BACKGROUND The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide. Gay, bisexual, and other men who have sex with men (GBM), and GBM living with HIV in particular, are disproportionately impacted by HPV-associated cancers. The HPV vaccine, given early enough in life, may markedly reduce the likelihood of such cancers. In Canada, most provincial insurance programs only cover HPV vaccination for GBM up to the age of 26. Our objective was to understand physicians' everyday experiences and challenges in recommending HPV vaccination to older GBM patients. METHODS As part of the HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, we conducted semi-structured interviews with 25 HIV-positive GBM patients who had received anal cancer screening and 15 service providers, including 13 physicians, who had arranged for anal cancer screening in the Canadian provinces of Ontario and British Columbia. In this analysis, we draw upon the 13 physician interviews, which were coded following Grounded Theory. RESULTS Physicians strongly supported the HPV vaccine for all GBM and considered it to be important for the management of HIV-related care. However, the overall support for HPV vaccination among physicians did not translate into consistent recommendation practices. There were two overarching factors that limited the strength/frequency of physicians' vaccine recommendation practices. First, cost/insurance coverage for some older patients impacted if and how the HPV vaccine was discussed. Second, physicians had diverse perspectives on both the prevention and therapeutic benefits of vaccinating older GBM and the reality that national guidelines are incongruent with publicly funded vaccine programs for vaccinating patients over 26 years old. These two interrelated factors have co-produced an apparent economic-evidentiary conundrum for many physicians regarding how and for whom to offer HPV vaccination. CONCLUSION Economic barriers coupled with evidentiary and guideline gaps have created clinical practice challenges for physicians and has resulted in different messages being communicated to some older GBM patients about how important HPV vaccination is for their health.

中文翻译：

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经济障碍、证据差距和道德难题：对医生建议老年同性恋、双性恋和其他男男性行为者接种 HPV 疫苗所面临挑战的定性研究。

背景技术人乳头瘤病毒(HPV)是全世界最常见的性传播感染(STI)。同性恋、双性恋和其他男男性行为者 (GBM)，特别是感染 HIV 的 GBM，尤其容易受到 HPV 相关癌症的影响。在生命早期接种 HPV 疫苗可能会显着降低患此类癌症的可能性。在加拿大，大多数省级保险计划仅承保 26 岁以下的 GBM HPV 疫苗接种。我们的目标是了解医生在向老年 GBM 患者推荐 HPV 疫苗接种时的日常经验和挑战。方法 作为 HPV 筛查和疫苗评估 (HPV-SAVE) 研究的一部分，我们对 25 名接受过肛门癌筛查的 HIV 阳性 GBM 患者和 15 名服务提供者进行了半结构化访谈，其中包括 13 名已安排肛门癌筛查的医生。加拿大安大略省和不列颠哥伦比亚省的癌症筛查。在本次分析中，我们借鉴了 13 名医生访谈，这些访谈是根据扎根理论进行编码的。结果 医生强烈支持针对所有 GBM 接种 HPV 疫苗，并认为它对于 HIV 相关护理的管理非常重要。然而，医生对 HPV 疫苗接种的总体支持并未转化为一致的推荐实践。有两个首要因素限制了医生疫苗推荐实践的强度/频率。首先，一些老年患者的费用/保险范围影响了是否以及如何讨论 HPV 疫苗。其次，医生们对老年 GBM 疫苗接种的预防和治疗益处以及国家指南与为 26 岁以上患者接种疫苗的公共资助疫苗计划不一致的现实持有不同的观点。这两个相互关联的因素共同给许多医生带来了一个明显的经济证据难题：如何以及为谁提供 HPV 疫苗接种。结论 经济障碍加上证据和指南的差距给医生带来了临床实践的挑战，并导致一些老年 GBM 患者就 HPV 疫苗接种对其健康的重要性传达了不同的信息。