Gay City Health Project

We assessed the sensitivity of self-reported human papillomavirus (HPV) vaccination among young adult men who have sex with men (MSM) with documented HPV vaccination. During 2016-2018, MSM and transgender women aged 18 to 26 years were enrolled in Seattle, WA. A history of HPV vaccination was assessed via self-administered survey, clinic electronic medical records, and the Washington State Immunization Information System. We assessed self-report sensitivity among participants with documented prior HPV vaccination (≥1 dose) in either the electronic medical record or the Washington State Immunization Information System, and used logistic regression to compare sensitivity by age, number of doses, and time since first dose. Of 292 participants with ≥1 documented HPV vaccine dose, 243 self-reported ≥1 dose (sensitivity, 83.2%; 95% confidence interval [CI], 78.4%-87.3%). Compared with participants whose first dose was <1 year ago, the likelihood of self-report was lower among those with ≥3 years since first dose (adjusted odds ratio [aOR], 0.2; 95% CI, 0.1-0.5). Furthermore, compared with participants with only 1 documented HPV vaccine dose, the likelihood of self-reporting ≥1 dose was higher among those with 2 (aOR, 2.4; 95% CI, 1.0-5.5) or ≥3 doses (aOR, 6.2; 95% CI, 2.7-14.4). Among 115 participants with ≥3 documented doses, sensitivity for recalling ≥3 doses was 69.6% (95% CI, 60.3%-77.8%). Most young adult MSM with a documented history of HPV vaccination self-reported prior HPV vaccination. Although recall was highest in those with ≥3 doses, 30% of this fully vaccinated subgroup did not correctly recall the number of doses received, highlighting limitations of self-reporting. Furthermore, results indicating reduced recall with ≥3 years since first dose suggest that sensitivity of self-report among young adult MSM may decline over time as adolescent vaccination coverage increases.

One barrier to human immunodeficiency virus preexposure prophylaxis (PrEP) is lack or perceived lack of health insurance or financial assistance. We performed a medical records review at a safety-net PrEP clinic in Seattle, Washington, and found that barriers to obtaining financial assistance were commonly recorded in association with initiation and persistence on PrEP.

Designing effective marketing and recruitment strategies for HIV prevention research requires attention to cultural relevance, logistical barriers, and perceived psychosocial barriers to accessing services. McGuire's communication/persuasion matrix (1985) guided our evaluation, with particular attention to success of each marketing "channel" (i.e., strategy) vis-à-vis the number of all callers, eligible callers, and enrolled callers, as well as reaching so-called "hard-to-serve" individuals. Nearly all channels offered success in reaching specific subgroups. Latinos responded favorably to posters, bisexuals responded favorably to paid media in an alternative (non-gay) publication, and precontemplators responded to referrals by family and friends. Although multiple recruitment strategies were used, three were crucial to the success of the project: (a) recruiters' presence in gay venues, (b) referrals by family and friends (snowball technique), and (c) paid advertisements in alternative (non-gay) local newspapers. Resource allocation and costs are also presented for each channel.