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Wei MY, Yeung JM, Faragher IG. It's time to consider screening for anal cancer in high risk populations. ANZ J Surg 2024. [PMID: 38874278 DOI: 10.1111/ans.19133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/15/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Matthew Y Wei
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Parkville, Victoria, Australia
| | - Justin M Yeung
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Parkville, Victoria, Australia
| | - Ian G Faragher
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
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2
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Wheldon CW, Sykes KJ, Ramaswamy M, Bass SB, Collins BN. Integrating HPV Vaccination Within PrEP care Delivery for Underserved Populations: A Mixed Methods Feasibility Study. J Community Health 2023; 48:640-651. [PMID: 36894796 PMCID: PMC10492896 DOI: 10.1007/s10900-023-01202-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/11/2023]
Abstract
Human Papillomavirus (HPV) vaccination is effective at preventing anal cancer, which disproportionally impacts gay/bisexual men (GBM) and transgender women (TGW). Vaccine coverage among GBM/TGW is insufficient to reduce anal cancer disparities. Federally qualified health centers (FQHCs) can increase reach and uptake of HPV vaccination by integrating and promoting HPV vaccination in ongoing HIV preventive care (e.g., Pre-exposure Prophylaxis [PrEP]). The purpose of the current study was to assess the feasibility and potential impact of integrating HPV vaccination with PrEP care. We conducted a mixed methods study of PrEP providers and staff (qualitative interviews, N = 9) and PrEP patients (quantitative survey, N = 88) at an FQHC in Philadelphia, Pennsylvania. Qualitative thematic analysis of PrEP provider/staff interviews was informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify and describe barriers and facilitators to HPV vaccination implementation. Quantitative analysis of PrEP patient survey was informed by the Information-Motivation-Behavioral Skills Model. Quantitative interviews resulted in 16 themes related to characteristics of the inner and outer clinic context. Barriers among providers included lack of focus on HPV in PrEP management guidelines, in metrics mandated by funding agencies, and in electronic medical record templates. Lack of anal cancer specific knowledge and motivation was identified in both PrEP patients and providers/staff. Providing HPV vaccination during routine PrEP visits was highly acceptable to both patients and providers. Based on these findings, we recommend several multi-level strategies to increase HPV vaccine uptake among PrEP patients.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA.
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas School of Medicine, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th floor, Philadelphia, PA, 19122, USA
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3
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Saraiva MM, Spindler L, Fathallah N, Beaussier H, Mamma C, Quesnée M, Ribeiro T, Afonso J, Carvalho M, Moura R, Andrade P, Cardoso H, Adam J, Ferreira J, Macedo G, de Parades V. Artificial intelligence and high-resolution anoscopy: automatic identification of anal squamous cell carcinoma precursors using a convolutional neural network. Tech Coloproctol 2022; 26:893-900. [DOI: 10.1007/s10151-022-02684-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
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4
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Ejaz M, Ekström AM, Ahmed A, Haroon A, Ali D, Ali TS, Salazar M. Human Papillomavirus associated prevention: knowledge, attitudes, and perceived risks among men who have sex with men and transgender women in Pakistan: a qualitative study. BMC Public Health 2022; 22:378. [PMID: 35193544 PMCID: PMC8864907 DOI: 10.1186/s12889-022-12775-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan. DESIGN A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan. METHODS Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis. RESULTS Three themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant's recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one's sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients' integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding. CONCLUSIONS The findings from this study can help public health policy and researchers to understand this minority's perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden. .,Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.
| | - Anna Mia Ekström
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Alyan Ahmed
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Aymen Haroon
- Department of Biostatistics and Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, United States
| | - Dania Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.,School of Nursing, the Aga Khan University, Karachi, Pakistan
| | - Mariano Salazar
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
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Laurie C, El-Zein M, Tota J, Khosrow-Khavar F, Tellier PP, Coutlée F, de Pokomandy A, Franco EL. Efficacy of a Carrageenan Gel in Increasing Clearance of Anal Human Papillomavirus Infections in Men: Interim Analysis of a Double-Blind, Randomized Controlled Trial. J Infect Dis 2022; 227:402-406. [PMID: 35090175 PMCID: PMC9891427 DOI: 10.1093/infdis/jiac019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/25/2022] [Indexed: 02/04/2023] Open
Abstract
Preclinical studies have demonstrated carrageenan's anti-human papillomavirus (HPV) activity. We assessed efficacy of a carrageenan-based gel compared to a placebo gel in increasing the clearance of anal HPV infections among gay, bisexual, and other men who have sex with men (gbMSM). Of 255 enrolled gbMSM, 134 were HPV positive at baseline and had valid HPV results for ≥2 visits. Carrageenan did not differ from placebo in clearing all baseline infections (hazard ratio, 0.84 [95% confidence interval, .31-2.27]), based on having 2 consecutive HPV-negative visits following at least 1 HPV-positive visit. There were no remarkable differences for analyses at the HPV type level or by human immunodeficiency virus status. CLINICAL TRIALS REGISTRATION NCT02354144.
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Affiliation(s)
- Cassandra Laurie
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Joseph Tota
- Present affiliation: Department of Pharmacoepidemiology, Merck Research Laboratories, West Point, Pennsylvania, USA
| | | | | | - François Coutlée
- Laboratoire de virologie moléculaire, Centre de recherche, Centre hospitalier de l’Université de Montréal, et Département de Microbiologie, infectiologie et immunologie, Université de Montréal, Montreal, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada,McGill University Health Centre, Montreal, Canada
| | - Eduardo L Franco
- Correspondence: Eduardo L. Franco, DrPH, Division of Cancer Epidemiology, McGill University, 5100 Maisonneuve Blvd West, Suite 720, Montreal, QC H4A 3T2, Canada ()
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6
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Wheldon CW, Garg A, Galvin AM, Moore JD, Thompson EL. Decision support needs for shared clinical decision-making regarding HPV vaccination among adults 27-45 years of age. PATIENT EDUCATION AND COUNSELING 2021; 104:3079-3085. [PMID: 33980398 DOI: 10.1016/j.pec.2021.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Identify HPV information needs and shared clinical decision-making preferences among adults 27-45 and describe differences in needs and preferences among underserved and vulnerable populations. METHODS Participants 27-45 years old with no history of HPV vaccination completed a cross-sectional web-based survey between April-May 2020 (N = 702). Preferred role in shared clinical decision making was described across demographic groups and sociodemographic correlates of HPV vaccine information needs. RESULTS Most (77.6%) reported a preference to make a medical decision on their own or after consulting with a healthcare provider, while the remaining respondents preferred to make a joint decision (17.0%) or for their doctor to make the decision (5.4%). Over 80% needed more information about safety, effectiveness, personal benefit, provider recommendation, side effects, and risks. Education was the strongest demographic factors associated with higher information needs (p<0.05). CONCLUSION The majority of individuals across demographic groups were individually focused with regard to their healthcare decisions and wanted more information about HPV vaccine safety, side effects, and risks, in addition to personalized information about benefits from HPV vaccination. PRACTICAL IMPLICATIONS Patient-centered interventions are needed to engage adults in shared decision-making regarding HPV vaccination.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, Temple University, 1301 Cecil B. Moore Ave. Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA 19122 USA.
| | - Ashvita Garg
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd Fort Worth, TX 76107 USA.
| | - Annalynn M Galvin
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, 3500 Camp Bowie Blvd Fort Worth, TX 76107 USA.
| | - Jonathan D Moore
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd Fort Worth, TX 76107 USA.
| | - Erika L Thompson
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, 3500 Camp Bowie Blvd Fort Worth, TX 76107 USA.
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Rosales BM, Langton-Lockton J, Hedley J, Cornall AM, Roberts JM, Garland SM, Kelly PJ, Hillman RJ, Webster AC. Prevalence of anal cytological abnormalities and high-risk human papillomavirus prevalence in kidney transplant recipients: A cross-sectional study. Clin Transplant 2021; 35:e14476. [PMID: 34498297 DOI: 10.1111/ctr.14476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transplant recipients are at high-risk of anal squamous cell cancer. We aimed to estimate the prevalence of high-risk human papillomavirus (HPV) and high-grade squamous intraepithelial lesion (HSIL) and assess characteristics associated with results METHODS: We recruited kidney transplant recipients in a single-center, 2015-2018. Participants completed a clinical questionnaire and received an anal-swab sent for HPV-DNA and cytological testing RESULTS: A total of 97 (74%) of 125 recipients approached consented to participate. Participants were median 47 (IQR 40-55) years, 60% male and median 4.5 (IQR .9-13) months-since-transplant. Of 86 assessable samples, at least one HPV genotype was detected in 15 (17%) participants; 1 (1%) HPV16, 8 (9%) other high-risk HPV. Of 76 assessable cytology samples, 9 (12%) showed evidence of abnormality; 1 (1%) HSIL, 1 (1%) atypical-squamous-cells, cannot exclude HSIL. Both HSIL recipients had high-risk HPV and biopsy confirmed HSIL. High-risk HPV was detected in six (9%) recipients with normal cytology. History of sexually transmitted infection, and abnormal cervical pap smear in women, was associated with high-risk HPV and HSIL CONCLUSIONS: High-risk HPV and HSIL testing may identify kidney transplant recipients at higher risk of anal cancer. Longitudinal studies are needed to describe the natural history of anal cancer in transplant recipients.
