and HIV Pre-exposure Prophylaxis (PrEP) Care Engagement Among Young Sexual Minority Men 17-24 Years Old in the USA. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1944-1953. [PMID: 36687804 PMCID: PMC9857745 DOI: 10.1007/s13178-022-00740-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 05/09/2023]
Abstract
Introduction HIV and human papillomavirus (HPV) are common sexually transmitted infections among young sexual minority men (YSMM) that are prevented by pre-exposure prophylaxis (PrEP) and HPV vaccination, respectively. We sought to determine the association between a history of PrEP use and HPV vaccination uptake among YSMM. Methods Data were collected from an online survey of YSMM (n = 287; M age = 20.6 years, range: 17-24; 58% Black or Latinx) recruited from social media and men-for-men geosocial networking apps in 2020 and analyses were conducted using chi-squared comparisons and Poisson regression using STATA (IC) version 15.1. Results About half (45.0%) of YSMM reported receiving at least one dose of the HPV vaccine. Controlling for other factors, YSMM who were living with HIV or had used PrEP were significantly more likely to have received at least one dose of an HPV vaccine (PR = 2.48, 95% CI = 1.52-4.07; PR = 1.70, 95% CI = 1.26-2.31, respectively). Conclusions YSMM living with HIV or with PrEP use experience reported higher rates of HPV vaccination compared to their counterparts, potentially due to greater utilization of health care or contacts with providers attuned to their health needs. Nevertheless, HPV vaccination uptake is suboptimal given the high prevalence of high-risk HPV genotypes among YSMM. Policy Implications Standard of care for YSMM should include revisiting HPV vaccination status and discussion of PrEP and other HIV prevention methods given suboptimal rates of HPV and PrEP uptake among this priority population for HPV vaccination, anal cancer, and HIV prevention.
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Affiliation(s)
- Benedikt Pleuhs
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer L. Walsh
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alan Nyitray
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven A. John
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Wheldon CW. HPV vaccination and HIV preexposure prophylaxis (PrEP): Missed opportunities for anal cancer prevention among at risk populations. Hum Vaccin Immunother 2022; 18:2114258. [PMID: 36018310 DOI: 10.1080/21645515.2022.2114258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBM), in addition to transgender women who have sex with men (TW), are at disproportionate risk for anal cancer. Anal cancer can be prevented with HPV vaccination, but uptake among adult GBM/TW is low. Targeted HPV vaccination during the clinical management of pre-exposure prophylaxis (PrEP) is an unexplored strategy relevant to these populations. The purpose of this study was (1) to determine the need for HPV vaccination among GBM and transgender women PrEP users and (2) to identify correlates of HPV vaccination among PrEP users. Secondary analysis of the 2020 Pennsylvania LGBT Health Needs Assessment was conducted to estimate prevalence ratios of HPV vaccination among PrEP users. Overall, 43.8% of the sample had initiated HPV vaccination. Vaccine initiation was significantly lower among respondents 27 to 35 (PR = 0.64; 95% CI: 0.49-0.83) and 36 to 45 (PR = 0.38; 95% CI: 0.25-0.58). Respondents who had received Hepatitis A vaccination were significantly more likely to have had initiated HPV vaccination after adjusting for age (aPR = 2.60; 95% CI: 1.75-3.84). Overall, more than half of eligible GBM and TW engaged in PrEP care have not initiated HPV vaccination and represent potential missed opportunities for anal cancer prevention.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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11
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Algarin AB, Wiginton JM, Sanchez TH, Hernandez-Avila M, Baruch-Dominguez R, Smith LR. Patient sexuality disclosure experience and associations with clinical sexual health outcomes among HIV-negative men who have sex with men in Mexico. Prev Med 2022; 163:107225. [PMID: 36029923 PMCID: PMC9985480 DOI: 10.1016/j.ypmed.2022.107225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022]
Abstract
