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CHAPS:
Community HPV screening for Anal cancer Prevention Study
Most anal cancers are caused by the human papillomavirus (HPV), a virus we can vaccinate against. A generation of Australian adults were never offered this vaccine.
HPV causes about 90% of anal cancers. Australia started vaccinating school students against HPV in 2007 for girls and 2013 for boys, and infection rates in those year groups have fallen sharply. However, people who had left school when the programs were introduced missed out.
Gay, bisexual and other men who have sex with men (GBMSM) are at much higher risk of anal cancer. Vaccination is recommended for GBMSM at any age but are only funded to those aged 25 and under. There is limited evidence on how well the vaccine works for people already exposed to HPV, which is a large share of the men it is recommended for. The Community HPV Screening for Anal Cancer Prevention Study (CHAPS) Project was funded to explore this.
What we want to find out.
Whether HPV vaccination in adulthood reduces the infections that cause anal cancer in gay and bisexual men, and non-binary people who have sex with men, aged 35 and over. We are also testing whether people can collect their own anal swab successfully and comfortably, which could make screening easier to offer outside a clinic.
CHAPS is led by Curtin University and funded by the National Health and Medical Research Council through the Targeted Call for Research: Anal Cancer 2025.
In partnership with:
Where is the study up to?
We are interviewing clinicians, health promotion practitioners, policy advisors and other experts about what stands in the way of HPV vaccination and anal cancer screening for gay and bisexual men, and non-binary people, aged 35 and over. What they tell us will provide the context for the findings of the main study, which we expect to open for recruitment in early 2027.
We have established a Community Advisory Board and we are also looking for more community members, and specifically for people who do not work in health or research to pilot test some of our materials. Details are below.
Key informant interviews
Interviews with clinicians, health promotion practitioners, program staff, policy advisors and staff from sexual health services and cancer organisations.
Around 30 interviews in total.
UNDERWAY
Community Advisory Board
We are recruiting people with personal experience and perspectives relevant to the CHAPS study.
open now
Piloting our study materials
Community members to read and test our questionnaire, self-sampling instructions and recruitment materials before they go out.
open now
The main study, Perth and Sydney
Ethics approval, laboratory arrangements and study design are being finalised.
In preparation
Interviews with participants
Around 40 participants interviewed in depth.
later
Putting the findings to use
Policy briefs, clinical guidance, community resources and stakeholder forums in Perth and Sydney.
ongoing
Help shape this study
Our Advisory Board includes clinicians, researchers, health promotion practitioners and policy staff. We now need more members whose perspective comes from community and personal experience rather than a professional role.
The Board advises across the whole study, from design and recruitment through to interpreting findings and turning them into policy and practice recommendations. Members meet online four times a year, and are paid $50 an hour covering the meeting and an hour of preparation.
Join our Community Advisory Board
Before anything goes out, we need community members to read it and provide feedback. These may include the questionnaire, self-sampling instructions, information sheets and recruitment materials. Usually an hour or two, paid at $50 an hour. You do not need to be on the Advisory Board to help.
Help us pilot our materials
Expressions of interest currently open
You do not need a research background, and you do not need to have had HPV, anal cancer or the vaccine.
Not sure whether you are the right fit? Email Dr Nang Phoo at nangngenge.phoo@curtin.edu.au and ask.
Why this study is needed
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The risk is concentrated. GBMSM are up to 20 times more likely to develop anal cancer than the general population, and among those living with HIV incidence runs at around 85 per 100,000 a year.
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Anal cancer is becoming more common in Australia. Incidence rose from 1.3 per 100,000 in 1985 to 2.2 per 100,000 in 2025, and is still trending upward.
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A generation missed out on vaccination. School programs began in 2007 and 2013. Adults who are now aged 35 and over were never eligible.
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Vaccination is recommended but not funded. The Australian Immunisation Handbook recommends HPV vaccination for men who have sex with men at any age if they have not been vaccinated before; however, the National Immunisation Program funds it only to those under 25 years.
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The evidence is limited. The HPV vaccine has mostly been tested in young people who had not been exposed to HPV. Studies covering older adults have been small, short, or have measured antibody response rather than protection against infection.
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There is no screening program. National guidelines cover some people living with HIV aged 35 and over. For everyone else, access depends on where you live and who your doctor is.
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Diagnosis often comes late. Limited awareness, stigma, embarrassment and past negative experiences with healthcare all delay people seeking help, and late diagnosis which can result in poorer health outcomes.
The main study
Comparing HPV in people who have been vaccinated with people who have not
This is the largest component of the study. We aim to recruit 1,800 people across Perth and Sydney and compare how often we find HPV in each group.