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Affiliation(s)
- Brenda M Rosales
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Julian Langton-Lockton
- Sexual Health and HIV Service, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - James Hedley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alyssa M Cornall
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Australia
| | - Jennifer M Roberts
- Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Australia.,Douglass Hanly Moir Pathology, Melbourne, Victoria, Australia
| | - Suzanne M Garland
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Richard J Hillman
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Angela C Webster
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
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- Douglass Hanly Moir Pathology, Melbourne, Victoria, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 750] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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Wheldon CW, Maness SB. An Assessment of Cancer Education Needs to Promote Mid-Adult HPV Vaccination Among Male Sexual Minorities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:401-405. [PMID: 31707641 DOI: 10.1007/s13187-019-01644-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The purpose of this study was to assess behavioral expectations and related psychosocial factors regarding an age-expanded human papillomavirus (HPV) vaccine schedule among male sexual minorities (MSM). A measure of behavioral expectation (BE) ("How likely are you to get the HPV vaccine if the CDC recommendation was changed to include men older than 26?") was evaluated on an ethnoracially diverse sample (N = 318) of MSM. Sixty-seven percent would likely initiate vaccination if the recommendations change. Benefits of HPV vaccination were widely endorsed. Barriers/harms of vaccination were endorsed less frequently. Only 15.4% were concerned that the vaccine would not be effective. The main driver of BE was perceived physical benefits (R2 = 0.34). Psychological benefits were independently associated with BE but did not improve the explanatory model. Expectation of HPV vaccination is high among MSM in the expanded age range. Prevention of anogenital warts and anal cancer is an important consideration for this population; however, promoting the benefits of vaccination must be done in accordance with realistic expectations of vaccine efficacy in older sexually active MSM.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA, 19122, USA.
| | - Sarah B Maness
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma, 73019, USA
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10
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Wheldon CW, Maness SB, Islam JY, Deshmukh AA, Nyitray AG. Gay and Bisexual Men in the US Lack Basic Information About Anal Cancer. J Low Genit Tract Dis 2021; 25:48-52. [PMID: 32947485 PMCID: PMC9101414 DOI: 10.1097/lgt.0000000000000571] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess knowledge of human papillomavirus (HPV) as a cause of anal cancer among at-risk gay, bisexual, and other men who have sex with men (GBM). MATERIALS AND METHODS Secondary analysis was conducted of cross-sectional data from 3 cycles of the Health Information National Trends Survey (2017, 2018, 2019). Results were reported for the subset of adults who identified as GBM (N = 212). Knowledge that HPV can cause anal cancer was the main outcome. Differences in knowledge were evaluated (using χ2 and multiple logistic regression) by demographic, health information factors, and access to care. RESULTS Sixty-eight percent of GBM were aware of HPV. Knowledge that HPV causes anal cancer was low (<20%) in the overall sample and sample of GBM (17.9%; 95% CI = 11.0-24.7). Gay, bisexual, and other men who have sex with men were no more knowledgeable that HPV causes anal cancer than heterosexual men (14.8%; 95% CI = 12.9-16.9; p = .376). College-educated GBM had higher odds (adjusted odds ratio = 3.50; 95% CI = 1.02-11.97) of knowing HPV causes anal cancer than GBM with no college degree. No other factors were associated with knowledge. CONCLUSIONS Gay, bisexual, and other men who have sex with men are largely unaware that HPV can cause anal cancer, despite high awareness of HPV itself. This is concerning given that GBM are at increased risk of HPV-associated anal cancer than the general population. Our findings suggest that information about anal cancer and health information about the benefits of HPV vaccination for anal cancer prevention are only reaching a small subset of college-educated GBM. Targeted anal cancer education programs are needed.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA
| | | | - Jessica Y Islam
- University of North Carolina Chapel Hill Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Ashish A Deshmukh
- Center for Health Services Research, UT Health School of Public Health, Houston, TX
| | - Alan G Nyitray
- Clinical Cancer Center/Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
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11
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Fontenot HB, White BP, Rosenberger JG, Lacasse H, Rutirasiri C, Mayer KH, Zimet G. Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study. J Med Internet Res 2020; 22:e22878. [PMID: 33146621 PMCID: PMC7673982 DOI: 10.2196/22878] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/24/2020] [Accepted: 10/09/2020] [Indexed: 01/05/2023] Open
Abstract
Background Mobile app-based interventions have been identified as potential facilitators for vaccination among young men who have sex with men (MSM). Objective This pilot study aimed to test the feasibility of a theoretically informed mobile health (mHealth) tool designed to reduce health disparities and facilitate human papillomavirus (HPV) vaccination among a sample of young MSM. Methods The development of the mHealth tool was guided by previous research, implementation intention theory, and design thinking. We recruited MSM aged 18-26 years through a popular online dating app and linked participants to our mHealth tool, which provided HPV vaccine information and fostered access to care. Results A total of 42 young MSM participated in this pilot study in Boston, Massachusetts. Participants reported variable HPV knowledge (ie, high knowledge of HPV risk factors and low knowledge of HPV-related cancer risks for men) and positive vaccine beliefs and attitudes. Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23% (8/35) utilized the mHealth tool to obtain HPV vaccination. Participants primarily utilized the tool’s (1) educational components and (2) capabilities facilitating concrete vaccine action plans. Conclusions We recruited an underserved at-risk population of youth via an online dating app for our mHealth intervention that resulted in in-person health care delivery. This study was limited by enrollment challenges, including low willingness to download the mHealth tool to mobile devices.
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Affiliation(s)
- Holly B Fontenot
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, United States.,The Fenway Institute, Boston, MA, United States.,Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | | | - Joshua G Rosenberger
- College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Hailee Lacasse
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Chokdee Rutirasiri
- Proper Villains, Boston, MA, United States.,School of Arts and Sciences, Boston College, Chestnut Hill, MA, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,School of Medicine, Harvard University, Boston, MA, United States
| | - Gregory Zimet
- Division of Adolescent Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
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12
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Goddard SL, Templeton DJ, Petoumenos K, Jin F, Hillman RJ, Law C, Roberts JM, Fairley CK, Garland SM, Grulich AE, Poynten IM, Farnsworth A, Biro C, Richards A, Thurloe J, Ekman D, McDonald R, Adams M, Tabrizi S, Phillips S, Molano Luque M, Comben S, McCaffery K, Howard K, Kelly P, Seeds D, Carr A, Feeney L, Gluyas R, Prestage G, Law M, Acraman B, McGrath P, Mellor R, Pezzopane P, Varma R, Langton-Lockton J, Tong W. Prevalence and Association of Perianal and Intra-Anal Warts with Composite High-Grade Squamous Intraepithelial Lesions Among Gay and Bisexual Men: Baseline Data from the Study of the Prevention of Anal Cancer. AIDS Patient Care STDS 2020; 34:436-443. [PMID: 32955927 DOI: 10.1089/apc.2020.0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Human papillomavirus (HPV) causes anal warts and anal squamous cell carcinoma (SCC). A higher incidence of anal cancer has been found among individuals previously diagnosed with anogenital warts. We aimed to investigate the association between anal warts and the presumed anal SCC precursor high-grade squamous intraepithelial lesion (HSIL), among participants in the Study of the Prevention of Anal Cancer (SPANC). SPANC was a longitudinal study of anal HPV infections and related lesions among gay and bisexual men (GBM) age 35 years and older, in Sydney, Australia. Anal cytology and high-resolution anoscopy were performed. Logistic regression was used to investigate the association between clinically diagnosed anal warts and intra-anal composite-HSIL (cytology and/or histology) at the baseline visit. The prevalence of HSIL within biopsies from intra-anal warts was calculated. Laser capture microdissection (LCM) and HPV-genotyping was performed on HSIL lesions. Among 616 participants at study entry, 165 (26.8%) and 51 (8.3%) had intra-anal and perianal warts, respectively. Warts were associated with composite-HSIL, even after adjustment for HIV status, age, lifetime receptive anal intercourse partner number, and smoking (perianal: aOR 2.13, 95% CI 1.17-3.87, p = 0.013; intra-anal: aOR 1.69, 95% CI 1.16-2.46, p = 0.006). HSIL was detected in 24 (14.5%) of 165 biopsies from intra-anal warts. Of 17 HSIL lesions, 16 (94.1%) had high-risk HPV detected by LCM. Anal warts were common. Prevalent anal warts were associated with composite-HSIL. HSIL may be detected within biopsies of intra-anal warts. Anal warts may be a useful addition to risk stratification for HSIL among GBM.
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Affiliation(s)
- Sian L. Goddard
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Infection and Immunity, Barts Health NHS Trust, London, United Kingdom
| | - David J. Templeton
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Sexual Health Service, Sydney Local Health District, and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathy Petoumenos
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Richard J. Hillman
- Dysplasia and Anal Cancer Services, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Carmella Law
- Dysplasia and Anal Cancer Services, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Christopher K. Fairley
- Melbourne Sexual Health Center, and Central Clinical School Monash University, Melbourne, Victoria, Australia
| | - Suzanne M. Garland
- Center for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia
- Infection Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew E. Grulich
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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13
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Gerend MA, Madkins K, Crosby S, Korpak AK, Phillips GL, Bass M, Houlberg M, Mustanski B. Evaluation of a Text Messaging-Based Human Papillomavirus Vaccination Intervention for Young Sexual Minority Men: Results from a Pilot Randomized Controlled Trial. Ann Behav Med 2020; 55:321-332. [PMID: 32914838 DOI: 10.1093/abm/kaaa056] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk for human papillomavirus (HPV) infection and HPV-related anal cancer. Although a safe and effective vaccine is available to prevent HPV infection, HPV vaccine uptake among young MSM remains low. PURPOSE This pilot randomized controlled trial tested the acceptability, feasibility, and preliminary efficacy of a text messaging-based HPV vaccination intervention for young sexual minority men. METHODS In 2018, unvaccinated sexual minority men aged 18-25 years were recruited from Chicago to participate in a 9 month sexual health program called txt2protect. Participants (N = 150) were randomized to the intervention or control condition. Intervention condition messages focused primarily on HPV vaccination, with only a brief mention of other sexual health practices (e.g., condom use and HIV testing), while control condition messages focused on a variety of sexual health practices with only a brief mention of HPV vaccination. Participants received daily text messages for the first 3 weeks and monthly text messages for the remaining ~8 months of the trial. Participants completed surveys at baseline and 3 week and 9 month follow-ups. RESULTS Participants reported high satisfaction with the intervention. Although trial retention was high (with over 88% completing the 9 month survey), the study fell short of meeting its recruitment goal. HPV vaccine series initiation was significantly higher among intervention participants (19.4%) compared to control participants (6.6%), odds ratio = 3.43, 95% confidence interval: 1.17, 10.08. CONCLUSIONS Findings suggest that txt2protect is an acceptable and potentially promising intervention for increasing HPV vaccine initiation among young sexual minority men. CLINICAL TRIAL REGISTRATION NCT02994108.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Krystal Madkins
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Shariell Crosby
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Aaron K Korpak
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Gregory L Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Michael Bass
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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14
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Nguyen Minh D, Taneepanichskul N, Hajek R. Effectiveness of a Health Talk Education Program on Human Papillomavirus (HPV) Knowledge, Attitudes, and Intentions to Vaccinate Children Among Mothers of Secondary School Boys in Thua Thien Hue Province, Vietnam. Risk Manag Healthc Policy 2020; 13:1207-1214. [PMID: 32884381 PMCID: PMC7443439 DOI: 10.2147/rmhp.s259097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of cancer related to human papillomavirus (HPV) that affects males is rising throughout the world. Currently, Vietnamese boys are typically not vaccinated against HPV while girls are. There are only a few studies pertaining to HPV vaccination among boys in Asian countries where parents play the most important role in deciding on such vaccination. We present here the first study to assess the effectiveness of a health talk education program on HPV knowledge, attitudes and intention to vaccinate children among mothers of secondary school students in the Thua Thien Hue province, Vietnam. Methods This was a quasi-experimental study. Two secondary schools in the Thua Thien Hue province, Vietnam were selected by purposive sampling. A total of 288 mothers of male students of two secondary schools were selected to participate, n=144 as controls and n=144 for the intervention arm for every school. Mothers of male students were invited to answer interview questions. The questionnaires covered social demographics, health history, HPV knowledge and HPV vaccination perception and intention. The study ran from September 2019 to January 2020. Results In total, 279 mothers finished the questionnaires. At the baseline, HPV knowledge in both groups was at the same level (p>0.05). One month after receiving the HPV health talk education, mothers of male students had much higher HPV knowledge than those who did not receive such HPV health talk education. The intervention group also had a much higher HPV vaccination intention than the control group (p<0.05). Conclusion Health education was shown in this study to be an effective method to increase HPV knowledge and vaccination intention among mothers of boys in Vietnam. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/o-SA_viExaA
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Affiliation(s)
- Duc Nguyen Minh
- Colleges of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.,Hue Central Hospital, Hue City, Vietnam
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15
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Higa DH, Crepaz N, McDonald CM, Adegbite-Johnson A, DeLuca JB, Kamitani E, Sipe TA. HIV Prevention Research on Men Who Have Sex With Men: A Scoping Review of Systematic Reviews, 1988-2017. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:1-S7. [PMID: 32073309 DOI: 10.1521/aeap.2020.32.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the United States, men who have sex with men (MSM) are disproportionately affected by HIV. To identify research gaps and inform HIV prevention for MSM, we conducted a scoping review of systematic reviews using CDC's Prevention Research Synthesis database. Eligibility criteria comprised English-language systematic reviews focused on HIV prevention for MSM, published during 1988-2017, and included at least one U.S. primary study. We coded data type, subpopulations, topics, and key findings. To assess study quality, we used the Assessment of Multiple Systematic Reviews (AMSTAR). Among 129 relevant systematic reviews, study quality was high or moderate for 63%. Most common topics were sexual behavior and disease vulnerability. The most frequently mentioned MSM subgroups were HIV-positive, Black or African American, and young. Research gaps include Hispanic/Latino MSM, pre-exposure prophylaxis (PrEP), treatment as prevention, social determinants of health, health disparities, syndemics, and protective factors for sexual health.
