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.

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 8,554
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.