1
|
Wassie M, Zegeye AF, Mekonen EG, Tekeba B, Ali MS, Gonete AT, Kassie AT, Workneh BS, Alemu TG, Tamir TT. Human papillomavirus vaccination coverage among young women in the three sub-Saharan African countries using Demographic and Health Surveys data. Hum Vaccin Immunother 2024; 20:2370111. [PMID: 38946555 PMCID: PMC11218800 DOI: 10.1080/21645515.2024.2370111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/17/2024] [Indexed: 07/02/2024] Open
Abstract
Cervical cancer is the fourth most common cancer, with 99% of cases linked to human papillomavirus (HPV) infection. It reflects global inequity as its burden is highest in low- and middle-income countries. The aim of this study was to determine the HPV vaccination coverage and its determinant factors among young women in the three sub-Saharan African countries. Data from the Demographic and Health Surveys among three sub-Saharan African countries were used for analysis. A total of 4,952 women were included in the study. Stata 14 was used to analyze the data. The determinants of the outcome variable were identified using a multilevel mixed-effects logistic regression model. Factors with p-values < 0.05 at 95% confidence interval were declared statistically significant. About 7.5% young women were vaccinated for HPV vaccine against cervical cancer in the current study. Younger age, use of internet, rich economic class, and individual-level media exposure were found to be favorable conditions, whereas being employed was negatively associated with HPV vaccination. Only few segments of young women in these three countries got HPV vaccination. The authors recommend that increasing internet use, media exposure, and economic level of young women will increase the HPV vaccination rates. Furthermore, creating awareness among employed women will also increase the possibility of HPV vaccination.
Collapse
Affiliation(s)
- Mulugeta Wassie
- Schools of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
2
|
Guillaume D, Waheed DEN, Schleiff M, Muralidharan KK, Vorsters A, Limaye RJ. Global perspectives of determinants influencing HPV vaccine introduction and scale-up in low- and middle-income countries. PLoS One 2024; 19:e0291990. [PMID: 38227567 PMCID: PMC10791006 DOI: 10.1371/journal.pone.0291990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 09/11/2023] [Indexed: 01/18/2024] Open
Abstract
Achieving WHO cervical cancer elimination goals will necessitate efforts to increase HPV vaccine access and coverage in low-and-middle-income countries (LMICs). Although LMICs account for the majority of cervical cancer cases globally, scale-up of HPV vaccine programs and progress toward coverage targets in LMICs has been largely insufficient. Understanding the barriers and facilitators that stakeholders face in the introduction and scale-up of HPV vaccination programs will be pivotal in ensuring that LMICs are equipped to optimize the implementation of HPV vaccination programs. This qualitative study interviewed 13 global stakeholders categorized as either academic partners or global immunization partners to ascertain perspectives regarding factors affecting the introduction and scale-up of HPV vaccination programs in LMICs. Global stakeholders were selected as their perspectives have not been as readily highlighted within the literature despite their key role in HPV vaccination programming. The results of this investigation identified upstream (e.g., financial considerations, vaccine prioritization, global supply, capacity and delivery, and vaccine accessibility, equity, and ethics) and downstream (e.g., vaccine acceptability and hesitancy, communications, advocacy, and social mobilization) determinants that impact program introduction and scale-up and confirmed that strong political commitment and governance are significant in garnering support for HPV vaccines. As LMICs introduce HPV vaccines into their national immunization programs and develop plans for scaling up vaccination efforts, strategic approaches to communications and advocacy will also be needed to successfully meet coverage targets.