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Affiliation(s)
- Darrel H Higa
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Nicole Crepaz
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Christina M McDonald
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | | | - Julia B DeLuca
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Emiko Kamitani
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Theresa Ann Sipe
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
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16
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Gerend MA, Madkins K, Crosby S, Korpak AK, Phillips GL, Bass M, Houlberg M, Mustanski B. A Qualitative Analysis of Young Sexual Minority Men's Perspectives on Human Papillomavirus Vaccination. LGBT Health 2019; 6:350-356. [PMID: 31556791 DOI: 10.1089/lgbt.2019.0086] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose: Men who have sex with men (MSM) are affected disproportionately by cancers caused by human papillomavirus (HPV). A safe and effective vaccine is available to prevent HPV infection, yet rates of HPV vaccination among young MSM are low. Guided by the Information, Motivation, and Behavioral Skills model, the purpose of this study was to identify young sexual minority men's perspectives on HPV vaccination. Methods: Men (N = 29) 18-26 years of age, who identified as gay, bisexual, or queer, completed a semistructured interview. Vaccinated (n = 9) and unvaccinated men (n = 20) were interviewed. The interview assessed knowledge, motivation, and behavioral skills related to HPV vaccination as well as relevant contextual factors (e.g., provider recommendation). Interviews were coded for recurring themes. Results: Most participants were aware of HPV and the HPV vaccine; however, misconceptions and knowledge gaps were common with many believing that HPV vaccination was only for women. Motivational factors included perceived advantages (e.g., reducing risk of HPV-related disease) and disadvantages (e.g., stigma) of HPV vaccination, perceived threat of HPV-related disease, and subjective norms for HPV vaccination. Relevant behavioral skills included disclosure of sexual orientation and comfort discussing HPV vaccination. Concerns about vaccine cost, access, and convenience were salient barriers to initiating and completing the series. Encouragement from a health care provider was cited as the primary reason for receiving the HPV vaccine. Conclusion: When developing interventions to increase HPV vaccination among young sexual minority men, it is important to address facilitators and barriers that reflect the unique needs of this population.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Krystal Madkins
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Shariell Crosby
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Aaron K Korpak
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Gregory L Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Michael Bass
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
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17
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Rosales BM, Langton-Lockton J, Cornall AM, Roberts JM, Hillman RJ, Webster AC. Transplant Recipients and Anal Neoplasia Study: Design, Methods, and Participant Characteristics of a Prevalence Study. Transplant Direct 2019; 5:e434. [PMID: 30993188 PMCID: PMC6445652 DOI: 10.1097/txd.0000000000000873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/22/2019] [Indexed: 01/23/2023] Open
Abstract
Supplemental digital content is available in the text. Kidney recipients have anal cancer rates 3 times higher than the general population in Australia and New Zealand. High-risk human papillomavirus (HPV) genotypes are implicated in the majority of anal cancers. Establishing the epidemiology of anal HPV infection and precursors of anal cancer in transplant recipient populations is 1 consideration in any potential screening program. The Transplant and Anal Neoplasia Study is a cross-sectional study of the prevalence of anal cytological abnormalities and HPV deoxyribonucleic acid in kidney transplant recipients, as well as evaluating the acceptability of an anal cancer screening intervention. The study aims to recruit 100 kidney transplant recipients, older than 18 years, in Australia. Transplant recipients attending for a protocol biopsy at 3 and 12 months and annually posttransplant are approached to participate. Participants undergo an anal swab, which is then analyzed using liquid-based cytological examination and tested for the detection of 37 anogenital HPV deoxyribonucleic acid genotypes. Participants also complete a demographic and behavioral questionnaire that covers sexual behavior, history of anal symptoms, and possible anal cancer risk factors. Associations will be tested using multiple regression analysis. Recruitment for the study began in 2015 and is ongoing. To date, 96 (77%) of 125 kidney transplant recipients approached have consented to the study. The mean age is 48 (median, 47 y; range, 20–76 y), 59% are male, and Northwest European (58%) represented the largest ethnic group. No participants self-identified as Aboriginal or Torres Strait Islander. High consent rates and positive qualitative results suggest that a larger screening program may be well received by kidney transplant recipients, with increased resources and some modification to the timing of approach. Further results of the study will inform the possible implementation of a larger screening trial for prevention of anal cancers in kidney and other solid organ transplant recipients.
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Affiliation(s)
- Brenda Maria Rosales
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Alyssa M Cornall
- HPV LabNet Regional Reference Laboratory, Royal Women's Hospital, Parkville, Australia.,Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | | | - Richard J Hillman
- HIV, Immunology and Infectious Disease, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Angela Claire Webster
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Renal Medicine and Transplantation at Westmead Hospital, Westmead, Australia
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18
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Wei F, Su Y, Yao X, Cui X, Bian L, Yin K, Yu X, Zhuang C, Bi Z, Huang S, Li M, Wu T, Xia N, Zhang J. Sex differences in the incidence and clearance of anal human papillomavirus infection among heterosexual men and women in Liuzhou, China: An observational cohort study. Int J Cancer 2019; 145:807-816. [PMID: 30848495 DOI: 10.1002/ijc.32255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/16/2019] [Accepted: 03/05/2019] [Indexed: 11/11/2022]
Abstract
Anal cancer is primarily caused by human papillomavirus (HPV) infection in both men and women. However, little is known about the sex differences in the natural history of anal HPV infection in a heterosexual population. From May 2014 to March 2016, perianal/anal canal (PA) swab samples were collected semiannually from 2,302 heterosexual men and 2,371 heterosexual women aged 18-55 years old in Liuzhou, China. The specimens were genotyped for HPV DNA by polymerase chain reaction. The incidence rate ratio (IRR) and clearance rate ratio (CRR) were used to analyze the sex differences of incidence and clearance by Poisson regression, respectively. The incidences of PA oncogenic HPV in men and women were 3.4 per 1,000 person-months and 8.6 per 1,000 person-months, respectively, with an IRR of 0.39 (95% confidence interval (CI), 0.29-0.54 for men versus women) (p < 0.0001). The CRR of PA oncogenic HPV infection for men versus women was 1.54 (95% CI, 1.17-2.03) (p = 0.0022). At 12 months, 44% (20/45) of HPV 16/18 infections among women remained positive, whereas no (0/7) infections persisted among men (p = 0.0350). Both the higher incidence and slower clearance of anal carcinogenic HPV infection among women may lead to a higher burden of anal cancer among women than among men in a heterosexual population.
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Affiliation(s)
- Feixue Wei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Yingying Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Xingmei Yao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Xuelian Cui
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Lihong Bian
- Department of Gynecology, The 307th Hospital of Chinese People's Liberation Army, Beijing, China
| | - Kai Yin
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Xiaojuan Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Chunlan Zhuang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Zhaofeng Bi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shoujie Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Mingqiang Li
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, China
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19
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Fontenot HB, Rosenberger JG, McNair KT, Mayer KH, Zimet G. Perspectives and preferences for a mobile health tool designed to facilitate HPV vaccination among young men who have sex with men. Hum Vaccin Immunother 2019; 15:1815-1823. [PMID: 30625049 DOI: 10.1080/21645515.2019.1568156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We sought to understand young men who have sex with men (YMSM) perspectives and preferred features for a mobile health (mHealth) tool designed to facilitate human papillomavirus (HPV) vaccination. YMSM were recruited on a popular social/sexual networking app to participate in online focus groups. Discussions were designed to elicit what the men would want in a mHealth tool specific for sexual health and HPV. Demographic data were analyzed using descriptive statistics and focus group data were analyzed using conventional content analysis. Forty-eight YMSM participated. Mean age was 23.4 years, and 70.0% reported their race as Black. Qualitative themes included general HPV knowledge and awareness, current patterns in technology use, desired app qualities, and desired app content. Youth described varying levels of HPV knowledge, utilized apps to engage socially, and for travel, banking, gaming, news and entertainment, and few used apps to facilitate personal health or engage with healthcare systems. Participants desired credible, relatable, secure, and easy to use interfaces that provided sexual health and HPV information in a positive context. They described ways to creatively engage and directly connect youth to health providers. We identified a culturally relevant youth driven approach to facilitate HPV vaccination and sexual health among YMSM.
