Determinants of Changes in HPV Vaccination Willingness Among Men Who Have Sex With Men: An Observational Cohort Study

Human papillomavirus (HPV) infection is highly prevalent among men who have sex with men (MSM) and increases the risk of cancer; however, vaccine uptake remains low. Our objective was to explore the factors influencing changes in HPV vaccination willingness among MSM. HIV-negative MSM aged ≥ 18 years in Xinjiang, China, were enrolled in an observational cohort study conducted from March 1, 2017, to March 30, 2023. A self-administered questionnaire was used to collect baseline and follow-up data every 6 months on HPV vaccination willingness, demographics, sexual behaviors, and HPV knowledge. Anal swabs were used for HPV genotyping. Participants were categorized based on their longitudinal willingness as consistently willing, transitioning, or consistently unwilling. Multivariable logistic regression was used to analyze determinants of changes in vaccination willingness. Among 746 enrolled MSM (median age 30 [IQR:25-36]), 442 (59.2%) were consistently willing to vaccinate, 160 (21.4%) transitioned to willingness, and 144 (19.4%) were consistently unwilling. In multivariate analysis, lower education (high school or below: adjusted odds ratio (AOR) = 2.4, 95% confidence interval (95% CI): 1.4-4.1; some college: AOR = 1.8, 95% CI: 1.1-2.9), lower income (1001-5000 yuan: AOR = 0.39, 95% CI: 0.19-0.77; 5001-10 000 yuan: AOR = 0.26, 95% CI: 0.13-0.54; ≥ 10 001 yuan: AOR = 0.14, 95% CI: 0.05-0.42), and lower HPV knowledge (AOR = 0.6, 95% CI: 0.4-0.9) were independently associated with vaccination willingness. HPV vaccine willingness was low but dynamic among MSM. Addressing modifiable factors, such as HPV knowledge, may improve uptake.