Collapse
Affiliation(s)
- Dominique Guillaume
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Jhpiego, A Johns Hopkins University Affiliate, Baltimore, Maryland, United States of America
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Dur-e-Nayab Waheed
- Center for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
- HPV Prevention and Control Board, University of Antwerp, Antwerp, Belgium
| | - Meike Schleiff
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kirthini Kasi Muralidharan
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alex Vorsters
- Center for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
- HPV Prevention and Control Board, University of Antwerp, Antwerp, Belgium
| | - Rupali J. Limaye
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| |
Collapse
|
3
|
Kalinganire N, Uwineza A, Kyokunda L, Banura C. Oral-genital HPV infection transmission, concordance of HPV genotypes and genital lesions among spouses/ partners of patients diagnosed with HPV-related head and neck squamous cell carcinoma (HNSCC): a scoping review. Infect Agent Cancer 2023; 18:63. [PMID: 37858187 PMCID: PMC10588123 DOI: 10.1186/s13027-023-00539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND There is an increase in number of Human Papillomavirus related head and neck squamous cell carcinoma (HPV-related HNSCC) High risk HPV(HR-HPV) types can be cleared by an infected person, however, some can persist and develop HN cancer. There is a broad knowledge gap regarding HPV and related cancers. MAIN TEXT The aim of this review is to assess existing published knowledge on oral-genital HPV transmission, concordance of HPV genotypes and risk of oral or/and genital lesions among spouses/partners of patients diagnosed with HPV-related HNSCC, identify gaps in the current research and highlight areas that requires further inquiry. METHOD Database like Pub med, Google Scholar, Scopus, Puplon, Wiley online library were used for search strategy. Published papers on transmission, concordance of HPV genotypes and genital lesions among spouses/partners of patients diagnosed with HPV-related HNSCC were included. Papers published from January1,2000 to October 31, 2022 were included. The published papers included are 8 Case reports, 2 cross-sectional studies, 3 Cohort studies and 2 systematic reviews. RESULTS A total of 2125 citations were retrieved from the five sources. 15papers were included. Case reports reported concurrent HPV-related oropharyngeal, tonsillar, unspecified HNSCC, laryngeal and nasopharyngeal carcinoma among couples. The two cross-sectional studies were done. Almost all the tumors taken from patients with HPV-related oropharyngeal carcinoma (HPV-related OPC) and their spouses were positive for identical HPV 16 type. The three cohort studies showed an increase risk of upper aero-digestive tract cancer among male spouses of females with cervical cancer. Two systematic reviews reviewed literature studies which evaluated concurrent cases of HPV-related Oropharyngeal cancers. Examination of these papers showed that the majority of the studies suggested that there is HPV transmission, concordance and risk of HNSCC cancer among spouses with HPV-related oral-genital cancer. No studies evaluated the risk of developing genital cancer in spouses of patients with HNSCC. CONCLUSION The findings of this review highlighted big need of further research on oral-genital HPV infection among spouses of patients diagnosed with HPV-related HNSCC. Studies are needed to evaluate the risk of getting genital and upper aero-digestive tract HPV-related cancer among spouses with HPV-related HNC.
Collapse
Affiliation(s)
- Nadia Kalinganire
- Department of Pathology, King Faisal Hospital, Kigali, Rwanda.
- University of Rwanda, Kigali, Rwanda.
| | - Annette Uwineza
- University of Rwanda, Kigali, Rwanda
- University Teaching Referral Hospital of Kigali, Kigali, Rwanda
| | | | | |
Collapse
|
4
|
Urrutia MT, Araya AX, Gajardo M, Chepo M, Torres R, Schilling A. Acceptability of HPV Vaccines: A Qualitative Systematic Review and Meta-Summary. Vaccines (Basel) 2023; 11:1486. [PMID: 37766161 PMCID: PMC10536942 DOI: 10.3390/vaccines11091486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/14/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
In 2006, the human papillomavirus (HPV) vaccine was approved for use as an effective intervention for reducing the risk of developing cervical cancer; however, its successful implementation is dependent on acceptability. This study aims to provide a comprehensive understanding of the reasons that favor or do not favor the acceptability of HPV vaccines. METHODS We conducted a systematic review and meta-summary of qualitative research on 16 databases. A total of 32 articles that considered the perspectives of vaccine users, their parents, and the professionals who care for them were reviewed. Synthesis was conducted as described by Sandelowski and Barroso. RESULTS We used inductive and deductive methods to obtain a total of 22 dimensions, out of which three issues stood out that should be considered to improve acceptability and are formed by three groups of study, namely, information about the vaccine, fears and side effects, and sexuality associated with the vaccine. CONCLUSIONS Acceptability, as well as adherence to HPV vaccination, is a complex concept. This review highlights the perspectives of the three sets of actors involved in the process (i.e., users, parents, and professionals) and views these factors in relation to acceptability as a guide for new interventions.