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Affiliation(s)
- Holly B Fontenot
- a Connell School of Nursing, Boston College , Chestnut Hill , MA , USA.,b Fenway Health/The Fenway Institute , Boston , MA , USA
| | - Joshua G Rosenberger
- c Department of Behavioral Health, Penn State University , University Park , PA , USA
| | - Katelyn T McNair
- a Connell School of Nursing, Boston College , Chestnut Hill , MA , USA
| | - Kenneth H Mayer
- b Fenway Health/The Fenway Institute , Boston , MA , USA.,d Beth Israel Deaconess Medical Center, Department of Medicine, Boston MA/Harvard Medical School , Boston , MA , USA
| | - Gregory Zimet
- e Section of Adolescent Medicine, Indiana University School of Medicine , Indianapolis , IN , USA
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20
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Grandahl M, Nevéus T, Dalianis T, Larsson M, Tydén T, Stenhammar C. 'I also want to be vaccinated!' - adolescent boys' awareness and thoughts, perceived benefits, information sources, and intention to be vaccinated against Human papillomavirus (HPV). Hum Vaccin Immunother 2018; 15:1794-1802. [PMID: 30481108 PMCID: PMC6746528 DOI: 10.1080/21645515.2018.1551670] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study investigates boys’ awareness and thoughts about human papillomavirus (HPV) and HPV vaccination, perceived benefits of vaccinating men, information sources and intention to be vaccinated against HPV. We used a qualitative approach and interviews were conducted with 31 upper secondary school male students. Two main themes 1) Promotion of equal health and 2) Increased knowledge facilitates the decision about HPV vaccination emerged from the analysis. The informants believed that it was important and fair to protect boys and girls equally against HPV. If HPV vaccination could prevent both girls and boys against an HPV-related disease, there was nothing to question or to discuss. It was not a matter of sex; it was a matter of equal rights. Moreover, an important reason for vaccinating boys was to prevent the transmission of the virus. However, the boys felt unsure and stated that they needed to know more. The school nurse and the school health were considered suitable both for distributing information and for providing the vaccinations. In conclusion, the participants were in favor of introducing HPV vaccination also for boys in the national vaccination program. Sex-neutral HPV vaccinations were viewed both as a way to stop the virus transmission and a means to promote equal health for the entire population.
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Affiliation(s)
- Maria Grandahl
- a Department of Women's and Children's Health, Uppsala University , Uppsala , Sweden
| | - Tryggve Nevéus
- a Department of Women's and Children's Health, Uppsala University , Uppsala , Sweden
| | - Tina Dalianis
- b Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Margareta Larsson
- a Department of Women's and Children's Health, Uppsala University , Uppsala , Sweden
| | - Tanja Tydén
- a Department of Women's and Children's Health, Uppsala University , Uppsala , Sweden
| | - Christina Stenhammar
- a Department of Women's and Children's Health, Uppsala University , Uppsala , Sweden
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21
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Tian T, Wang D, Papamichael C, Yan Z, Guoyao S, Zhanlin Z, Mahan Y, Xiaoqing T, Zheng G, Jianghong D. HPV vaccination acceptability among men who have sex with men in Urumqi, China. Hum Vaccin Immunother 2018; 15:1005-1012. [PMID: 30230946 PMCID: PMC6628869 DOI: 10.1080/21645515.2018.1520591] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Human papillomavirus (HPV) infection is common among men who have sex with men (MSM), especially among Human Immunodeficiency Virus (HIV)-infected MSM. The prevalence of HPV among MSM, accounts for the higher incidence of HPV-related cancer observed in this population. It is well known that targeted HPV vaccination is an effective way to prevent HPV infection; an intervention which could be beneficial for a high-risk group such as MSM. The current study aimed to assess the attitudes towards and acceptability of the HPV vaccine among MSM in in Urumqi, China. Methods: A total of 253 HIV-uninfected and 205 HIV-infected MSM (in Urumqi, China participated in the current cross-sectional study. Information on HPV-related knowledge, willingness to be vaccinated as well as demographic data were collected through a self-administered survey. A logistic regression model was applied to determine the predictors of HPV vaccine acceptability among the population. Results: The survey results indicated that only 218 (47.6%) of MSM questioned were aware of the term HPV, nevertheless, once awareness was established the prevalence of acceptability of free HPV vaccine was recorded at 96.7% of the total MSM sample. However, HIV-uninfected and HIV-infected MSM demonstrated significantly different attitudes in regard to their acceptability of free HPV vaccination (94.9% vs. 99.0%, p < 0.001) as well as their willingness to pay for the HPV vaccination (64.8% vs. 80.5%, p < 0.001), with the HIV-infected group being significantly more receptive towards HPV immunization. A multivariate logistic regression analysis indicated that local residency, employment status, hepatitis B vaccination status, previous awareness of HPV and HIV status were independent predictors of the participants’ willingness to pay for HPV vaccination. Conclusions: Participants in the current study demonstrated poor knowledge of HPV but the majority of MSM were willing to accept HPV vaccine after consultation; with HIV-infected MSM displaying higher acceptability towards a potential HPV vaccination than HIV-uninfected MSM. MSM who were previously aware of HPV were more likely to be willing to pay for HPV vaccine.
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Affiliation(s)
- Tian Tian
- a Department of Epidemiology and Health Statistics, School of Public Health , Xinjiang Medical University , Urumqi , Xinjiang , China
| | - Duolao Wang
- b Department of Clinical Sciences , Liverpool School of Tropical Medicine , Liverpool , UK
| | - Christiana Papamichael
- b Department of Clinical Sciences , Liverpool School of Tropical Medicine , Liverpool , UK
| | - Zhang Yan
- c Youth Road Hospital , Friendship Hospital , Urumqi , China
| | - Sang Guoyao
- d Clinical laboratory of Xinjiang Medical University First Affiliated Hospital , Urumqi , Xinjiang , China
| | - Zhang Zhanlin
- a Department of Epidemiology and Health Statistics, School of Public Health , Xinjiang Medical University , Urumqi , Xinjiang , China
| | - Yeledan Mahan
- a Department of Epidemiology and Health Statistics, School of Public Health , Xinjiang Medical University , Urumqi , Xinjiang , China
| | - Tuo Xiaoqing
- a Department of Epidemiology and Health Statistics, School of Public Health , Xinjiang Medical University , Urumqi , Xinjiang , China
| | - Gong Zheng
- a Department of Epidemiology and Health Statistics, School of Public Health , Xinjiang Medical University , Urumqi , Xinjiang , China
| | - Dai Jianghong
- a Department of Epidemiology and Health Statistics, School of Public Health , Xinjiang Medical University , Urumqi , Xinjiang , China
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22
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Ma X, Wang Q, Ong JJ, Fairley CK, Su S, Peng P, Jing J, Wang L, Soe NN, Cheng F, Zhang L. Prevalence of human papillomavirus by geographical regions, sexual orientation and HIV status in China: a systematic review and meta-analysis. Sex Transm Infect 2018; 94:434-442. [PMID: 29794242 DOI: 10.1136/sextrans-2017-053412] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/26/2018] [Accepted: 04/21/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Human papillomavirus (HPV) infection causes multiple cancers in both women and men. In China, both HPV vaccination and cervical cancer screening coverages are low. We aim to investigate the temporal and geographical trends of HPV DNA prevalence in heterosexual men, women, men who have sex with men (MSM) and people living with HIV (PLHIV) in China. METHODS We conducted a systematic review, collecting publications in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Data from January 2000 to May 2017. A total of 247 studies were selected for this meta-analysis to estimate pooled HPV prevalence, incidence of cervical cancer and risk of infection for subgroups. Meta-regression was applied to identify contributing factors to prevalence heterogeneities. RESULTS The national HPV prevalence was 15.6% (95% CI (14.4% to 16.9%)) in women with normal cervical cytology, and Central China had the highest prevalence (20.5% (15.2% to 25.8%)). HPV prevalence in heterosexual men (14.5% (11.3% to 17.7%)) was comparable with that of women (OR=1.09 (0.98 to 1.17)), but HPV prevalence in MSM (59.9% (52.2% to 67.6%)) was significantly higher than that in heterosexual men (OR=8.81 (8.01 to 9.69)). HIV-positive women (45.0% (38.4% to 51.6%)) and HIV-positive MSM (87.5% (82.3% to 90.9%)) had 4.67 (3.61 to 6.03) and 6.46 (5.20 to 8.02) times higher risk of HPV infection than their HIV negative counterparts. CONCLUSION HPV infection is prevalent in China, particularly in Central China, in comparison with the global level and neighbouring countries. Targeted HPV vaccination for women, MSM and PLHIV and scale-up of cervical screening for women are priorities in curbing the HPV epidemic in China.
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Affiliation(s)
- Xiaomeng Ma
- Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Research Centre for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Qian Wang
- Maternal and Child Healthcare Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jason J Ong
- Central Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Shu Su
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Peng Peng
- Research Centre for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Jun Jing
- Research Centre for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Linhong Wang
- Maternal and Child Healthcare Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Nyi Nyi Soe
- Research Centre for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Feng Cheng
- Research Centre for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Zhang
- Research Centre for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Central Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
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Lacombe-Duncan A, Newman PA, Baiden P. Human papillomavirus vaccine acceptability and decision-making among adolescent boys and parents: A meta-ethnography of qualitative studies. Vaccine 2018; 36:2545-2558. [PMID: 29625768 DOI: 10.1016/j.vaccine.2018.02.079] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/04/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Genital warts and human papillomavirus (HPV)-associated cancers in men can be substantially reduced through HPV vaccination; yet, globally, HPV vaccine uptake among boys remains low. This meta-ethnography synthesizes qualitative studies to understand, in-depth, HPV vaccine acceptability and decision-making among adolescent boys and/or their parents. METHODS A systematic search identified qualitative studies examining HPV vaccines from the perspectives of boys and/or boys' parents. The Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist was used to assess quality of reporting. Using meta-ethnographic techniques, we conducted a structured and iterative process of data analysis, coded original studies, and then developed descriptive and analytic themes to synthesize the findings. RESULTS Review of 15 eligible studies (n = 3362 parents, n = 39 boys) revealed multilevel factors that influence HPV vaccine acceptability and decision-making among adolescent boys and their parents: (1) individual, e.g., low HPV vaccine knowledge/awareness, (2) interpersonal, e.g., key relationships between parents, sons, and healthcare providers (HCP), (3) community/societal, e.g., parental duty to protect, and (4) systemic, e.g., HPV vaccine messaging. Parents generally accepted adolescent boys' sexuality and the need for vaccination, motivated by wanting to protect their sons from HPV and HPV-associated cancers, and valued HCP-initiated discussion and recommendation. Acceptability was mitigated by low awareness/knowledge of HPV vaccines and low perceived benefits for boys, lack of HCP-initiated discussion, out-of-pocket costs, multiple doses, stigma, and mixed messages about HPV. CONCLUSIONS Multilevel factors influence HPV vaccine acceptability and decision-making among parents and their adolescent sons. Providing clear and unambiguous messages about HPV vaccines-for whom (boys and girls), for what (genital warts and cancers in men), and when (before sexual debut)-through increased HCP-initiated discussion and targeted public health campaigns may support HPV vaccine uptake among boys. Future research should consistently disaggregate findings by sex of child and parent, and explore effective messaging tailored for boys and parents.
