Integrating HPV Vaccination Within PrEP care Delivery for Underserved Populations: A Mixed Methods Feasibility Study

Wheldon, Christopher W.; Sykes, Kevin J.; Ramaswamy, Megha; Bass, Sarah Bauerle; Collins, Bradley N.

doi:10.1007/s10900-023-01202-y

Cited by 6 publications

(4 citation statements)

References 42 publications

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“…Although the stringent eligibility criteria for publicly funded vaccination in Ontario likely played a role, a previous study found that PrEP stakeholders (ie, providers, clinic staff, patients) perceived the exclusion of HPV vaccine in PrEP management guidelines to be the greatest barrier to integrating HPV vaccination within PrEP care. 24 Putting this into context, pooled estimates from a recent meta-analysis found that only 24% of patients initiated HPV vaccination without provider recommendations compared with 60% whose provider recommended getting vaccinated. 25 Including HPV vaccine in both Canadian and international PrEP guidelines and encouraging providers to recommend HPV vaccination during PrEP consultations are important strategies for improving vaccine uptake among PrEP users.…”

Section: Discussionmentioning

confidence: 99%

HIV pre-exposure prophylaxis and opportunities for vaccination against hepatitis A virus, hepatitis B virus and human papillomavirus: an analysis of the Ontario PrEP cohort study

McGarrity,

Lisk,

MacPherson

et al. 2024

Sex Transm Infect

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ObjectivesPopulations who seek HIV pre-exposure prophylaxis (PrEP) are disproportionately affected by hepatitis A virus (HAV), hepatitis B virus (HBV) and human papillomavirus (HPV). We examined immunity/vaccination against these infections among participants in the Ontario PrEP cohort study (ON-PrEP).MethodsON-PrEP is a prospective cohort of HIV-negative PrEP users from 10 Ontario clinics. We descriptively analysed baseline immunity/vaccination against HAV (IgG reactive), HBV (hepatitis B surface antibody >10) and HPV (self-reported three-dose vaccination). We further performed multivariable logistic regression to identify characteristics associated with baseline immunity/vaccination. We used cumulative incidence functions to describe vaccine uptake among participants non-immune at baseline.ResultsOf 633 eligible participants, 59.1% were white, 85.8% were male and 79.6% were gay. We found baseline evidence of immunity/vaccination against HAV, HBV and HPV in 69.2%, 81.2% and 16.8% of PrEP-experienced participants and 58.9%, 70.3% and 10.4% of PrEP-naïve participants, respectively. Characteristics associated with baseline HAV immunity were greater PrEP duration (adjusted OR (aOR) 1.41/year, 95% CI 1.09 to 1.84), frequent sexually transmitted and bloodborne infection (STBBI) testing (aOR 2.38, 95% CI 1.15 to 4.92) and HBV immunity (aOR 3.53, 95% CI 2.09 to 5.98). Characteristics associated with baseline HBV immunity were living in Toronto (aOR 3.54, 95% CI 1.87 to 6.70) or Ottawa (aOR 2.76, 95% CI 1.41 to 5.40), self-identifying as racialised (aOR 2.23, 95% CI 1.19 to 4.18), greater PrEP duration (aOR 1.39/year, 95% CI 1.02 to 1.90) and HAV immunity (aOR 3.75, 95% CI 2.19 to 6.41). Characteristics associated with baseline HPV vaccination were being aged ≤26 years (aOR 9.28, 95% CI 2.11 to 40.77), annual income between CAD$60 000 and CAD$119 000 (aOR 3.42, 95% CI 1.40 to 8.34), frequent STBBI testing (aOR 7.00, 95% CI 1.38 to 35.46) and HAV immunity (aOR 6.96, 95% CI 2.00 to 24.25). Among those non-immune at baseline, overall cumulative probability of immunity/vaccination was 0.70, 0.60 and 0.53 among PrEP-experienced participants and 0.93, 0.80 and 0.70 among PrEP-naïve participants for HAV, HBV and HPV, respectively.ConclusionsBaseline immunity to HAV/HBV was common, and a sizeable proportion of non-immune participants were vaccinated during follow-up. However, HPV vaccination was uncommon. Continued efforts should be made to remove barriers to HPV vaccination such as cost, inclusion in clinical guidelines and provider recommendation.

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Section: Discussionmentioning

confidence: 99%

HIV pre-exposure prophylaxis and opportunities for vaccination against hepatitis A virus, hepatitis B virus and human papillomavirus: an analysis of the Ontario PrEP cohort study

McGarrity,

Lisk,

MacPherson

et al. 2024

Sex Transm Infect

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“…Research on problematic RAI -encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and/or decreased sexual desire -due to gastrointestinal diseases and their treatments is lacking. The National Comprehensive Cancer Network acknowledges that RAI is a risk factor for anal cancer 54 , that anal cancer is more common in cisgender gay and bisexual men than in the general population 54 (with anal cancer incidence being approximately 20-80 times higher in gay and bisexual men than in the general population) 55 , and that sexual dysfunction is among the most distressing toxic effects of cancer treatment 54 . Unfortunately, National Comprehensive Cancer Network guidelines fail to acknowledge problematic RAI as a distressing outcome or to offer guidance for engaging in RAI after cancer treatments 54 .…”

