WACC II-16THE EFFECT OF PAYMENT ON THE HPV VACCINATION INTENTION AMONG MALE CLIENTS OF THE STI OUTPATIENT CLINIC IN AMSTERDAM, THE NETHERLANDS

05. HPV prophylactic vaccines
E. Marra 1, C.J. Alberts 1, G. Zimet 2, T. Paulussen 3, T. Heijman 1, A. Hogewoning 1, G. Sonder 1, H. Fennema 1, H. De Vries 4, M. Schim Van Der Loeff 1.
1Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands (Netherlands), 2Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America (United States), 3Expertise Center Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands (Netherlands), 4Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (Netherlands)

Background / Objectives

In the Netherlands only girls are offered vaccination against human papillomavirus (HPV); free of charge. Men can become infected with HPV as well, and can develop HPV-induced diseases like genital and oral warts, penile, oropharyngeal and anal cancer. We studied the effect of out-of-pocket payment on the intention to get vaccinated against HPV among male clients of the sexually transmitted infections (STI) clinic in Amsterdam, the Netherlands.


Methods

Men aged ≥18 years were recruited from the STI clinic and asked to complete a web-based survey addressing HPV vaccination intention, measured on a 7-point Likert scale (-3 to 3); knowledge about HPV; socio-psychological determinants of HPV vaccination intention; demographics; and sexual behavior. The selected socio-psychological factors were derived from the Theory of Planned Behaviour and Social Cognitive Theory. Different amounts of out-of-pocket payment (€50;€100;€200;€350) were proposed to different groups of participants, based on the period of participation (the study duration was divided in 4 periods of roughly equal length). Univariable and multivariable linear regressions were performed to assess the impact of out-of-pocket payment on HPV vaccination intention.


Results

Between June and October 2015, 1490 men participated; 1053 (71%) were men who have sex with men (MSM). HPV vaccination intention was very high (mean: 2.2, SD 1.2) if vaccination was free of charge. However, with each step increase in the required out-of-pocket payment for HPV vaccination, mean HPV vaccination intention decreased 0.74 (95%CI: 0.71 - 0.77) scale-point, to a mean value  of -0.75 (SD 1.8) when out-of-pocket payment was €350. Also in multivariable analysis, including socio-psychological factors (attitude, self-efficacy, beliefs, social influences, and anticipated regret), and socio-demographics (age, sex group, and lifetime number of sex partner) HPV vaccination intention decreased by 0.74 (95% CI: 0.71 - 0.78) on the 7-point Likert scale, for each increment of price. Higher age was independently associated with higher intention to vaccinate, regardless of out-of-pocket payment.


Conclusion

HPV vaccination intention among male clients of the Amsterdam STI clinic is very high if free of charge. Out-of-pocket payment has a strong negative impact on HPV vaccination intention. These data suggest that if HPV vaccination for men would be offered at STI clinics, uptake would decrease substantially if out-of-payment would be required.


References