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Affiliation(s)
- Ashley Lacombe-Duncan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada.
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada.
| | - Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper Street, Box 19129, Arlington, Texas, USA.
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Tian T, Mijiti P, Bingxue H, Fadong Z, Ainiwaer A, Guoyao S, Zhanlin Z, Mahan Y, Xiaoqin T, Zheng G, Jianghong D. Prevalence and risk factors of anal human papillomavirus infection among HIV-negative men who have sex with men in Urumqi city of Xinjiang Uyghur Autonomous Region, China. PLoS One 2017; 12:e0187928. [PMID: 29141014 PMCID: PMC5687769 DOI: 10.1371/journal.pone.0187928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/27/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Infection with human papillomavirus (HPV) is the most common sexually transmitted infection among men who have sex with men (MSM). Study on prevalence and risk factors of anal HPV infection among HIV-negative MSM in Northwestern China was rare. METHODS We performed a cross-sectional study of HPV prevalence using anal swab specimens among HIV-negative MSM in Urumqi city of Xinjiang Uyghur Autonomous Region, China between April 1st and October 30th in 2016. Prevalence of any anal HPV infection, high-risk and low-risk HPV infection was estimated. Risk factors associated with any anal HPV infection was analyzed using univariate and multivariate logistic regression models. RESULTS Among 538 potential participants, 500(92.9%) were recruited in this study. The genotyping results of anal HPV infection were available for all. Of them, 259 (51.8%), 190 (38.0%) and 141(28.2%) were positive for at least one of the targeted 37 HPV genotypes, high-risk HPV genotypes, and any low-risk HPV genotypes. The most prevalent anal HPV genotype was HPV 6(11.8%), followed by HPV 16(11.2%), HPV 11(10.8%), HPV 51(7.0%) and HPV 18(5.4%).Among those infected with at least one of the targeted 37 anal HPV genotypes, 75(29.0%), 155(59.8%) and 191(73.7%) were infected with 2-valent, quadrivalent and 9-valent HPV vaccine-covered genotypes. Receptive anal intercourse in the past year was the only predictor of any anal HPV infection in multivariate logistic regression model. CONCLUSION Prevalence of any anal HPV infection and high-risk HPV infection among HIV-negative MSM in Urumqi city of Xinjiang is high. The majority of genotypes detected in our study were covered by quadrivalent and 9-valent HPV vaccines. Regular anal exams and early HPV vaccination among MSM may be considered in future HPV prevention programs in Xinjiang, China.
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Affiliation(s)
- Tian Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Peierdun Mijiti
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Huang Bingxue
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhang Fadong
- Surgery Department of Toutunhe District General Hospital, Urumqi, Xinjiang, China
| | - Abidan Ainiwaer
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Sang Guoyao
- Clinical Laboratory of Xinjiang Medical University First Affiliated Hospital, Urumqi, Xinjiang, China
| | - Zhang Zhanlin
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yeledan Mahan
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tuo Xiaoqin
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Gong Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Dai Jianghong
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
- * E-mail:
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25
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Khattab R, McMeekin E, Taege AJ, Hekman JM, Brainard JA, Underwood D, Procop GW, Sturgis CD. Unsatisfactory exfoliative anal cytology samples, 15-year experience with histologic, cytologic, and molecular follow-up. Diagn Cytopathol 2017; 46:117-121. [PMID: 29124900 DOI: 10.1002/dc.23858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/21/2017] [Accepted: 10/23/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The incidence of anal carcinoma has risen in recent decades. Exfoliative cytology screening of selected high risk patients is performed in many centers. Unsatisfactory cytology results are frustrating to patients, clinicians, and laboratorians. The aim of this study is to ascertain outcomes of patients with non-diagnostic anal cytology. METHODS A retrospective review of anal cytology testing performed at the Cleveland Clinic between 01/01/2001 and 12/31/2015 was performed. All cases were received as liquid-based samples and processed as ThinPreps (Hologic, Marlborough, MA). Co-testing for HR-HPV DNA was performed using Hybrid Capture 2® (Qiagen, Germantown, MD) in the majority of patients. RESULTS Of 1,276 ThinPrep anal cytology samples, 130 (10%) were deemed unsatisfactory. 77% of patients were HIV positive. 85% were males. Of the unsatisfactory cases, 116 (89%) were co-tested for HR-HPV DNA. Of those, 40 patients (34%) had a simultaneous positive HR-HPV DNA. Adequate follow up cytology within a one year and a two year period revealed that 18/130 (14%) and 26/130 (20%) of patients had ASC or SIL respectively. Histologic follow-up within one and two years showed 3 patients (2%) and 8 patients (6%) with HSIL or worse. CONCLUSIONS High risk patients with unsatisfactory anal cytology are not "negative". At least one-third proved to be concomitantly HR-HPV DNA positive with one-fifth showing subsequent cytologic squamous abnormalities and with more than 5% being diagnosed with a high grade intraepithelial lesion within two years. Prompt repeat cytology and/or HR-HPV DNA is recommended for high risk patients with non-diagnostic cytology.
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Affiliation(s)
- Ruba Khattab
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Emily McMeekin
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alan J Taege
- Department of Infectious Diseases, Cleveland Clinic, Ohio
| | - James M Hekman
- Department of Community Internal Medicine, Cleveland Clinic, Ohio
| | - Jennifer A Brainard
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dawn Underwood
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles D Sturgis
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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26
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Stupiansky NW, Liau A, Rosenberger J, Rosenthal SL, Tu W, Xiao S, Fontenot H, Zimet GD. Young Men's Disclosure of Same Sex Behaviors to Healthcare Providers and the Impact on Health: Results from a US National Sample of Young Men Who Have Sex with Men. AIDS Patient Care STDS 2017; 31:342-347. [PMID: 28753396 DOI: 10.1089/apc.2017.0011] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many men who have sex with men (MSM) do not disclose their same sex behaviors to healthcare providers (HCPs). We used a series of logistic regression models to explore a conceptual framework that first identified predictors of disclosure to HCPs among young MSM (YMSM), and subsequently examined young men's disclosure of male-male sexual behaviors to HCPs as a mediator between sociodemographic and behavioral factors and three distinct health outcomes [HIV testing, sexually transmitted infection (STI) testing, and human papillomavirus (HPV) vaccination]. We determined the predictors of disclosure to HCPs among YMSM and examined the relationship between disclosure and the receipt of appropriate healthcare services. Data were collected online through a US national sample of 1750 YMSM (ages 18-29 years) using a social and sexual networking website for MSM. Sexual history, STI/HIV screening history, sexual health, and patient-provider communication were analyzed in the logistic regression models. Participants were predominantly white (75.2%) and gay/homosexual (76.7%) with at least some college education (82.7%). Young men's disclosure of male-male sexual behaviors to HCPs was associated with the receipt of all healthcare outcomes in our model. Disclosure was a stronger mediator in HPV vaccination than in HIV and STI testing. Disclosure to non-HCP friends and family, HCP visit in the past year, and previous STI diagnosis were the strongest predictors of disclosure. Young men's disclosure of male-male sexual behaviors to HCPs is integral to the receipt of appropriate healthcare services among YMSM. HPV vaccination is more dependent on provider-level interaction with patients than HIV/STI testing.
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Affiliation(s)
- Nathan W. Stupiansky
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Adrian Liau
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Joshua Rosenberger
- Pennsylvania State University College of Health and Human Development, State College, Pennsylvania
| | | | - Wanzhu Tu
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Shan Xiao
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Holly Fontenot
- Boston College William F. Connell School of Nursing, Boston, Massachusetts
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Wentzensen N, Arbyn M, Berkhof J, Bower M, Canfell K, Einstein M, Farley C, Monsonego J, Franceschi S. Eurogin 2016 Roadmap: how HPV knowledge is changing screening practice. Int J Cancer 2017; 140:2192-2200. [PMID: 28006858 DOI: 10.1002/ijc.30579] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 01/01/2023]
Abstract
Human papillomaviruses (HPVs) are the necessary cause of most cervical cancers, a large proportion of other anogenital cancers, and a subset of oropharyngeal cancers. The knowledge about HPV has led to development of novel HPV-based prevention strategies with important impact on clinical and public health practice. Two complementary reviews have been prepared following the 2015 Eurogin Conference to evaluate how knowledge about HPV is changing practice in HPV infection and disease control through vaccination and screening. This review focuses on screening for cervical and anal cancers in increasingly vaccinated populations. The introduction of HPV vaccines a decade ago has led to reductions in HPV infections and early cancer precursors in countries with wide vaccination coverage. Despite the high efficacy of HPV vaccines, cervical cancer screening will remain important for many decades. Many healthcare systems are considering switching to primary HPV screening, which has higher sensitivity for cervical precancers and allows extending screening intervals. We describe different approaches to implementing HPV-based screening efforts in different healthcare systems with a focus in high-income countries. While the population prevalence for other anogenital cancers is too low for population-based screening, anal cancer incidence is very high in HIV-infected men who have sex with men, warranting consideration of early detection approaches. We summarize the current evidence on HPV-based prevention of anal cancers and highlight important evidence gaps.
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Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology & Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Johannes Berkhof
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark Bower
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Einstein
- Department of OB/GYN & Women's Health, Rutgers New Jersey Medical School, Newark, USA
| | - Christopher Farley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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28
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Gottvall M, Stenhammar C, Grandahl M. Parents' views of including young boys in the Swedish national school-based HPV vaccination programme: a qualitative study. BMJ Open 2017; 7:e014255. [PMID: 28246143 PMCID: PMC5337740 DOI: 10.1136/bmjopen-2016-014255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explore parents' views of extending the human papillomavirus (HPV) vaccination programme to also include boys. DESIGN Explorative qualitative design using individual, face-to-face, interviews and inductive thematic analysis. SETTING 11 strategically chosen municipalities in central Sweden. PARTICIPANTS Parents (n=42) who were offered HPV vaccination for their 11-12 years old daughter in the national school-based vaccination programme. RESULTS The key themes were: equality from a public health perspective and perception of risk for disease. Parents expressed low knowledge and awareness about the health benefits of male HPV vaccination, and they perceived low risk for boys to get HPV. Some parents could not see any reason for vaccinating boys. However, many parents preferred gender-neutral vaccination, and some of the parents who had not accepted HPV vaccination for their daughter expressed that they would be willing to accept vaccination for their son, if it was offered. It was evident that there was both trust and distrust in authorities' decision to only vaccinate girls. Parents expressed a preference for increased sexual and reproductive health promotion such as more information about condom use. Some parents shared that it was more important to vaccinate girls than boys since they believed girls face a higher risk of deadly diseases associated with HPV, but some also believed girls might be more vulnerable to side effects of the vaccine. CONCLUSIONS A vaccine offered only to girls may cause parents to be hesitant to vaccinate, while also including boys in the national vaccination programme might improve parents' trust in the vaccine. More information about the health benefits of HPV vaccination for males is necessary to increase HPV vaccination among boys. This may eventually lead to increased HPV vaccine coverage among both girls and boys.
