A human papillomavirus (HPV) vaccination programme targeted at men who have sex with men (MSM) can be effectively delivered using specialist sexual health and HIV clinics, according to an analysis of an English pilot study published in Eurosurveillance. Uptake of the vaccine by eligible MSM was high, relatively few men attended specifically to receive the vaccine and there was no evidence that provision of the vaccine caused disruption to clinics.
“HPV vaccine update data and survey results suggest it is feasible to deliver HPV vaccination opportunistically to MSM through sexual health clinics/HIV clinics,” say the authors.
In 2015, the Joint Committee on Vaccination and Immunisation (JCVI) for England advised that HPV vaccination programmes should be extended from school-aged girls to include MSM aged up to 45 attending sexual health or HIV clinics. The decision was made because MSM have high rates of HPV infection, which can cause anal and penile cancer, and the school-based programme has minimal impact in this population.
As a first step to wider rollout, a pilot programme was initiated to determine the acceptability, feasibility, equity, vaccine uptake and impact on clinic services. Dr Michael Edelstein and colleagues at Public Health England reported on outcomes during the first year of the pilot, April 2016 to March 2017.
“It is hoped that the lessons outlined here may also be relevant to other countries considering what HPV vaccination strategy to adopt for MSM,” they comment .
Forty-two sexual health/HIV clinics in seven of the nine English regions participated in the pilot. These clinics provide services to approximately a third of the estimated 140,000 MSM eligible for HPV vaccination in England.
During the ten months of analysis, the clinics provided services to 18,875 vaccine-eligible MSM. Their median age was 31 years. Overall, 46% of those eligible were recorded as receiving the first of the three vaccine doses. Uptake decreased slightly with increasing age, from 51% among MSM aged 25 years and under, to 37% in MSM in their early 40s. Perhaps surprisingly, uptake was higher in rural areas than in major urban conurbations and towns and cities (54% vs 45%).
But the investigators believe that actual vaccine rates were likely to have been somewhat higher, with anecdotal reports that administration was sometimes not recorded on patients’ notes. The study does not include data on how many men returned for their second and third doses.
Attendance rates at clinics participating in the pilot increased by 4.5%, matching the overall 4.8% increase seen in English sexual health/HIV clinics during the study period.
A total of 8554 questionnaires were returned by MSM attending the pilot clinics and receiving the vaccine. The vast majority (92%) had previously attended a sexual health/HIV clinic and 86% accessed another service when attending for HPV vaccination. Just 12% attended specifically to receive the vaccine.
When asked where they would like to receive the second vaccine dose, 95% of MSM expressed a preference for a sexual health/HIV clinic. Only 7% preferred their GP, though this increased to 12% among men using clinics in rural areas.
Future surveillance will monitor the impact of this programme on HPV infection, genital warts and HPV-related cancers.
Edelstein M et al. Implementation and evaluation of the human papillomavirus (HPV) vaccination pilot for men who have sex with men (MSM), England, April 2016 to March 2017. Eurosurveillance, 24 (8), 2019. (Full text freely available).