Collapse
Affiliation(s)
- María-Teresa Urrutia
- School of Nursing, Universidad Andrés Bello, Santiago 8370134, Chile; (A.-X.A.); (M.C.)
| | | | - Macarena Gajardo
- School of Medicine, Universidad de Chile, Santiago 9170022, Chile;
| | - Macarena Chepo
- School of Nursing, Universidad Andrés Bello, Santiago 8370134, Chile; (A.-X.A.); (M.C.)
| | - Romina Torres
- Sistema de Bibliotecas UC, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile;
| | - Andrea Schilling
- Clinical Research Center, Institute of Science and Innovation in Medicine, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago 7610315, Chile;
| |
Collapse
|
5
|
Lubeya MK, Chibwesha CJ, Mwanahamuntu M, Mukosha M, Frank S, Kawonga M. "When you get the HPV vaccine, it will prevent cervical cancer; it will act as a shield": adolescent girls' knowledge and perceptions regarding the human papillomavirus vaccine in Zambia. FRONTIERS IN HEALTH SERVICES 2023; 3:1208458. [PMID: 37780403 PMCID: PMC10534003 DOI: 10.3389/frhs.2023.1208458] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023]
Abstract
Introduction The human papillomavirus (HPV) vaccination is an important preventive measure for HPV-related conditions such as cervical cancer. In 2019, Zambia introduced a free national HPV vaccination program for 14-year-old girls. However, the adolescents' knowledge and perceptions regarding the HPV vaccine are not well understood. Therefore, this study aimed to understand adolescent girls' knowledge and perceptions regarding the HPV vaccine and discuss its acceptability and uptake implications. Methods We conducted a qualitative study in the Lusaka district between June 2021 and November 2021 using semi-structured interviews with adolescent girls aged 15-18 years regardless of their HPV vaccination status. Interviews were transcribed verbatim, and NVIVO 12 was used for data management and analysis. We coded transcripts deductively and inductively based on emerging themes. Perceptions were coded using the health belief model constructs. Results We interviewed 30 adolescent girls to reach saturation. Seventeen girls reported having received at least one dose of the HPV vaccine. Participants expressed variable knowledge and awareness about HPV and the HPV vaccine. Participants exhibited positive attitudes towards the HPV vaccine and perceived it as beneficial. However, there were multiple perceived barriers to vaccination, such as the need for parental consent, not being in school, concerns about vaccine side effects, and belief in myths and misinformation. Conclusion The adolescent girls in this study showed variable knowledge and positive attitudes toward the HPV vaccine despite the many perceived barriers. To support increased HPV vaccine acceptability and uptake among adolescent girls in Zambia, it is critical to actively engage stakeholders involved in HPV vaccination, such as adolescents and their parents, and debunk myths and misconceptions about HPV vaccination. Health education in schools and communities should be implemented to increase knowledge about HPV and HPV vaccination among adolescents and their parents.