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Affiliation(s)
- Maria Gottvall
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Red Cross University College, Huddinge, Sweden
| | - Christina Stenhammar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Grandahl
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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29
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Limia CM, Soto Y, García Y, Blanco O, Kourí V, López MV, Toledo ME, Pérez L, Baños Y, Caturla Y, Aguayo F. Human papillomavirus infection in anal intraepithelial lesions from HIV infected Cuban men. Infect Agent Cancer 2017; 12:5. [PMID: 28115985 PMCID: PMC5240437 DOI: 10.1186/s13027-017-0118-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/11/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND An association between HPV infection and progression to anal squamous intraepithelial lesions (ASIL) has been established, specifically in high-risk populations such as HIV-infected men. In this population, anal cancer is one of the most common non-AIDS-defining malignancies. METHODS A cross-sectional study to detect anal lesions and HPV infection was performed. Anal mucosa samples were collected from 56 HIV-infected men from Cuba. The cytological diagnosis was done according to Bethesda 2001 System. HPV DNA detection was determined by qPCR for six high-risk HPV types and end point PCR for low-risk HPV types (6 and 11). The end point PCR with nucleotide sequencing technique was achieved to detect other genotypes of HPV not included in the qPCR in those samples negative for HPV- 6 and 11 or negative for the six genotypes identified in the qPCR. RESULTS Cytological diagnosis identified 53 of 56 (95%) men with abnormal anal cytology. Among those, 26% (14/53) had atypical squamous cells of undetermined significance (ASC-US), 4% (2/53) had atypical squamous cells of undetermined significance cannot exclude high-grade lesions (ASC-H), 64% (34/53) had low-grade squamous intraepithelial lesions (LSIL), and 6% (3/53) had high-grade squamous intraepithelial lesions (HSIL). HPV DNA was detected in 89% (50/56) of men and 79% had at least one of the high-risk HPV types. HPV- 16 was the most common genotype (52%), while HPV-18 was the most frequently detected genotype in men with HSIL. We found statistically significant differences in the HPV viral loads with respect to the cytology results (p = 0.0006) and that the practice of receptive anal sex was a risk factor for anal HPV infection (p = 0.032). CONCLUSION This study shows a high prevalence of ASIL and high-risk HPV infections in the study group and is the first study showing the distribution of HPV genotypes in HIV infected Cuban men with abnormal anal cytology. This information may be of importance for local decision makers to improve prevention strategies, including the introduction of HPV vaccine in Cuba.
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Affiliation(s)
- Celia M Limia
- Institute of Tropical Medicine "Pedro Kourí", Autopista Novia del Mediodía Km 6 ½, P.O.Box. 601, Marianao 13, La Habana Cuba
| | - Yudira Soto
- Institute of Tropical Medicine "Pedro Kourí", Autopista Novia del Mediodía Km 6 ½, P.O.Box. 601, Marianao 13, La Habana Cuba
| | - Yanara García
- General Hospital "Enrique Cabrera Cossío", Calzada Aldabó 11117 esquina E, Boyeros, 10800 La Habana Cuba
| | - Orestes Blanco
- Institute of Tropical Medicine "Pedro Kourí", Autopista Novia del Mediodía Km 6 ½, P.O.Box. 601, Marianao 13, La Habana Cuba
| | - Vivian Kourí
- Institute of Tropical Medicine "Pedro Kourí", Autopista Novia del Mediodía Km 6 ½, P.O.Box. 601, Marianao 13, La Habana Cuba
| | - María V López
- General Hospital "Enrique Cabrera Cossío", Calzada Aldabó 11117 esquina E, Boyeros, 10800 La Habana Cuba
| | - María E Toledo
- Institute of Tropical Medicine "Pedro Kourí", Autopista Novia del Mediodía Km 6 ½, P.O.Box. 601, Marianao 13, La Habana Cuba
| | - Lissette Pérez
- Institute of Tropical Medicine "Pedro Kourí", Autopista Novia del Mediodía Km 6 ½, P.O.Box. 601, Marianao 13, La Habana Cuba
| | - Yoanna Baños
- Institute of Tropical Medicine "Pedro Kourí", Autopista Novia del Mediodía Km 6 ½, P.O.Box. 601, Marianao 13, La Habana Cuba
| | - Yaniris Caturla
- Institute of Tropical Medicine "Pedro Kourí", Autopista Novia del Mediodía Km 6 ½, P.O.Box. 601, Marianao 13, La Habana Cuba
| | - Francisco Aguayo
- Virology Program, I.C.B.M., Faculty of Medicine, University of Chile, Independencia, 1027 Chile
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30
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Fontenot HB, Fantasia HC, Vetters R, Zimet GD. Increasing HPV vaccination and eliminating barriers: Recommendations from young men who have sex with men. Vaccine 2016; 34:6209-6216. [PMID: 27838067 DOI: 10.1016/j.vaccine.2016.10.075] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/20/2016] [Accepted: 10/28/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is a disparity in HPV vaccination rates in particular among young men who have sex with men (YMSM) and until very recently there has been a dearth of research examining factors related to HPV vaccination for YMSM. The purpose of this study was to elicit YMSM's beliefs about HPV and the HPV vaccine as well as describe perceived barriers and facilitators of vaccine initiation and completion. METHODS A qualitative, descriptive study that utilized a focus group design was conducted among an urban and racially diverse sample of YMSM. Questionnaire data were analyzed using descriptive statistics, and focus group data were analyzed using content analysis. FINDINGS 34 YMSM with a mean age of 20.8years participated. The sample was diverse, with the largest proportion of youth identifying as Black (35.4%). Over 90% reported having an annual exam each year, 61.8% reported obtaining a flu vaccine during the past year, and 58.8% reported initiating the HPV vaccine 3-dose series. Themes identified included low HPV knowledge and awareness, positive vaccine beliefs, perceived stigmas, and HPV vaccine facilitators. Participants identified 3 ways health providers/ researchers could facilitate vaccination: creative use of mobile technology, bundling vaccination with other health services, and increasing HPV and HPV vaccine awareness. CONCLUSIONS Our findings point to some clear avenues to pursue in research and practice to improve HPV vaccination rates among YMSM, including increased use of mobile health strategies, making HPV vaccination a co-occurring part of other health-related services (e.g., HIV testing), and providing information on the relevance of HPV and HPV vaccination to YMSM.
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Affiliation(s)
- Holly B Fontenot
- Boston College, W.F. Connell School of Nursing, Chestnut Hill, MA 02467, United States; The Fenway Institute, 1340 Boylston St., Boston, MA 02215, United States; Fenway Health/Sidney Borum Jr. Health Center, 75 Kneeland St., Boston, MA 02111, United States.
| | - Heidi C Fantasia
- University of Massachusetts Lowell, College of Health Sciences, School of Nursing, 113 Wilder Street, Lowell, MA 01854, United States.
| | - Ralph Vetters
- Fenway Health/Sidney Borum Jr. Health Center, 75 Kneeland St., Boston, MA 02111, United States.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, Section of Adolescent Medicine, 410 West 10th St., Indianapolis, IN 46202, United States.
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Cromwell I, Gaudet M, Peacock SJ, Aquino-Parsons C. Cost-effectiveness analysis of anal cancer screening in women with cervical neoplasia in British Columbia, Canada. BMC Health Serv Res 2016; 16:206. [PMID: 27349646 PMCID: PMC4924299 DOI: 10.1186/s12913-016-1442-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 05/28/2016] [Indexed: 12/02/2022] Open
Abstract
Background Precursors to anal squamous cell carcinoma may be detectable through screening; however, the literature suggests that population-level testing is not cost-effective. Given that high-grade cervical neoplasia (CIN) is associated with an increased risk of developing anal cancer, and in light of changing guidelines for the follow-up and management of cervical neoplasia, it is worthwhile to examine the costs and effectiveness of an anal cancer screening program delivered to women with previously-detected CIN. Methods A model of anal cancer screening and treatment was constructed, to estimate the cost-effectiveness of a population of CIN II/III+ women who were screened using anal cytology vs. one that received no anal cancer screening. Costs were based on Canadian estimates, and survival was based on estimates taken from the scientific literature. Effectiveness was measured in terms of life years gained (LYG) and quality-adjusted life years (QALYs). The model was run for 50 cycles, with each cycle representing one year. Results Incremental cost (screened vs. unscreened) was $82.17 per woman in the model. Incremental effectiveness was 0.004 LYG, and was equivalent to zero in terms of QALY. An ICER of $20,561/LYG was calculated, while no meaningful incremental cost-effectiveness ratio (ICER) could be calculated for quality-adjusted survival. Conclusion Our analysis suggests that anal cancer screening is cost-effective in terms of overall survival in women with a previous diagnosis of CIN II or CIN III as part of regular follow-up, but may not contribute meaningfully-different quality-adjusted survival due to the adverse effects of screening-related interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1442-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Cromwell
- Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada. .,Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada.
| | - M Gaudet
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada.,Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Canada
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada.,Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - C Aquino-Parsons
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada
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Meites E, Gorbach PM, Gratzer B, Panicker G, Steinau M, Collins T, Parrish A, Randel C, McGrath M, Carrasco S, Moore J, Zaidi A, Braxton J, Kerndt PR, Unger ER, Crosby RA, Markowitz LE. Monitoring for Human Papillomavirus Vaccine Impact Among Gay, Bisexual, and Other Men Who Have Sex With Men-United States, 2012-2014. J Infect Dis 2016; 214:689-96. [PMID: 27296847 DOI: 10.1093/infdis/jiw232] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/26/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM) are at high risk for human papillomavirus (HPV) infection; vaccination is recommended for US males, including MSM through age 26 years. We assessed evidence of HPV among vaccine-eligible MSM and transgender women to monitor vaccine impact. METHODS During 2012-2014, MSM aged 18-26 years at select clinics completed a computer-assisted self-interview regarding sexual behavior, human immunodeficiency virus (HIV) status, and vaccinations. Self-collected anal swab and oral rinse specimens were tested for HPV DNA (37 types) by L1 consensus polymerase chain reaction; serum was tested for HPV antibodies (4 types) by a multiplexed virus-like particle-based immunoglobulin G direct enzyme-linked immunosorbent assay. RESULTS Among 922 vaccine-eligible participants, the mean age was 23 years, and the mean number of lifetime sex partners was 37. Among 834 without HIV infection, any anal HPV was detected in 69.4% and any oral HPV in 8.4%, yet only 8.5% had evidence of exposure to all quadrivalent vaccine types. In multivariate analysis, HPV prevalence varied significantly (P < .05) by HIV status, sexual orientation, and lifetime number of sex partners, but not by race/ethnicity. DISCUSSIONS Most young MSM lacked evidence of current or past infection with all vaccine-type HPV types, suggesting that they could benefit from vaccination. The impact of vaccination among MSM may be assessed by monitoring HPV prevalence, including in self-collected specimens.
