Vaccine acceptability, uptake and completion amongst men who have sex with men: A systematic review, meta-analysis and theoretical framework

Tom Nadarzynski; Miles Frost; Danny Miller; Christopher W Wheldon; Brenton M Wiernik; Huachun Zou; Daniel Richardson; Laura A V Marlow; Helen Smith; Christina J Jones; Carrie Llewellyn

doi:10.1016/j.vaccine.2021.05.013

Vaccine acceptability, uptake and completion amongst men who have sex with men: A systematic review, meta-analysis and theoretical framework

Vaccine. 2021 Jun 16;39(27):3565-3581. doi: 10.1016/j.vaccine.2021.05.013. Epub 2021 May 24.

Authors

Affiliations

¹ The University of Westminster, London, United Kingdom. Electronic address: T.Nadarzynski@westminster.ac.uk.
² The University of Southampton, Southampton, United Kingdom.
³ The University of Westminster, London, United Kingdom.
⁴ Temple University, Philadelphia, PA, USA.
⁵ The University of South Florida, Tampa, USA.
⁶ Sun Yat-sen University, School of Public Health, Shenzhen, China.
⁷ Brighton & Sussex University Hospitals NHS Trust, Brighton; Brighton & Sussex Medical School, University of Sussex, Falmer, United Kingdom.
⁸ Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.
⁹ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.
¹⁰ University of Surrey, Guildford, United Kingdom.
¹¹ Brighton & Sussex Medical School, University of Sussex, Falmer, United Kingdom.

PMID: 34034949
DOI: 10.1016/j.vaccine.2021.05.013

Abstract

Background: Due to an increased risk of sexually transmitted infections (STIs), gay, bisexual and other men who have sex with men (MSM) have been recommended to receive vaccinations against human papillomavirus, meningitis C and hepatitis A/B. This review aimed to compare the rates of vaccine acceptability, uptake and completion, and to identify determinants of vaccine outcomes specific to MSM to inform a theoretical framework.

Methods: In January 2020 four databases were explored to identify vaccination behaviours and associated factors among MSM. A narrative systematic review and meta-analysis were performed. Data were synthesised for theoretical modelling.

Results: Seventy-eight studies, mostly from the USA, were included. The average vaccine acceptability was 63% (median = 72%, range: 30%-97%), vaccine uptake 45% (median = 42%, range: 5%-100%) and vaccine completion 47% (median = 45%, range: 12%-89%). Six categories of factors associated with vaccination acceptability, uptake and completion were conceptualised: Individual (e.g., demographic and psychosocial); Interpersonal (e.g., peer education); Healthcare provider (e.g., vaccine recommendation); Organisational and practice setting (e.g., routine collection of patient sexual orientation information that is integrated into a clinical decision support system); Community environment (e.g., targeted health promotion campaigns); and National, state and local policy environment (e.g., public health guidelines targeting MSM).

Conclusion: Despite overall high levels of acceptability, uptake and completion rates were below targets predicted by cost-effectiveness modelling across all recommended vaccines. These parameters may need to be adjusted for more precise estimations of cost-effectiveness. Addressing the multiple levels of determinants, as outlined in our theoretical framework, will help guide interventions to increase vaccine completion among MSM.

Keywords: Bisexual; Gay; HAV; HBV; HPV; MSM; Meningitis; Vaccination.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Female
Health Knowledge, Attitudes, Practice
Homosexuality, Male
Humans
Male
Papillomavirus Infections*
Papillomavirus Vaccines*
Patient Acceptance of Health Care
Sexual and Gender Minorities*
Vaccination

Substances

Papillomavirus Vaccines