Collapse
Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka, Zambia
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carla J. Chibwesha
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg, South Africa
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka, Zambia
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Moses Mukosha
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Simone Frank
- School of Medicine, North Carolina Translational and Clinical Sciences (NC TraCS) Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| |
Collapse
|
6
|
Lubeya MK, Chibwesha CJ, Mwanahamuntu M, Mukosha M, Maposa I, Kawonga M. Correlates of Parental Consent to Human Papillomavirus Vaccine Uptake by Their Adolescent Daughters in ZAMBIA: Application of the Health Belief Model. Vaccines (Basel) 2023; 11:912. [PMID: 37243016 PMCID: PMC10224425 DOI: 10.3390/vaccines11050912] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Parental consent for adolescent human papillomavirus (HPV) vaccine uptake is important; however, refusal is prevalent. Therefore, this study aimed to understand factors associated with parental consent for their adolescent daughter's HPV vaccination. A cross-sectional study was conducted in Lusaka, Zambia, between September and October 2021. We recruited parents from different social settings. The means and standard deviations or median and interquartile ranges were used as appropriate to summarise continuous variables. Simple and multiple logistic regression models were fitted with robust estimation of standard errors. The odds ratios are presented with 95% CI. Mediation analysis was conducted using a generalised structural equation model. The study enrolled 400 parents, mean age 45.7 years [95% CI, 44.3-47.1]. Two hundred and fifteen (53.8%) parents reported consenting to their daughters' HPV vaccination, and their daughters received it. None of the health belief model (HBM) construct scores showed an independent association with parental consent. Higher, compared to lower wealth index (AOR; 2.32, 95% CI: 1.29-4.16), knowing someone with genital warts (AOR = 2.23, 95 CI: 1.04-4.76), cervical cancer screening uptake (AOR = 1.93, 95% CI: 1.03-3.62) were associated with increased odds of parental consent. This study highlights factors influencing parental consent for their daughters' HPV vaccination. Ongoing sensitisation programs are important to improve their decision-making.
Collapse
Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka 10101, Zambia;
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (M.M.); (M.K.)
| | - Carla J. Chibwesha
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg 2193, South Africa;
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka 10101, Zambia;
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
| | - Moses Mukosha
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (M.M.); (M.K.)
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia
| | - Innocent Maposa
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, Witwatersrand University, Johannesburg 2193, South Africa;
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (M.M.); (M.K.)
- Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| |
Collapse
|
7
|
Miti S, Shato T, Asante C, Baumann A, Chongwe G, Bobo PM, Silver MI, Hunleth JM. Leveraging health infrastructure to optimize HPV vaccination for adolescents in Zambia: Protocol for an implementation study. PLoS One 2023; 18:e0285031. [PMID: 37159471 PMCID: PMC10168569 DOI: 10.1371/journal.pone.0285031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer death in Zambia, where HIV prevalence is also high (11.3%). HIV heightens the risk of developing and dying from cervical cancer. The human papillomavirus (HPV) vaccine can prevent 90% of cervical cancers, and in Zambia is recommended for adolescent girls ages 14-15 years, including those with HIV. Currently they mainly deliver HPV vaccination via school-based campaigns, which may exclude the most vulnerable adolescents-those out-of-school or who irregularly attend. Adolescents living with HIV (ALHIV) are more likely to have these vulnerabilities. Further, school-based campaigns are not tailored to the WHO-recommended HPV vaccination schedule for ALHIV (3 versus 2 doses). Integrating HPV vaccination into routine care in adolescent HIV clinics may ensure that ALHIV have access to vaccine at the WHO-recommended schedule. Such integration requires a multilevel approach, stakeholder engagement, and diversified implementation strategies, given known challenges of providing the HPV vaccine in LMICs, including Zambia. METHODS Our study aims to integrate HPV vaccination into routine care in adolescent HIV clinics. To achieve success, we will co-design a package of implementation strategies using a previously successful implementation research approach developed for cervical cancer prevention in LMICs: the Integrative Systems Praxis for Implementation Research (INSPIRE). INSPIRE is a novel, comprehensive approach to develop, implement, and evaluate implementation science efforts. Following key elements of INSPIRE, our specific aims are to: 1) Identify the unique multilevel contextual factors (barriers and facilitators) across HIV settings (rural, urban, peri-urban) that influence HPV vaccine uptake; 2) Use Implementation Mapping to translate stakeholder feedback and findings from Aim 1 into a package of implementation strategies to integrate HPV vaccine into HIV clinics; 3) Conduct a Hybrid Type 3 effectiveness-implementation trial to evaluate the package of multilevel implementation strategies for integrating HPV vaccine into HIV clinics. DISCUSSION Our research team has strong support, technical expertise, and resources (e.g., vaccines) from the Zambian Ministry of Health; and political will for scale-up. This stakeholder-based implementation model has the potential to be transported to HIV clinics across Zambia and serve as a model to address cancer prevention priorities for those with HIV in other LMICs. TRIAL REGISTRATION To be registered prior to Aim 3, when implementation strategies finalized.