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Affiliation(s)
- Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles
| | | | - Gitika Panicker
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases
| | - Martin Steinau
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases
| | - Tom Collins
- College of Public Health, University of Kentucky, Lexington
| | - Adam Parrish
- College of Public Health, University of Kentucky, Lexington
| | | | - Mark McGrath
- Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles
| | - Steven Carrasco
- Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles
| | - Janell Moore
- Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles
| | - Akbar Zaidi
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jim Braxton
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter R Kerndt
- Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases
| | | | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
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Machalek DA, Poynten IM, Jin F, Hillman RJ, Templeton DJ, Law C, Roberts JM, Tabrizi SN, Garland SM, Farnsworth A, Fairley CK, Grulich AE. A Composite Cytology-Histology Endpoint Allows a More Accurate Estimate of Anal High-Grade Squamous Intraepithelial Lesion Prevalence. Cancer Epidemiol Biomarkers Prev 2016; 25:1134-43. [PMID: 27197289 DOI: 10.1158/1055-9965.epi-15-1106] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/19/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is debate about the accuracy of anal cytology and high-resolution anoscopy (HRA), in the diagnosis of anal human papillomavirus (HPV)-related squamous intraepithelial lesions (SIL). Few studies have performed both simultaneously in a large sample of high-risk individuals. METHODS At baseline in a community-based cohort of HIV-infected and uninfected homosexual men ages ≥35 years in Sydney, Australia, all men underwent anal swabbing for cytology and HPV genotyping, and HRA-guided biopsy. We evaluated the separate and combined diagnostic accuracy of cytology and histology, based on a comparison with the prevalence of HPV16 and other high-risk (HR) HPV. We examined trends in HPV prevalence across cytology-histology combinations. RESULTS Anal swab, HRA, and HPV genotyping results were available for 605 of 617 participants. The prevalence of cytologically predicted high-grade SIL (HSIL, 17.9%) was lower than histologically diagnosed HSIL (31.7%, P < 0.001). The prevalence of composite-HSIL (detected by either method) was 37.7%. HPV16 prevalence was similar in men with HSIL by cytology (59.3%), HSIL by histology (51.0%), and composite-HSIL (50.0%). HPV16 prevalence was 31.1% in men with composite-atypical squamous cells suggestive of HSIL, to 18.5% in men with composite-low-grade SIL, to 12.1% in men with composite-negative results (Ptrend < 0.001). CONCLUSIONS Significantly more HSIL was detected when a composite cytology-histology endpoint was used. Increasing grade of composite endpoint was associated with increasing HPV16 prevalence. IMPACT These data suggest that a composite cytology-histology endpoint reflects meaningful disease categories and is likely to be an important biomarker in anal cancer prevention. Cancer Epidemiol Biomarkers Prev; 25(7); 1134-43. ©2016 AACR.
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Affiliation(s)
- Dorothy A Machalek
- HIV Epidemiology and Prevention Program, The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia. Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia. Murdoch Childrens Research Institute, Melbourne, Australia
| | - I Mary Poynten
- HIV Epidemiology and Prevention Program, The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Fengyi Jin
- HIV Epidemiology and Prevention Program, The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Richard J Hillman
- Western Sydney Sexual Health Centre, University of Sydney, Sydney, Australia. St Vincent's Hospital, Sydney, Australia
| | - David J Templeton
- HIV Epidemiology and Prevention Program, The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia. RPA Sexual Health, Sydney Local Health District, Sydney, Australia
| | | | | | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia. Murdoch Childrens Research Institute, Melbourne, Australia. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia. Murdoch Childrens Research Institute, Melbourne, Australia. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Andrew E Grulich
- HIV Epidemiology and Prevention Program, The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia.
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Cornall AM, Roberts JM, Molano M, Machalek DA, Phillips S, Hillman RJ, Grulich AE, Jin F, Poynten IM, Templeton DJ, Garland SM, Tabrizi SN. Laser capture microdissection as a tool to evaluate human papillomavirus genotyping and methylation as biomarkers of persistence and progression of anal lesions. BMJ Open 2015; 5:e008439. [PMID: 26310402 PMCID: PMC4554896 DOI: 10.1136/bmjopen-2015-008439] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Anal squamous cell carcinoma is preceded by persistent infection with high-risk human papillomavirus (HPV) and the cancer precursor, high-grade squamous intraepithelial lesion (HSIL). Detection of specific HPV genotypes and HPV-related biomarkers may be an option for primary anal screening. However, more data on the natural history of HPV-related anal lesions are required. The outcomes from this study will enhance our understanding of the clinical and biological behaviour of HPV-related anal lesions and inform the development of future HPV genotype and/or biomarker screening tests. METHODS AND ANALYSIS HIV-negative and HIV-positive men who have sex with men, aged 35 years and over, recruited from community-based settings in Sydney, Australia, attend 6 clinic visits over 3 years. At the first 5 visits, participants undergo a digital anorectal examination, an anal swab for HPV genotyping and anal cytology, and high-resolution anoscopy with directed biopsy of any visible abnormalities that are suggestive of any abnormality suspicious of SIL. Tissue sections from participants diagnosed with histologically confirmed HSIL at the baseline clinic visit will undergo laser capture microdissection, HPV detection and genotyping, and quantitation of CpG methylation in baseline and follow-up biopsies. Histological and cytological findings in combination with HPV genotyping data will be used to identify persistent HSIL. HSIL will be stratified as non-persistent and persistent based on their status at 12 months. The performance of HPV genotype and methylation status in predicting disease persistence at 12 months will be assessed, along with associations with HIV status and other covariates such as age. ETHICS AND DISSEMINATION The St Vincent's Hospital Ethics Committee granted ethics approval for the study. Written informed consent is obtained from all individuals before any study-specific procedures are performed. Findings from this study will be disseminated to participants and the community through study newsletters, and through peer-reviewed publications and international conferences.
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Affiliation(s)
- Alyssa M Cornall
- Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | | | - Monica Molano
- Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Dorothy A Machalek
- Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Samuel Phillips
- Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Richard J Hillman
- Western Sydney Sexual Health Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew E Grulich
- The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia
| | - I Mary Poynten
- The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia
| | - David J Templeton
- The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia
- RPA Sexual Health, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Suzanne M Garland
- Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne
| | - Sepehr N Tabrizi
- Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne
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Li Z, Zhang H, Li X, Yang Y, Xin H, Li M, Feng B, Gao L. Anal Human Papillomavirus Genotyping among HIV-Positive Men Who Have Sex with Men in Xi'an, China. PLoS One 2015; 10:e0125120. [PMID: 25923768 PMCID: PMC4414525 DOI: 10.1371/journal.pone.0125120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/20/2015] [Indexed: 12/28/2022] Open
Abstract
Background Anal human papillomavirus (HPV) infection and its related diseases are relatively common in men who have sex with men (MSM), especially in those HIV positive. In China, molecular epidemiology of anal HPV infection among HIV-positive MSM has been sparsely studied. Methods A cross-sectional study was conducted among HIV-positive MSM in Xi’an, China between April and July 2014. Anal swabs were collected for HPV genotyping. Results A total of 195 HIV-positive MSM were included in this study. HPV genotyping showed that 99.0% (191/193) of participants were positive for at least one of the targeted 37 HPV genotypes. 183 (94.8%) of them were infected with multiple high-risk types and 154 (79.8%) of them with low-risk HPV types. HPV 18 was the most frequently identified high-risk type, followed by HPV 16 and HPV 51. As for low-risk types, HPV11, HPV 6 and HPV 81 were most commonly observe. High-risk HPV infection was found to be associated with the status of antiretroviral therapy (ART), the distribution of low-risk types was observed to be varied by CD4+ T cell level. Conclusion Almost all HIV-positive MSM were anal HPV infected in our study. It is highly recommended to consider regular active screening and preventive intervention of HPV infection among this high risk population.
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Affiliation(s)
- Zhen Li
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Haoran Zhang
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Xiangwei Li
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Yu Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, 100191, China
| | - Henan Xin
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Mufei Li
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Boxuan Feng
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Lei Gao
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
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Abstract
Human papillomavirus (HPV) is one of the most common sexually transmitted infections. It is a leading cause of cervical cancer in women but the virus is increasingly being linked to several other cancers in men and women alike. Since the introduction of safe and effective but also expensive vaccines, many developed countries have implemented selective vaccination programs for girls. Some however argue that these programs should be expanded to include boys, since (1) HPV constitutes non-negligible health risks for boys as well and (2) protected boys will indirectly also protect girls. In this paper we approach this discussion from an ethical perspective. First, on which moral grounds can one justify not reimbursing vaccination for the male sex? We develop an ethical framework to evaluate selective vaccination programs and conclude that, in the case of HPV, efficiency needs to be balanced against non-stigmatization, non-discrimination and justice. Second, if vaccination programs were to be expanded to boys as well, do the latter then also have a moral duty to become immunized? Two arguments in favor of such a moral duty are well known in vaccination ethics: the duty not to harm others and to contribute to the public good of public health. However, we argue that these are not particularly convincing in the context of HPV. In contrast, we believe a third, more powerful but also more controversial argument is possible. In our view, the sexual mode of transmission of HPV constitutes an additional reason to believe that boys in fact may have a moral obligation to accept vaccination.