Many men who have sex with men (MSM) do not disclose their sexuality to their healthcare provider, despite potential health benefits. Data from the 2017 Encuesta de Sexo Entre Hombres online survey of 13,277 HIV-negative or unknown status MSM in Mexico were used to explore MSM patients' sexuality disclosure experience on sexual health outcomes using multivariable Poisson models with robust variance estimation to estimate adjusted prevalence ratios (aPR). Sexual health outcomes included Hepatitis B (HepB) and human papillomavirus (HPV) vaccination, and lifetime and past year HIV testing. Overall, 53.9% (n/N) disclosed their sexuality to their healthcare provider, and of those 6.4%, 62.9%, and 30.7% reported a negative, neutral, or positive disclosure experience, respectively. In comparison to no disclosure, neutral and positive disclosure experiences were associated with HepB vaccination (aPR[95% Confidence Interval (95% CI)] = 1.17[1.09, 1.25], p < 0.001; aPR[95% CI] = 1.35[1.25, 1.46], p < 0.001, respectively) and positive disclosure experiences were associated with HPV vaccination (aPR[95% CI] = 1.46[1.24, 1.71], p < 0.001). Those who disclosed their sexual behavior were more likely than those who did not disclose their sexual behavior to have received an HIV test in their lifetime (negative: aPR[95% CI] = 1.51[1.43, 1.60], p < 0.001; neutral: aPR[95% CI] = 1.61[1.56, 1.66], p < 0.001; positive: aPR[95% CI] = 1.64[1.58, 1.69], p < 0.001) and an HIV test in the past year (negative: aPR[95% CI] = 1.89[1.70, 2.10], p < 0.001; neutral: aPR[95% CI] = 2.09[1.98, 2.20], p < 0.001; positive: aPR[95% CI] = 2.24[2.12, 2.37], p < 0.001). There is a need to implement trainings for healthcare providers that focus on sexual health risk assessments and creating a space that encourages MSM patients and healthcare providers to discuss sexual health.
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Affiliation(s)
- Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
| | - John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, USA.
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA.
| | - Mauricio Hernandez-Avila
- Dirección de Presentaciones Económicas y Sociales, Instituto Mexicano del Seguro Social, Av. Reforma 476, col. Juárez, 06600 Cuauhtémoc, Ciudad de México, Mexico.
| | - Ricardo Baruch-Dominguez
- International Planned Parenthood Federation, Western Hemisphere Region, Mexico City, MX, Mexico.
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
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LoSchiavo C, D’Avanzo PA, Emmert C, Krause KD, Ompad DC, Kapadia F, Halkitis PN. Predictors of Anal High-Risk HPV Infection Across Time in a Cohort of Young Adult Sexual Minority Men and Transgender Women in New York City, 2015-2020. Am J Mens Health 2022; 16:15579883221119084. [PMID: 36005272 PMCID: PMC9421230 DOI: 10.1177/15579883221119084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Cisgender sexual minority men (SMM) and transgender women are disproportionately vulnerable to HPV-related anal cancer, but little is known about longitudinal predictors of high-risk human papillomavirus (hrHPV) infection in this population. As such, this analysis aims to identify factors associated with incident anal hrHPV infection in a diverse cohort of young SMM and transgender women. This study of HPV infection, nested within a larger cohort study, took place between October 2015 and January 2020. Participants completed a brief computer survey assessing HPV symptomatology, risk, and prevention alongside multi-site testing, in addition to biannual cohort study assessments. In the analytic sample of 137 participants, 31.6% tested positive for an anal hrHPV infection, with 27.0% and 29.9% testing positive for incident anal hrHPV infections at Visits 2 and 3, respectively. When adjusting for time between study visits, participants had significantly greater odds of incident anal hrHPV at Visit 2 if they had a concurrent HSV infection (AOR = 5.08 [1.43, 18.00]). At Visit 3, participants had significantly greater odds of incident anal hrHPV infection if they reported a greater number of sex partners in the previous month (AOR = 1.25 [1.03, 1.51]). Prevalence of cancer-causing HPV at baseline was high and many participants tested positive for additional types of anal hrHPV at subsequent visits. Risk for newly detected anal hrHPV infection was significantly associated with biological and behavioral factors. Our findings strongly indicate a need for programs to increase uptake of HPV vaccination and provide HPV-related health education for sexual and gender minorities.