Collapse
Affiliation(s)
- Sam Miti
- Arthur Davison Children's Hospital, Ndola, Zambia
- Tropical Diseases Research Center, Ndola, Zambia
| | - Thembekile Shato
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Comfort Asante
- Tropical Diseases Research Center, Ndola, Zambia
- Ndola Teaching Hospital, Ndola, Zambia
| | - Ana Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | | | | | - Michelle I Silver
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Jean M Hunleth
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| |
Collapse
|
8
|
Guillaume D, Rosen JG, Mlunde LB, Njiro BJ, Munishi C, Mlay D, Gerste A, Holroyd TA, Giattas MR, Morgan C, Sunguya BF, Kyesi F, Tinuga F, Ishengoma J, Limaye RJ. Acceptability of an integrated school-based HPV vaccination program within two districts of Tanzania: A qualitative descriptive study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001394. [PMID: 36962916 PMCID: PMC10021529 DOI: 10.1371/journal.pgph.0001394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/24/2022] [Indexed: 01/06/2023]
Abstract
Tanzania has one of the highest cervical cancer incidence and mortality rates in sub-Saharan Africa. The Tanzanian Ministry of Health developed an integrated adolescent health program, HPV-Plus, that combines HPV vaccination with additional health services: nutritional assessments, vision screening, and vaccination for adolescent girls, and education for all genders. This qualitative descriptive study evaluated the acceptability of the HPV-Plus program in two districts in Tanzania. Key informants comprising of adolescent girls, parents, program planners, and program implementers in Njombe and Dar es Salaam Tanzania were interviewed to assess the program acceptability. Transcripts were analyzed using a team-based iterative thematic analysis approach, consisting of both inductive and deductive coding. The Theoretical Framework of Acceptability was used to guide analysis, with themes categorized according to theoretical constructs of intervention coherence, affective attitudes and perceptions, and perceived effectiveness. Overall acceptability of the HPV-Plus program was high among stakeholders. The most salient finding regarding factors that influenced HPV vaccine acceptability was largely related to education and knowledge levels surrounding the HPV, cervical cancer, and HPV vaccines. The educational component of the HPV-Plus program was key in increasing acceptability. Parents reported the lowest acceptability towards the program. This was found to be primarily due to perceptions of not being sufficiently engaged throughout program implementation. Increasing acceptability of HPV vaccination programs among key stakeholders is critical to facilitating vaccine uptake and meeting vaccination coverage targets. Our results demonstrate that the inclusion of a comprehensive education component within the HPV-Plus program was key in facilitating HPV vaccine acceptability amongst stakeholders.
