HPV vaccination among gay, bisexual and other men who have sex with men in Canada's three largest cities: a person-centred approach

Starting in 2015, many Canadian provinces and territories introduced publicly-funded human papillomavirus (HPV) vaccination programs targeted to gay, bisexual and other men who have sex with men (GBM) 9-26 years old. Using baseline data from the Engage study, a sexual health study of GBM from three Canadian cities, we explored how social and programmatic factors intersect and affect stages of HPV vaccination (Stage 1: unaware of HPV vaccine, Stage 2: undecided/unwilling to get vaccinated, Stage 3: willing to get vaccinated, Stage 4: vaccinated with at least one dose). First, by city, we created subgroups of GBM <= 26 years old (N Vancouver = 178; Toronto = 123; Montreal = 249) using latent class analysis. Next, by latent class, we estimated the probability of being in the four HPV vaccination stages using the Bolck, Croon and Hagenaar method. Latent class membership was associated with HPV vaccination stage in Vancouver (p = 0.003) and Montreal (p = 0.048) but not Toronto (p = 0.642). In Vancouver and Montreal, membership in the "no barriers" latent class had the highest probability of vaccination (56-58%). In Vancouver, the "racialized, GBM privacy, immigration and healthcare access barriers" class had a 75% probability of being vaccine unaware. In Montreal, the "immigration and past vaccines barriers" and "socio-economic, GBM privacy and healthcare access barriers" classes had the highest probabilities of being vaccine unaware (43% and 46%) and of being undecided or unwilling to get vaccinated (40% and 25%). In conclusion, our person-centred findings suggest tailored interventions by locale may help to increase HPV vaccine uptake among GBM in Canada's three largest cities.