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Affiliation(s)
- Caleb LoSchiavo
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA,Department of Health Behavior, Society
& Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Paul A. D’Avanzo
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA,The HIV Center for Clinical and
Behavioral Studies, New York State Psychiatric Institute, Columbia University, New
York, NY, USA
| | - Connor Emmert
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA,Department of Urban-Global Public
Health, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Danielle C. Ompad
- Department of Epidemiology, School of
Global Public Health, New York University, New York City, USA,Center for Drug Use and HIV/HCV
Research (CDUHR), School of Global Public Health, New York University, New York
City, USA
| | - Farzana Kapadia
- Department of Epidemiology, School of
Global Public Health, New York University, New York City, USA
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA,Department of Urban-Global Public
Health, Rutgers School of Public Health, Piscataway, NJ, USA,Department of Biostatistics and
Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA,Dr. Perry N. Halkitis, PhD, MS, MPH,
Department of Biostatistics and Epidemiology, Rutgers School of Public Health,
683 Hoes Ln W, Piscataway, NJ 08854, USA.
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13
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Increases in human papillomavirus vaccine coverage over 12 months among a community-recruited cohort of gay, bisexual, and other men who have sex with men in Canada. Vaccine 2022; 40:3690-3700. [PMID: 35577633 DOI: 10.1016/j.vaccine.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Starting in 2015/16, most Canadian provinces introduced publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) aged ≤ 26 years. We estimated 12-month changes in HPV vaccine coverage among community-recruited GBM from 2017 to 2021 and identified baseline factors associated with vaccine initiation (≥1 dose) or series completion (3 doses) among participants who were unvaccinated or partially vaccinated at baseline. METHODS We recruited sexually-active GBM aged ≥ 16 years in Montreal, Toronto, and Vancouver, Canada, from 02/2017 to 08/2019 and followed them over a median of 12 months (interquartile range = 12-13 months). We calculated the proportion who initiated vaccination (≥1 dose) or completed the series (3 doses) by 12-month follow-up. Analyses were stratified by city and age-eligibility for the publicly-funded programs at baseline (≤26 years or > 26 years). We used multivariable logistic regression to identify baseline factors associated with self-reported incident vaccine initiation or series completion. RESULTS Among 165 unvaccinated participants aged ≤ 26 years at baseline, incident vaccine initiation (≥1 dose) during follow-up was 24.1% in Montreal, 33.3% in Toronto, and 38.9% in Vancouver. Among 1,059 unvaccinated participants aged > 26 years, incident vaccine initiation was 3.4%, 8.9%, and 10.9%, respectively. Higher education and trying to access pre-exposure prophylaxis for HIV were associated with incident vaccination among those aged ≤ 26 years, while younger age, residing in Vancouver (vs. Montreal), being diagnosed with anogenital warts, having both government and private extended medical insurance, and being vaccinated against influenza were associated with incident vaccination among those aged > 26 years. CONCLUSIONS We observed substantial gains in HPV vaccine coverage among young GBM within 5 + years of targeted program implementation, but gaps remain, particularly among older men who are ineligible for publicly-funded programs. Findings suggest the need for expanded public funding or insurance coverage for HPV vaccines.
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14
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Ejaz M, Ekström AM, Ahmed A, Haroon A, Ali D, Ali TS, Salazar M. Human Papillomavirus associated prevention: knowledge, attitudes, and perceived risks among men who have sex with men and transgender women in Pakistan: a qualitative study. BMC Public Health 2022; 22:378. [PMID: 35193544 PMCID: PMC8864907 DOI: 10.1186/s12889-022-12775-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan. DESIGN A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan. METHODS Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis. RESULTS Three themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant's recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one's sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients' integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding. CONCLUSIONS The findings from this study can help public health policy and researchers to understand this minority's perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden. .,Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.
