An epidemiological evaluation of targeted HPV vaccination for gay, bisexual and other men who have sex with men (GBMSM) in England

Abstract

Gay, bisexual, and other men who have sex with men (GBMSM) are at high risk for human papillomavirus (HPV) infection and associated disease, i.e. anogenital warts (AGW), and anal, oropharyngeal, and penile cancers. Since 2018, England has offered HPV vaccination to GBMSM aged ≤45 attending specialist sexual health services (SHSs) and HIV clinics, following a successful pilot (2016-2018). This thesis aims to evaluate the impact and effectiveness of HPV vaccination for GBMSM in England, one of the first centrally planned HPV programmes targeting this population.
Analyses of routine national surveillance data estimated a first dose uptake of approximately 50% during the pilot, and 30% by the end of 2023, in GBMSM attending specialist SHSs. However, vaccination recording in routine surveillance data was underreported, likely underestimating vaccination coverage. I designed and established an HPV antibody seroprevalence study to validate vaccination uptake estimates from routine surveillance and to estimate vaccination coverage in the GBMSM population. I designed and analysed findings from two cross-sectional surveys of anal HPV infection in GBMSM attending specialist SHSs to monitor changes in the epidemiology of HPV infection. Five years after the introduction of HPV vaccination for GBMSM, the prevalence of HPV16/18 and HPV6/11/16/18 declined by 26% and 14%, respectively. However, there was a lack of association between HPV prevalence and recorded vaccination status, likely due to the misclassification of vaccination status, herd protection and bias towards vaccination of higher risk GBMSM. Finally, I analysed routine national surveillance data to assess vaccination impact and effectiveness against first episode AGW in GBMSM. Results showed clear evidence of a 10-15% reduction in the risk of AGW diagnosis in vaccinated versus unvaccinated GBMSM.
Findings from this PhD thesis provide the first epidemiological evidence of the impact and effectiveness of HPV vaccination for GBMSM in England. Evidence of declines in HPV prevalence and AGW incidence is an early indicator of the future impact of vaccination on anal and other HPV-related cancers in GBMSM. This PhD research may inform future decisions about changes to targeted HPV vaccination for GBMSM and other vaccination programmes in England and internationally.

Date of Award	20 Jan 2026
Original language	English
Awarding Institution	University of Bristol
Sponsors	UK Health Security Agency
Supervisor	Matt Hickman (Supervisor), Kate Soldan (Supervisor) & Clare E French (Supervisor)