The challenges for a targeted HPV vaccination programme in men who have sex with men Tom Nadarzynski PhD student 1
HPV vaccination for MSM Human Papilloma Virus (HPV) - Anogenital, oral cancers and genital warts - Female HPV vaccination with over 85% coverage (PHE, 2015) Why targeting MSM? -No benefit from herd protection (Ali et al., 2013) -72% are HPV positive (King et al., 2015) - Anal cancer (Machalek et al., 2012) The Joint Committee on Vaccination and Immunisation (JCVI) - Sexual health clinics and extended settings (e.g. GPs) -MSM < 45 years oldand transgender women - 100% uptake? 2
Current issues Targeting adult MSM vs vaccinating all adolescent men Cost-effective vs socially equitable Preventative vs therapeutic Unknown number of MSM in the UK Funding My focus: HPV vaccine acceptability and potential uptake 3
Study 1: Perceptions of HPV vaccine Study 1 Aim: -To understand perceptions of HPV and the HPV vaccine Methods: - Qualitative design (interviews and focus groups) - MSM from Brighton recruited via local social media - Information about HPV and the HPV vaccine Sample: -N = 32 -Median age = 25 years, range: 18-40 4
Study 1: Perceptions of HPV vaccine Positive attitudes towards vaccines Knowledge about vaccines I remember when I got it [the hepatitis vaccine], they didn t give much information. Especially at the time when you re offering it to people, there should be more information. (Tim, 27) Poor understanding of HPV Anxiety about genital warts Low perceived susceptibility to anal cancer Difficulty linking HPV with genital warts and cancers 5
Study 1: Perceptions of HPV vaccine HPV vaccine acceptable, if offered by a doctor I would not request it. I d be more likely to accept it if it was offered to me. If it was recommended, it would be coming from a trusted source. (Sam, 30) Perceived barriers - Openness about sexuality - Side-effects, pain, marks or scars - Vaccine effectiveness in sexually active men - Health education fatigue Attitudes towards targeting MSM -In favour of male HPV vaccination at school -Stigma similar to AIDS 6
Study 2: HPV vaccine acceptability Study 2 Aim: - To identify HPV vaccine acceptability and potential barriers Methods: - Quantitative design (online survey 64 items) - Facebook advertisement targeting MSM - Acceptability measured at tree time points Sample: - N = 1508, geographically dispersed around the UK -Median age = 22 years, range: 14-63 7
Study 2: HPV vaccine acceptability Consider being vaccinated Visit a sexual health clinic Disclose sexuality Ask a doctor Accept the HPV vaccine if offered Receive 3 injections over 6 months HPV VACCINE ACCEPTABILITY 78% 72% 61% 55% 89% 85% 0% 20% 40% 60% 80% 100% 8
Study 2: HPV vaccine acceptability Access to sexual health services -32% never tested for an STI -52% use GUM for testing (14% at GP, 7% home sampling kit) -26% never disclosed sexuality to a doctor or nurse Disclosure of sexuality -Age of sexual debut = 16, range: 8-33 -Age of first STI test = 19, range: 13-37 -Age of the disclosure of sexuality = 19, range: 13-35 -For MSM<20 median no of sex. partners = 3, mean = 7, range: 0-300 9
Study 2: HPV vaccine acceptability BARRIERS TO HPV VACCINATION Know about HPV 19% Perceived risk of HPV Perceived seriousness of HPV Preference to test for HPV Perceived side-effects Discomfort about sexuality HPV vaccine effectiveness Hep A vaccination Hep B vaccination 25% 30% 21% 28% 27% 42% 50% 49% 0% 10% 20% 30% 40% 50% 60% 10
Study 3: Doctors attitudes Study 3 Aim: - To examine doctors attitudes towards HPV vaccination for MSM - To understand decision-making re: HPV vaccination for MSM Methods: - Mixed methods design (online survey & telephone interviews) -Recruited online (email & BASHH newsletter) Sample: - N = 325, geographically dispersed around the UK - 19 follow-up interviews 11
Study 2: Doctors attitudes Off-label HPV vaccination - 11% vaccinating MSM - 3% vaccinating heterosexual men Doctors recommendations - 87% would recommend gender-neutral vaccination - 65% would support targeting MSM - But 18% were against targeted HPV vaccination Knowledge and skills - 49% sufficient knowledge about HPV and MSM -48% skills to identify MSM eligible for HPV vaccine 12
Study 3: Doctors attitudes Evidence-based approach - Guided by cost-effectiveness analysis and BASHH guidelines - Expressed a need for more scientific evidence I don t have a particular attitude one way or another really, I d be guided by what is found to be cost-effective and if it s thought to be efficacious. I don t have any particular ethical view on it. I think if we have an intervention to prevent it and we re able to use it I think we should. (Female Consultant) 13
Study 3: Doctors attitudes Intuition-based approach - Guided by beliefs and gut feelings -Ethical paradigms of inequality and social fairness -Heuristics (or mental shortcuts) of existing HPV vaccination programmes (e.g. Gender-neutral model in Australia and the US) I know what my gut reaction is and I know what the data is and they are different. My gut reaction is to vaccinate everybody. (Female Consultant) I think it should be all men. I feel that really, really strongly. You know in the same way we re vaccinating all women. ( ) I think everyone school-aged should get vaccinated (Male Consultant) 14
Conclusions HPV vaccine acceptability - MSM are receptive to HPV vaccination - HPV vaccine promotion by healthcare professionals - Willingness to discuss sexuality are access GUM are main barriers -Estimated uptake 30%-65% in young MSM Recommendations - Education and training - Monitoring of attitudes and uptake Future research - Digital health promotion - Hepatitis A-B & HPV vaccination schedules 15
Thanks to: Dr Carrie Llewellyn Prof. Helen Smith Dr Daniel Richardson Dr Christina Jones Dr Elizabeth Ford Alex Pollard Tom Nadarzynski T.Nadarzynski@BSMS.ac.uk 16