How the comparison works
Australia has never funded HPV vaccination past the age of 25 nationally, and state programs that went further have been limited and short-lived. Some adults have paid for it privately or accessed a state initiative, but this has not been universal. So now there are both vaccinated and unvaccinated adults over 35 living in Australia that we want to compare.
participants aged 35 and over who have had at least one dose of an HPV vaccine after the age of 25.
Vaccinated
participants aged 35 and over who have not been vaccinated against HPV.
unVaccinated
900
900
We are recruiting both groups in Perth and in Sydney, so that any difference we find is less likely to reflect something particular to one city’s population or health services.
What we measure
Our main question is whether HPV16 is present. HPV16 is the type most strongly linked to anal cancer, and one of the nine covered by Gardasil 9. We will also record which of the other eight are present.
Vaccination status is only one of the things that affects HPV risk, so we will also consider age, sexual history, HIV status, smoking, alcohol use, how many vaccine doses someone had and how long ago.
Taking your own swab
Every participant collects their own anal swab in a private room at the study site. It takes less than five minutes, with written and illustrated instructions. Nobody watches, and nobody performs an examination.
Samples are tested using HPV genotyping that detects a wide panel of high-risk and low-risk types. The test also includes an internal quality check to make sure that there is enough material in the sample for the test to work properly.
Self-sampling has already reshaped cervical screening. If it works here, anal screening could be offered through general practice and community services, not only the specialist clinics that provide it now.
The questionnaire
Alongside the swab, participants complete a questionnaire covering health, sexual history, vaccination history, what they know about anal cancer and HPV, and how they found the self-sampling.
How you will hear about the study
Sexual health clinics in Perth and Sydney, LGBTIQ+ community organisations, general practices with gay and bisexual patients, and geotargeted advertising on social media and dating apps.
The supporting qualitative research
These interviews will examine why vaccination and screening are not reaching this group, and what would have to change for a program to work in practice.
Interviews with clinicians and other experts.
Around 30 interviews with sexual health doctors and nurses, general practitioners, health promotion practitioners, policy advisors and staff from sexual health and cancer organisations. We will ask what makes it harder or easier to recommend vaccination to older patients, what offering self-sampling would need in practice, and what training and resources providers are missing.
Interviews with participants.
Around 40 people from the main study (20 from each city) will talk with us in more depth about what they knew about anal cancer, how they made decisions about vaccination, their experiences with healthcare, and how they found collecting their own swab. We will select a range of backgrounds, incomes, cultural communities and HIV statuses.
Findings from both sets of interviews are analysed alongside the HPV results and will inform the final recommendations.
Putting the findings to use
We are using an integrated knowledge translation approach, working with the people who will use the findings while the research is still underway.
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Policy briefs on extending funded HPV vaccination beyond age 25, developed with our Community Advisory Board
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Clinical guidance on offering self-sampling for anal cancer screening
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Community resources on anal cancer prevention, in plain language and in several languages
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Stakeholder forums in Perth and Sydney where community members, clinicians, policymakers and community, sexual health and cancer organisations work through what implementation would require
Who can take part?
Recruitment is expected to open in early 2027.
We will be looking for people who:
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have sex with men. You might be a man or a non-binary person, and you might describe yourself as gay or bisexual, use a different word, or use no label at all
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are 35 or older
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live in Perth or Sydney
You can take part whether or not you have had the HPV vaccine. A few short questions when you register will confirm your eligibility to participate.
What taking part involves:
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One appointment of about 30 minutes at a study site in Perth or Sydney
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An anal swab you collect yourself, in private, in under five minutes
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A questionnaire about your health and experiences
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You choose whether to receive your HPV results
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Reimbursement for your time
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An invitation to a follow-up interview, if you would like one
Everything you tell us is confidential. We will not report information that could identify you.
The research team
Chief Investigators
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A/Prof Jonathan Hallett (CERIPH, Curtin University), Project Lead
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A/Prof Jenny McCloskey (Royal Perth Hospital)
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Dr Daniel Vujcich (WAAC)
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Dr Anthony Smith (Centre for Social Research in Health, UNSW)
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Dr Renee Carey (CERIPH, Curtin University)
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Prof Sharyn Burns (CERIPH, Curtin University)
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Prof Sepehr Tabrizi (UWA)
Associate Investigators
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Dr Mary Poynten (Kirby Institute, UNSW)
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Jakob James
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Mark Reid AM
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Scott Walsberger (ACON)
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Melissa Ledger (Cancer Council WA)
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Amy Harrison (Clinical Services Strategy, Planning and Innovation at Child and Adolescent Health Service)