Collapse
Affiliation(s)
- Dominique Guillaume
- International Vaccine Access Center, Johns Hopkins University, Baltimore, Maryland, United States of America
- Jhpiego, Johns Hopkins University affiliate, Baltimore, Maryland, United States of America
- Center for Infectious Disease and Nursing Innovation, School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joseph G Rosen
- International Vaccine Access Center, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Linda B Mlunde
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Belinda J Njiro
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Castory Munishi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Davis Mlay
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Amelia Gerste
- International Vaccine Access Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Taylor A Holroyd
- International Vaccine Access Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mary Rose Giattas
- Jhpiego, Johns Hopkins University affiliate, Baltimore, Maryland, United States of America
| | - Christopher Morgan
- Jhpiego, Johns Hopkins University affiliate, Baltimore, Maryland, United States of America
- School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Bruno F Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | | | | | - Joseline Ishengoma
- President's Office Regional Authority and Local Government, United Republic of Tanzania
| | - Rupali J Limaye
- International Vaccine Access Center, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| |
Collapse
|
9
|
Guillaume D, Waheed DEN, Schlieff M, Muralidharan K, Vorsters A, Limaye R. Key decision-making factors for human papillomavirus (HPV) vaccine program introduction in low-and-middle-income-countries: Global and national stakeholder perspectives. Hum Vaccin Immunother 2022; 18:2150454. [PMID: 36485172 PMCID: PMC9766470 DOI: 10.1080/21645515.2022.2150454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Low-and-middle-income countries (LMICs) experience a high burden of cervical cancer. The human papillomavirus (HPV) vaccine prevents high-risk strains of HPV that cause cervical cancer; however, the integration of HPV vaccines into national immunization programs within many LMICs has been suboptimal. Our study evaluated key factors that drive the decision-making process for the implementation of HPV vaccine programs in LMICs. Stakeholder analysis and semi-structured in-depth interviews were conducted with national and global stakeholders. Interview data were analyzed through qualitative descriptive methods. Findings from our study revealed the decision-making process for HPV vaccines requires the involvement of multiple institutions and stakeholders from national and global levels, with decision-making being a country-specific process. Partner considerations, locally driven processes, availability of data, and infrastructure and resource considerations were found to be critical factors in the decision-making process. Future programs should evaluate the best approaches for investing in initiatives to enhance coordination, ensure vaccine introduction is locally driven, increase the availability of data needed for decision-making, and equip countries with the necessary resources to guide country decision-making in the face of increasingly complex decision-making environments.
Collapse
Affiliation(s)
- Dominique Guillaume
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Jhpiego, A Johns Hopkins University Affiliate, Baltimore, MD, USA,School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Dur-e-Nayab Waheed
- Center for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium,HPV Prevention and Control Board, University of Antwerp, Antwerp, Belgium
| | - Meike Schlieff
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kirthini Muralidharan
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alex Vorsters
- Center for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium,HPV Prevention and Control Board, University of Antwerp, Antwerp, Belgium
| | - Rupali Limaye
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,CONTACT Rupali Limaye International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| |
Collapse
|
10
|
Nan X, Wang Y, Thier K, Adebamowo C, Quinn S, Ntiri S. Moral Foundations Predict COVID-19 Vaccine Hesitancy: Evidence from a National Survey of Black Americans. JOURNAL OF HEALTH COMMUNICATION 2022; 27:801-811. [PMID: 36576158 DOI: 10.1080/10810730.2022.2160526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In this study we examine the role of moral values in predicting COVID-19 vaccine hesitancy among Black Americans. Guided by moral foundations theory, we assess the associations between six moral foundations (care, fairness, loyalty, authority, purity, liberty) and attitudes and intentions toward COVID-19 vaccination. Results of a national survey of Black Americans (N = 1,497) indicate that the care and loyalty moral foundations consistently predicted less vaccine hesitancy with overall more favorable attitudes and intentions toward COVID-19 vaccination, whereas the purity and liberty moral foundations were consistently associated with greater vaccine hesitancy. Relationships between the foundations and vaccine hesitancy were mediated by perceived vaccine effectiveness and safety. Implications of the findings for COVID-19 vaccine communication are discussed.