| | - Anna Mia Ekström
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Alyan Ahmed
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Aymen Haroon
- Department of Biostatistics and Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, United States
| | - Dania Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.,School of Nursing, the Aga Khan University, Karachi, Pakistan
| | - Mariano Salazar
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
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15
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Winer RL, Lin J, Querec TD, Unger ER, Stern JE, Rudd JM, Golden MR, Swanson F, Markowitz LE, Meites E. Effectiveness of Human Papillomavirus (HPV) Vaccination Against Penile HPV Infection in Men Who Have Sex With Men and Transgender Women. J Infect Dis 2022; 225:422-430. [PMID: 34320185 PMCID: PMC8842819 DOI: 10.1093/infdis/jiab390] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In the United States, human papillomavirus (HPV) vaccination has been recommended since 2011 for boys aged 11-12 years, with catch-up vaccination recommended through age 26 years for previously unvaccinated men who have sex with men (MSM). METHODS During 2016-2018, a cross-sectional study enrolled MSM and transgender women aged 18-26 years in Seattle, Washington. Participants submitted self-collected penile swab specimens for HPV genotyping. HPV vaccination history was self-reported. We compared HPV prevalence among vaccinated participants with that in participants with no or unknown vaccination history, using log-binomial regression to estimate adjusted prevalence ratios and confidence intervals. RESULTS Among 687 participants, 348 (50.7%) self-reported ever receiving ≥1 HPV vaccine dose; the median age at first HPV vaccination was 21 years, and the median age at first sex, 17 years. Overall, the prevalence of penile quadrivalent HPV vaccine (4vHPV)-type HPV was similar in vaccinated participants (12.1%) and participants with no or unknown vaccination (15.6%) (adjusted prevalence ratio, 0.69 [95% confidence interval, .47-1.01]). However, the prevalence was significantly lower in participants vaccinated at age ≤18 years than in those with no of unknown vaccination (0.15 [.04-.62]), corresponding to a vaccine effectiveness of 85% against 4vHPV-type HPV. CONCLUSIONS Results suggest that HPV vaccination is effective in preventing penile HPV infections in young MSM when administered at age ≤18 years.
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Affiliation(s)
- Rachel L. Winer
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - John Lin
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Troy D. Querec
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth R. Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joshua E. Stern
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jessica M. Rudd
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew R. Golden
- Center for AIDS & STD, University of Washington, Seattle, Washington, USA
| | - Fred Swanson
- Gay City Health Project, Seattle, Washington, USA
| | - Lauri E. Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Forward T, Meites E, Lin J, Hughes JP, Unger ER, Markowitz LE, Golden M, Swanson F, Faestel PM, Winer RL. Sensitivity of Self-Reported Human Papillomavirus Vaccination History Among 18- to 26-Year-Old Men Who Have Sex With Men: Seattle, WA, 2016 to 2018. Sex Transm Dis 2022; 49:81-85. [PMID: 34166303 PMCID: PMC8665109 DOI: 10.1097/olq.0000000000001503] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We assessed the sensitivity of self-reported human papillomavirus (HPV) vaccination among young adult men who have sex with men (MSM) with documented HPV vaccination. METHODS During 2016-2018, MSM and transgender women aged 18 to 26 years were enrolled in Seattle, WA. A history of HPV vaccination was assessed via self-administered survey, clinic electronic medical records, and the Washington State Immunization Information System. We assessed self-report sensitivity among participants with documented prior HPV vaccination (≥1 dose) in either the electronic medical record or the Washington State Immunization Information System, and used logistic regression to compare sensitivity by age, number of doses, and time since first dose. RESULTS Of 292 participants with ≥1 documented HPV vaccine dose, 243 self-reported ≥1 dose (sensitivity, 83.2%; 95% confidence interval [CI], 78.4%-87.3%). Compared with participants whose first dose was <1 year ago, the likelihood of self-report was lower among those with ≥3 years since first dose (adjusted odds ratio [aOR], 0.2; 95% CI, 0.1-0.5). Furthermore, compared with participants with only 1 documented HPV vaccine dose, the likelihood of self-reporting ≥1 dose was higher among those with 2 (aOR, 2.4; 95% CI, 1.0-5.5) or ≥3 doses (aOR, 6.2; 95% CI, 2.7-14.4). Among 115 participants with ≥3 documented doses, sensitivity for recalling ≥3 doses was 69.6% (95% CI, 60.3%-77.8%). CONCLUSIONS Most young adult MSM with a documented history of HPV vaccination self-reported prior HPV vaccination. Although recall was highest in those with ≥3 doses, 30% of this fully vaccinated subgroup did not correctly recall the number of doses received, highlighting limitations of self-reporting. Furthermore, results indicating reduced recall with ≥3 years since first dose suggest that sensitivity of self-report among young adult MSM may decline over time as adolescent vaccination coverage increases.