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Affiliation(s)
- Jeroen Luyten
- Centre for Health Economics Research and Modelling Infectious Diseases, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium,
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Burgos J, Curran A, Tallada N, Guelar A, Navarro J, Landolfi S, Villar J, Crespo M, Ribera E, Falcó V. Risk of progression to high-grade anal intraepithelial neoplasia in HIV-infected MSM. AIDS 2015; 29:695-702. [PMID: 25849833 DOI: 10.1097/qad.0000000000000603] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the value of several factors to predict the risk of progression to high-grade anal intraepithelial neoplasia (HGAIN) in a cohort of HIV-infected MSM. DESIGN Longitudinal study of 556 HIV-infected MSM who underwent screening for anal dysplasia (include anal cytology and high-resolution anoscopy at each visit). METHODS Progression rate to HGAIN was estimated by Kaplan-Meier analysis. Predictors of progression were assessed by Cox-proportional hazards regression. RESULTS Sixty-eight incidents HGAIN cases over 649 person-years of follow-up were diagnosed, resulting in a progression rate of 10.5 cases/100 person-years [95% confidence interval (CI), 8.1-13.3). The cumulative incidence of HGAIN was 7.2% at 12 months (95% CI, 4.3-10.1) and 16.2% at 24 months (95% CI, 11.7-20.7). Independent risk factors for progression were as follows: abnormal cytology [hazard ratio (HR), 2.5 (95% CI, 1.2-4.9) if low-grade squamous intraepithelial lesion, HR 2.76 (95% CI, 1.4-5.3) if atypical squamous cells of uncertain significance and HR 7.73 (95% CI, 2.3-25.4) if high-grade squamous intraepithelial lesion], abnormal high-resolution anoscopy (HR 3.57; 95% CI, 2-6.4) and infection by 16 or 18 human papillomavirus (HR 1.63; 95% CI, 1-2.6). To be receiving HAART (HR 0.4; 95% CI, 0.2-0.7) and have stable sexual couple (HR 0.62; 95% CI, 0.4-0.9) were protective factors. Patients with favorable predictors had an incident rate of 2.86 cases/100 person-years (95% CI, 3.5-10.3). CONCLUSION The rate of progression to HGAIN varies according to different predictors that should be considered when assessing the particular risk of each patient. Patients with low risk of progression could be screened at longer intervals. BRIEF SUMMARY We describe the risk of progression to HGAIN in a cohort of 556 HIV-infected MSM. The incidence rate of HGAIN varies widely according to different predictors. These factors should be considered when assessing the particular risk of each patient.
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Walsh T, Bertozzi-Villa C, Schneider JA. Systematic review of racial disparities in human papillomavirus-associated anal dysplasia and anal cancer among men who have sex with men. Am J Public Health 2015; 105:e34-45. [PMID: 25713941 DOI: 10.2105/ajph.2014.302469] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We systematically reviewed the literature on anal human papillomavirus (HPV) infection, dysplasia, and cancer among Black and White men who have sex with men (MSM) to determine if a racial disparity exists. We searched 4 databases for articles up to March 2014. Studies involving Black MSM are nearly absent from the literature. Of 25 eligible studies, 2 stratified by race and sexual behavior. Both reported an elevated rate of abnormal anal outcomes among Black MSM. White MSM had a 1.3 times lower prevalence of group-2 HPV (P < .01) and nearly 13% lower prevalence of anal dysplasia than did Black MSM. We were unable to determine factors driving the absence of Black MSM in this research and whether disparities in clinical care exist. Elevated rates of abnormal anal cytology among Black MSM in 2 studies indicate a need for future research in this population.
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Affiliation(s)
- Tim Walsh
- Tim Walsh, Clara Bertozzi-Villa, and John. A. Schneider are with the Department of Medicine and the Chicago Center for HIV Elimination, University of Chicago, IL. John A. Schneider is also with the Department of Public Health Sciences, University of Chicago
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Newman PA, Lacombe-Duncan A. Human papillomavirus vaccination for men: advancing policy and practice. Future Virol 2014. [DOI: 10.2217/fvl.14.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT The quadrivalent HPV vaccine (HPV4) is safe and highly efficacious, and can significantly reduce the burden of HPV-related genital warts and cancers among men, in addition to promoting herd immunity. Nevertheless, HPV4 coverage among boys remains low in most settings. Research to date has focused predominantly on HPV vaccination of girls to prevent cervical cancer. Most countries with publicly funded healthcare where HPV4 is licensed cover the costs of HPV vaccination programs for girls only. We critically review the evidence for extending publicly funded HPV vaccination programs to boys in addition to girls. After an overview of research on HPV prevalence and associated cancers among men, we review cost–effectiveness studies, benefits of universal versus targeted vaccination approaches and multifaceted health equity concerns, along with directions in vaccine delivery programs and intervention research to promote HPV vaccine uptake for boys. Comprehensive evaluation of the systematic exclusion of boys from publicly financed HPV vaccination programs is warranted given tremendous public health implications of new infections and subsequent cancers that could have otherwise been averted.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, M5S 1V4, Canada
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Bartoletti R, Cai T, Meliani E, Mondaini N, Meacci F, Addonisio P, Albanese S, Nesi G, Mazzoli S. Human papillomavirus infection is not related with prostatitis-related symptoms: results from a case-control study. Int Braz J Urol 2014; 40:247-56. [PMID: 24856493 DOI: 10.1590/s1677-5538.ibju.2014.02.16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 01/15/2014] [Indexed: 01/17/2023] Open
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Abstract
BACKGROUND The ability to detect and treat pre-malignant anal lesions suggests screening may prevent anal cancer. The incidence of anal cancer in men who have sex with men (MSM) living with HIV exceeds that of cervical cancer before screening was introduced. METHODS High-resolution anoscopy (HRA) with intervention for high-grade squamous intraepithelial lesions (HSILs) was offered to asymptomatic HIV-positive MSM. Patients with HSILs were treated and follow-up HRA performed after 6 months, whilst patients with low-grade squamous intraepithelial lesions had a repeat HRA after 12 months. RESULTS Three hundred and sixty-eight asymptomatic MSM had a total of 1497 HRAs during a median follow-up of 4.2 years (maximum 13 years). At first HRA, 36% had normal appearances, 16% had no dysplasia, 15% anal intraepithelial neoplasia (AIN)-1, 19% AIN-2 and 13% AIN-3. During follow-up, five patients (1.4%) developed invasive anal cancer (incidence 2.7 per 1000 person-years). The 5-year cancer rate for the 368 patients was 0.3% [95% confidence interval (CI) 0-0.6%]. Progression to cancer was associated with higher age (P=0.049) and AIN-3 (P=0.024). Ninety patients had AIN-3 present at least at one HRA. The cumulative risk of cancer from first AIN-3 diagnosis was 3.2% (95% CI 0-7.8%) at 5 years. One hundred and seventy-one patients had HSILs (AIN-2 or 3) present at least once. The cumulative risk of cancer from first HSIL diagnosis was 0.6% (95% CI 0-1.8%) at 5 years. CONCLUSION AIN-3 is a significant risk factor for subsequent anal cancer, although the tumours detected in screened patients were small localized, and generally the outcomes were favourable.
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Colón-López V, Ortiz AP, Del Toro-Mejías L, Clatts MC, Palefsky JM. Epidemiology of anal HPV infection in high-risk men attending a sexually transmitted infection clinic in Puerto Rico. PLoS One 2014; 9:e83209. [PMID: 24400071 PMCID: PMC3882217 DOI: 10.1371/journal.pone.0083209] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 10/25/2013] [Indexed: 12/28/2022] Open
Abstract
Purpose Recent studies in Puerto Rico have reported an increasing incidence of anal cancer in Puerto Rican men. The objective of this study was to determine the prevalence, genotype distribution and risk factors associated with anal HPV infection among men attending an STI clinic in Puerto Rico. Methods We conducted a cross-sectional study among 205 men 18 years and older. A comprehensive survey was administered that included a demographic and a behavioral assessment. Separate logistic regression models were performed to determine factors associated with any, high-risk (HR), and multiple anal HPV infection. Results The mean age of the study sample was 38.0±13.5 years. The most common HR types were 58, 51 and 31. Overall, HR anal HPV infection was found in 53.5% of the participants. Multiple HPV types in the anal canal were found in 47.6% of the sample. A third (29.8%) of participants reported being men who had sex with men (MSM). MSM had a significantly higher prevalence of any, HR and multiple HPV infection (p-value<0.05). Separate multivariate logistic regression analyses showed that being MSM was associated with any (OR = 4.5; [95%CI: 1.9–10.7]), HR (OR = 3.4; [95%CI: 1.1–10.3) and multiple anal HPV infection (OR = 3.6; [95%CI: 1.5–9.1). HIV was marginally associated with multiple anal HPV infection in multivariate analysis (OR = 3.3; 95%CI = 1.0–11.0). Conclusions Anal HPV is common among sexually active men attending this STI clinic, with higher likelihood of anal HPV infection among MSM.
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Affiliation(s)
- Vivian Colón-López
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- * E-mail:
| | - Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Lizbeth Del Toro-Mejías
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Michael Craig Clatts
- Center for Research on Global Health, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Joel M. Palefsky
- University of California San Francisco, San Francisco, California, United States
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Random Biopsy During High-Resolution Anoscopy Increases Diagnosis of Anal High-Grade Squamous Intraepithelial Lesions. J Acquir Immune Defic Syndr 2014; 65:65-71. [DOI: 10.1097/qai.0b013e3182a9b3d3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Templeton DJ, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11:217-29. [DOI: 10.1071/sh14003] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/09/2014] [Indexed: 01/07/2023]
Abstract
Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009–May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.
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Fairley CK, Brotherton JML, Hillman R, Grulich AE. Why a special issue on anal cancer and what is in it? Sex Health 2013; 9:501-3. [PMID: 23380233 DOI: 10.1071/sh12109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/03/2012] [Indexed: 11/23/2022]
Abstract
This editorial describes the contents of this special issue of Sexual Health devoted to anal cancer. The aim of the issue is to provide readers with information to assist them in making decisions about what to do about detecting anal cancer early in men who have sex with men with HIV. Should they be advocating screening? It discusses the epidemiology of HPV infection, anal intraepithelial neoplasia, and anal cancer in MSM, heterosexual men and women; anal cancer screening and treatment of anal cancer. And most importantly, what should be done about vaccinating boys with the HPV vaccine.
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Grulich AE, Hillman R, Brotherton JML, Fairley CK. Time for a strategic research response to anal cancer. Sex Health 2012; 9:628-31. [DOI: 10.1071/sh12116] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/30/2012] [Indexed: 11/23/2022]
Abstract
Anal cancer was until recently regarded as a rare cancer of little consequence. The articles in this special edition of Sexual Health clearly demonstrate that anal cancer is increasing in incidence and, in some populations, it has become an urgent public health priority. In this summary paper, we will review the data presented in this issue and elsewhere on the magnitude of the issue, the means of prevention and treatment, and suggest a way forward.
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