Collapse
Affiliation(s)
- Xiaoli Nan
- Department of Communication, University of Maryland, College Park, Maryland, U.S.A
| | - Yuan Wang
- Department of Communication, University of Maryland, College Park, Maryland, U.S.A
| | - Kathryn Thier
- Department of Communication, University of Maryland, College Park, Maryland, U.S.A
| | - Clement Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, U.S.A
| | - Sandra Quinn
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, U.S.A
| | - Shana Ntiri
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, U.S.A
| |
Collapse
|
11
|
Marfo EA, King KD, Adjei CA, MacDonald SE. Features of human papillomavirus vaccination education strategies in low- and middle-income countries: a scoping review. Public Health 2022; 213:61-67. [PMID: 36371953 DOI: 10.1016/j.puhe.2022.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 09/05/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We aimed to describe studies on human papillomavirus (HPV) vaccination education strategies from low- and middle-income countries in the published literature that could be applicable in Sub-Sahara Africa. STUDY DESIGN This scoping review was guided by Arksey and O'Malley's methodological framework advanced by Levac et al. METHODS We searched four electronic health sciences databases for relevant reports published between January 2006 and January 2021. Two reviewers screened for inclusion and extracted data for analysis and synthesis. Descriptive statistics and narrative descriptions were used to summarize the findings. RESULTS The database search retrieved 1757 reports, of which 48 were from low- and middle-income countries and met the inclusion criteria. Of these, there were 39 interventional studies (81.3%). Less than one-fifth of the studies (n = 9) reported a theoretical basis for their strategies. Most strategies sought to improve knowledge and awareness about HPV (75%, n = 36), whereas outcomes for the remaining studies were related to increasing HPV vaccine acceptability. HPV education strategies (1) primarily targeted females, (2) were mostly provided by health professionals, and (3) used various modalities of learning, including in-person sessions, text-based materials, media, theater, and online delivery. CONCLUSIONS HPV educational strategies are underresearched in most LMICs, suggesting the need for more primary observational, interventional, and experimental research, as well as program evaluations, focused on HPV educational strategies and theoretically informed. Once additional studies are added to the body of evidence, it will be valuable to review and synthesize diverse sources of evidence to determine what educational strategies are most useful and have the greatest impact on HPV vaccination in these settings, particularly Sub-Saharan Africa.
Collapse
Affiliation(s)
- E A Marfo
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - K D King
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - C A Adjei
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - S E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
12
|
Arechkik A, Lahlou L, Obtel M, Kharbach A, Razine R. Cervical cancer in Morocco: A systematic review. Rev Epidemiol Sante Publique 2022; 70:230-242. [DOI: 10.1016/j.respe.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/13/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022] Open
|
13
|
Rice DR, Balamo A, Thierry AR, Gueral A, Fidele D, Mateen FJ, Sakadi F. COVID-19 vaccine acceptance and hesitancy in N'Djamena, Chad: A cross-sectional study of patients, community members, and healthcare workers. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000608. [PMID: 36962369 PMCID: PMC10022375 DOI: 10.1371/journal.pgph.0000608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/17/2022] [Indexed: 06/18/2023]
Abstract
As of March 2022, the COVID-19 vaccination rate in Chad approximated 1%. There are no published reports of COVID-19 vaccine hesitancy or beliefs in Chad. We aimed to study COVID-19 vaccine acceptance and hesitancy among community members, patients, and health care workers in urban Chad. We recruited a prospective convenience sample of adult patients, community members, and healthcare workers from N'Djamena, Chad between August-October 2021. Participants completed a 15-minute, 25-question survey instrument exploring demographic, social, and clinical variables related to COVID-19 and an adapted WHO SAGE Vaccine Hesitancy Survey. Primary outcomes were vaccine acceptance and vaccine hesitancy. Regression models were fit to assess associations between Vaccine Hesitancy Scale (VHS) scores, ranging from 10 (least hesitant) to 50 (most hesitant) points, and pre-selected variables of interest. An inductive thematic analysis was used to analyze the qualitative vaccine hesitancy responses. Of 508 participants (32% female; mean age 32 years), 162 were patients, 153 were community members, and 193 were healthcare workers. COVID-19 vaccine acceptance was significantly higher among patients (67%) than community members (44%) or healthcare workers (47%), p < .001. The average VHS score was 29 points (patients = 27.0, community members = 28.9, healthcare workers = 29.4), and more than one-third of participants were classified as highly vaccine hesitant (score >30 points). Knowing someone who died from COVID-19, believing local healthcare workers support vaccination, trusting the government, having a higher socioeconomic status (i.e. having electricity), and reporting medical comorbidities were each associated with less vaccine hesitancy (all p < .05). The vaccine concerns most frequently endorsed were: vaccine side effects (48%), efficacy (38%), safety (34%), concerns about the pharmaceutical industry (27%), and lack of government trust (21%). Four main themes arose from qualitative vaccine hesitancy responses (n = 116): education, trust, clinical concerns, and misinformation and false beliefs. Overall, COVID-19 vaccine acceptance was low, including among health care workers, and reasons for vaccine hesitancy were broad. We detail the most commonly reported concerns of urban Chadians for receiving the COVID-19 vaccine; we also identify subgroups most likely to endorse vaccine hesitancy. These analyses may inform future vaccination outreach campaigns in N'Djamena.