Section: Management Of Problematic Rai Conclusionmentioning

confidence: 99%

“…Among the general population, anal cancer is rare; however, among sexual minority men, transgender and gender diverse people, and those with long-term immunosuppression, anal cancer is a relatively common malignancy 206,[298][299][300][301][302][303][304][305] . In the USA, sexual minority men constitute approximately 43% of new anal cancer cases among cisgender men 306 , with incidence rates ~20-80 times higher in cisgender sexual minority men than in cisgender men and/or women 55 . Additionally, among gender-expansive individuals, anal cancer ranks as the second most common cancer 301 .…”

Section: Anal Cancermentioning

confidence: 99%

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Dickstein,

Edwards,

Rowan

et al. 2024

Nat Rev Gastroenterol Hepatol

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The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI -encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable. Sections Key points• Receptive anal intercourse (RAI) is common worldwide.• Pleasurable RAI occurs through stimulation of the perianal or anal nerves and prostate or paraurethral glands, inducing vasodilation, erectile tissue engorgement, anopelvic tissue sensitization, and anal sphincter and pelvic muscular contractions.• Patients with a stoma and anorectal stump should be counselled on hygiene and dilator use to minimize infections, maintain anorectal patency, and prevent a permanent stoma, promoting RAI restoration.• Antidiarrhoeals, anti-flatulence medications, fibre supplements, lower residue diet to control regularity, avoiding spicy foods, timing meals, and defecation prior to RAI can help control symptoms and relieve distress.• Survivors of anal, rectal, and colon cancer and patients with gastrointestinal disease should be counselled on problematic RAI due to anal sphincter, neurovasculature, and prostate or paraurethral gland damage resulting in arousal dysfunction, anodyspareunia or orgasm dysfunctions.• Management strategies, including anal dilators for anodyspareunia, anal vibrators for arousal disorders, pelvic floor strengthening for anorgasmia and psychological interventions for decreased desire, should be discussed with patients.Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author selfarchiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

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“…13 Although vaccine hesitancy has been reported to be less frequent among PrEP users when compared with the general population, there might be uninvestigated factors associated with missing these vaccinations among PrEP users. [14][15][16][17][18][19][20][21][22][23][24] Moreover, understanding which subgroups among PrEP users require focus regarding the offer of these vaccinations might help clinicians deliver a more personalized approach and, in a long-term scenario, develop new delivery strategies concerning already available vaccinations and new investigated products. The aims of this study were to describe among MSM accessing PrEP, the HAV, HBV, and HPV serologic status and vaccination history; analyze vaccinations uptake after PrEP prescription; protection rates for HAV, HBV, and HPV; and evaluate factors associated with the lack of triple vaccination (HAV, HBV, and HPV).…”

Section: Introductionmentioning

confidence: 99%

Viral Hepatitis and Human Papillomavirus Vaccination During HIV Pre-Exposure Prophylaxis: Factors Associated With Missed Vaccination

Raccagni

Ceccarelli

Trentacapilli

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: We evaluated factors associated with lack of triple vaccination (hepatitis A virus [HAV], hepatitis B virus [HBV], and human papillomavirus [HPV]) among men who have sex with men using pre-exposure prophylaxis (PrEP). Setting: PrEP users at the San Raffaele Scientific Institute, Italy, with ≥1 follow-up visit (May 2017–2022). Methods: Participants were considered protected if (1) before PrEP access: positive serology (IgG-HAV+, hepatitis B surface antigen >10 mUI/mL) or vaccination history was recorded and (2) after starting PrEP: ≥1 dose of each vaccination was administered. Individuals were considered fully protected if they received the following before/during PrEP access: HAV vaccination/infection, HBV vaccination/infection, and HPV vaccination. χ2 and Kruskal–Wallis tests were used to compare characteristics of those fully, partially, and not protected. Factors associated with the lack of triple vaccination were assessed by using multivariable logistic regression and classification tree analysis. Results: Overall, 473 men who have sex with men were considered: 146 (31%) were fully protected, 231 (48%) partially, and 96 (20%) were not. Daily-based PrEP users (fully: 93, 63.7%; partially: 107, 46.3%; and not protected: 40, 41.7%; P = 0.001) and those with a sexually transmitted infection at the first visit (43, 29.5%; 55, 23.8%; 15, 15.6%; P = 0.048) were more frequently fully protected. At multivariable analysis, the odds of lack of triple vaccination was lower among daily-based users (adjusted odds ratio = 0.47, 95% confidence interval = 0.31–0.70, P < 0.001). Classification tree analysis showed that among daily-based users, with sexually transmitted infection prior and at the first PrEP visit, there was a lower chance of lack of triple vaccination (P = 44%). Conclusions: Strategies targeting PrEP users at risk of missing HAV, HBV, and HPV vaccinations need to be implemented, focusing mostly on event-based users.

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Integrating HPV Vaccination Within PrEP care Delivery for Underserved Populations: A Mixed Methods Feasibility Study

Cited by 6 publications

References 42 publications

HIV pre-exposure prophylaxis and opportunities for vaccination against hepatitis A virus, hepatitis B virus and human papillomavirus: an analysis of the Ontario PrEP cohort study

HIV pre-exposure prophylaxis and opportunities for vaccination against hepatitis A virus, hepatitis B virus and human papillomavirus: an analysis of the Ontario PrEP cohort study

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Viral Hepatitis and Human Papillomavirus Vaccination During HIV Pre-Exposure Prophylaxis: Factors Associated With Missed Vaccination

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