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Affiliation(s)
- Terra Forward
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 98195 USA
- Department of Preventive Medicine, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431 USA
| | - Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329 USA
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 98195 USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington School of Public Health, 3980 15 Ave NE, Box 351617, Seattle, WA 98195 USA
| | - Elizabeth R. Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329 USA
| | - Lauri E. Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329 USA
| | - Matthew Golden
- Center for AIDS & STD, University of Washington, 325 9th Ave, Box 359777, Seattle, WA 98104 USA
| | - Fred Swanson
- Gay City Health Project, 517 E Pike Street, Seattle, WA 98122 USA
| | - Paul M. Faestel
- Department of Preventive Medicine, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431 USA
| | - Rachel L. Winer
- Department of Epidemiology, University of Washington School of Public Health, 3980 15th Ave NE, Box 351619, Seattle, WA 98195 USA
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Amiling R, Winer RL, Newcomb ME, Gorbach PM, Lin J, Crosby RA, Mustanski B, Markowitz LE, Meites E. Human papillomavirus vaccination coverage among young, gay, bisexual, and other men who have sex with men and transgender women - 3 U.S. cities, 2016-2018. Hum Vaccin Immunother 2021; 17:5407-5412. [PMID: 35213950 PMCID: PMC8904010 DOI: 10.1080/21645515.2021.2005436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Gay, bisexual, and other men who have sex with men (MSM) and transgender women are disproportionately affected by human papillomavirus (HPV). HPV vaccination is routinely recommended for U.S. adolescents at age 11-12 years, with catch-up vaccination through age 26 years. We assessed HPV vaccination coverage and associated factors among young MSM and transgender women. The Vaccine Impact in Men study enrolled MSM aged 18-26 years from clinics in Seattle, Chicago, and Los Angeles, during February 2016-September 2018. Participants self-reported socio-demographic information and HPV vaccination status. Among 1416 participants, 673 (47.5%) reported ≥1 HPV vaccine dose. Among vaccinated participants, median age at first dose was 19 years and median age at first sex was 17 years; 493 (73.3%) reported that their age at first dose was older than their age at first sex. There were significant differences in HPV vaccination coverage by city (range 33%-62%), age, race/ethnicity, and gender identity. Coverage was highest in Seattle, where younger age was the only factor associated with vaccination. Differences in coverage by city may be due to variation in vaccination practices or enrollment at study sites. Increasing both routine and catch-up vaccination will improve coverage among MSM and transgender women.
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Affiliation(s)
- Raiza Amiling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel L. Winer
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Michael E. Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pamina M. Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - John Lin
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Richard A. Crosby
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauri E. Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA,CONTACT Elissa Meites Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, H24-5, Atlanta, GA30329-4027, USA
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18
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Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Brisson M, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay, bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019. Vaccine 2021; 39:3756-3766. [PMID: 34074547 DOI: 10.1016/j.vaccine.2021.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization. METHODS Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator. RESULTS Across the three cities, 26-35% and 14-21% of men ≤ 26 years and 7-26% and 2-9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06-4.36; ≥27: PR = 2.73, 95%CI 1.14-6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64-5.05; ≥27: PR = 2.03, 95%CI 1.07-3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance. CONCLUSIONS Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.
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Affiliation(s)
- R Grewal
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - S L Deeks
- University of Toronto, Canada; Public Health Ontario, Canada
| | - T A Hart
- University of Toronto, Canada; Ryerson University, Canada
| | - J Cox
- McGill University, Canada; Direction régionale de santé publique - Montréal, Canada
| | | | - T Grennan
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - G Lambert
- Direction régionale de santé publique - Montréal, Canada
| | - D Moore
- University of British Columbia, Canada; BC Centre for Excellence in HIV/AIDS, Canada
| | | | - F Coutlée
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - C George
- University of Southern Maine, United States
| | - D Grace
- University of Toronto, Canada
| | | | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Canada; Community-Based Research Centre, Canada; University of Victoria, Canada
| | - R Nisenbaum
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - C Sauvageau
- Université Laval, Canada; Institut national de santé publique du Québec, Canada
| | - D H S Tan
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - A Yeung
- Unity Health Toronto, Canada
| | - A N Burchell
- Unity Health Toronto, Canada; University of Toronto, Canada.
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