Factors associated with human papillomavirus, hepatitis A, hepatitis B and mpox vaccination uptake among gay, bisexual and other men who have sex with men in the UK – findings from the large community-based RiiSH-Mpox survey

Background Gay, bisexual, and other men who have sex with men (GBMSM) face a disproportionate burden of sexually transmitted infections and are eligible for targeted vaccinations for hepatitis A (HAV), hepatitis B (HBV), human papilloma virus (HPV) and mpox. This study examines the sociodemographic characteristics, sexual behaviours, and sexual healthcare service (SHS) use associated with vaccination uptake. Methods We undertook analyses of RiiSH-Mpox - an online, community-based survey with GBMSM recruited via social media and dating apps. We calculated vaccination uptake (≥1 dose) among eligible GBMSM. Bivariate and multivariable logistic regression was performed to identify factors independently associated with vaccination uptake among eligible participants. Results Reported uptake in eligible GBMSM was around two-thirds for each of the vaccinations considered: mpox 69% (95% confidence interval (CI): 66%-72%), HAV 68% (CI:65%-70%), HBV 72% (CI:69%-74%) and HPV 65% (CI:61%-68%). Vaccination course completion (receiving all recommended doses) ranged from 75% (HBV) to 89% (HAV) among eligible GBMSM. Individuals who represented missed opportunities for vaccination ranged from 22-30% of eligible SHS attendees. Younger participants, individuals identifying as bisexual, reporting lower educational qualifications, or being unemployed reported lower uptake across GBMSM-selective vaccinations. Individuals who reported greater levels of sexual behaviour and recent SHS use were more likely to report vaccinations. Conclusion Eligible participants reported high uptake of vaccinations; however, uptake was lower amongst young GBMSM and self-identifying bisexual men. Awareness of groups with lower vaccination uptake will help inform practice, delivery strategies and health promotion, to improve the reach and impact of vaccinations amongst GBMSM. Contributions DP, RW, KF, CHM, JS, HM reviewed and updated the survey instrument. Survey implementation, data collection and data management were carried out by RW and DO. GB, CM, DO, HM curated secondary analysis plan with review and contributions from KF, MC, JS, RS, SM. GB conducted analysis and completed the first manuscript draft. All authors contributed to successive drafts and reviewed and approved the final manuscript. Ethics statement Ethical approval of this study was provided by the UKHSA Research and Ethics Governance Group (REGG; ref: R&D 524). Online informed consent was received from all participants and all methods were performed in accordance with guidelines and regulations set by the UKHSA REGG. Competing interests Authors have no competing interests to declare. Data availability statement The data that support the findings of this study are available upon reasonable request from the UK Health Security Agency (UKHSA). Requests can be directed to Dr Hamish Mohammed (hamish.mohammed{at}ukhsa.gov.uk). Funding This study did not receive any funding and was conducted as part of the UKHSA public health response to mpox. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding and was conducted as part of the UKHSA public health response to mpox. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of the United Kingdom Health Security Agency gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available upon reasonable request from the UK Health Security Agency (UKHSA). Requests can be directed to Dr Hamish Mohammed (hamish.mohammed{at}ukhsa.gov.uk).