Impact of the HPV vaccination programme on anal HPV infection in gay, bisexual and other men who have sex with men: multi-site enhanced surveillance study in specialist sexual health services in England

BACKGROUND: A national human papillomavirus (HPV) vaccination programme for gay, bisexual, and other men who have sex with men (GBMSM) in England began in 2016. We evaluated the impact of this programme by monitoring the prevalence of type-specific HPV infections over time. METHODS: Residual rectal swab specimens were collected from GBMSM aged ≤45 years undergoing chlamydia and/or gonorrhoea screening at 10 sexual health services (SHSs) between 2017-19 (Phase 1) and 2021-24 (Phase 2). Specimens were linked to data on sociodemographic characteristics, previous STI diagnoses, and HPV vaccination reported to the UK Health Security Agency's (UKHSA's) national STI surveillance system. Anonymised specimens were tested for type-specific HPV DNA using an in-house multiplex PCR and Luminex-based genotyping test. We compared the prevalence of vaccine-type HPV in each phase, and in those with and without any reported HPV vaccinations. RESULTS: Data from 5,787 rectal swab specimens with HPV testing results were analysed: 3,291 in Phase 1 and 2,496 in Phase 2. There was a 36% decline in the prevalence of anal HPV16/18 infection between Phase 1 and Phase 2. Overall, the prevalence of HPV16/18 was similar in GBMSM with (16.6%; 95% CI 15.2-18.1) and without reported HPV vaccination (15.8%; 95% CI 14.5-17.1). CONCLUSION: Eight years after HPV vaccination of GBMSM began, the prevalence of vaccine-type HPV in GBMSM has declined. Available data did not permit accurate estimation of vaccine effectiveness, likely due to the combined effects of underreporting of vaccinations, herd protection, and bias in vaccination uptake. These findings, albeit ecological, bode well for this targeted programme meeting its aim of reducing HPV-related diseases among GBMSM and reducing health inequalities.