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
Date
2021
Authors
Grewal, R.
Hart, T. A.
Deeks, S. L.
Cox, J.
De Pokomandy, A.
Grennan, T.
Lambert, G.
Moore, D.
Brisson, M.
Coutlée, F.
Journal Title
Journal ISSN
Volume Title
Publisher
Vaccine
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) lesser than or equal to 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 (lesser than or equal to 26 years old = eligible for vaccination, greater than or equal to 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 lesser than or equal to 26 years and 7–26% and 2–9% of
men greater than or equal to 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 (lesser than or equal to 26: prevalence
ratio[PR] = 2.15, 95% confidence interval[CI] 1.06–4.36; greater than or equal to 27: PR = 2.73, 95%CI 1.14–6.51) and past
hepatitis A or B vaccination (lesser than or equal to 26: PR = 2.88, 95%CI 1.64–5.05; greater than or equal to 27: PR = 2.03, 95%CI 1.07–3.86). Among
men greater than or equal to 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 greater than or equal to 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 greater or less than 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.
Description
The authors would like to thank the Engage/Momentum II study
participants, office staff, and community engagement committee
members, as well as our community partner agencies. The authors
also wish to acknowledge the support of Catharine Chambers and
Ashley Mah and their contribution(s) to the work presented here.
Keywords
Human papillomavirus, Men who have sex with men, Vaccine uptake, Vaccine preventable disease, Immunization program, Primary prevention
Citation
Grewal, R., Deeks, S. L., Hart, T. A., Cox, J., De Pokomandy, A., Grennan, T., Lambert, G., Moore, D., Brisson, M., Coutlée, F., Gaspar, M., George, C., Grace, D., Jollimore, J., Lachowsky, N. J., Nisenbaum, R., Ogilvie, G., Sauvageau, C., Tan, D. H. S., Yeung, A., & Burchell, A. N. (2021). “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, 39, 3756-3766. DOI: https://doi.org/10.1016/j.vaccine.2021.05.031