Collapse
Affiliation(s)
- Dylan R. Rice
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Anatole Balamo
- Neurology Unit, National Reference Teaching Hospital, N’Djamena, Chad
| | | | - Aremadji Gueral
- Neurology Unit, National Reference Teaching Hospital, N’Djamena, Chad
| | - Djerakoula Fidele
- Neurology Unit, National Reference Teaching Hospital, N’Djamena, Chad
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Foksouna Sakadi
- Neurology Unit, National Reference Teaching Hospital, N’Djamena, Chad
| |
Collapse
|
14
|
HPV Vaccination: An Underused Strategy for the Prevention of Cancer. Curr Oncol 2022; 29:3780-3792. [PMID: 35621693 PMCID: PMC9140027 DOI: 10.3390/curroncol29050303] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
Human papillomavirus (HPV) vaccination prevents cervical, head and neck, and anogenital cancers. However, global HPV vaccine coverage falls short of global targets and has seen unexpected and dramatic declines in some countries. This paper synthesizes the impact of HPV on the global burden of cancer and the potential benefit of HPV vaccination. Approximately 5% of the world’s cancers are specifically attributed to HPV. While the greatest global burden of HPV is cervical cancers in low- and middle-income countries, HPV-associated head and neck cancers are increasing in high-income countries and have surpassed cervical cancer as the primary HPV-associated cancer in some countries. Therefore, it is also critical to improve gender-neutral HPV vaccination. Understanding the modifiable drivers of vaccine acceptance and uptake is important for increasing HPV vaccination. The Behavioural and Social Drivers of Vaccination framework is broadly applied to identify key factors associated with HPV vaccination including domains concerning practical issues, motivation, social processes, and thinking and feeling. Among the behavioural strategies available to reduce the incidence and mortality of cancer, increasing HPV vaccination stands out as having unrealized potential to prevent disease, financial cost, and psychological distress. An understanding of the shifting burden of HPV and the factors associated with vaccination can be leveraged to regularly measure these factors, develop interventions to promote vaccine uptake, and improve global HPV vaccine coverage. Future research in diverse contexts is necessary to investigate the barriers and facilitators of global HPV vaccination.
Collapse
|
15
|
Abuduxike G, Asut O, Cali S, Vaizoglu S. Knowledge and Awareness of Parents Towards Human Papillomavirus (HPV) and HPV Vaccines, and Vaccine Acceptability in Northern Cyprus. JOURNAL OF PREVENTION (2022) 2022; 43:225-240. [PMID: 35286543 DOI: 10.1007/s10935-021-00657-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
The human papillomavirus (HPV) vaccine is one of the most cost-effective public health measures for preventing cervical cancer and other HPV-related diseases. However, the vaccine uptake in many countries remains suboptimal. This cross-sectional study aimed to assess the knowledge and awareness of parents towards HPV, related diseases, and HPV vaccines, as well as to examine the effect of brief educational information on parents' vaccine acceptability. We used a structured interviewer-administered questionnaire to collect information from 227 outpatient visitors to a healthcare center who had children under the age of 19 years. We asked parents again about their acceptance of HPV vaccines after being provided brief educational information. Of all the parents, 43% were aware of HPV and related diseases, and 59% of those had sufficient knowledge regarding HPV while 45% of them reported that they were aware of HPV vaccines. Being Northern Cypriot was a predictor of having good knowledge, whilst being a female, having a higher education level, being 35 years or older, and being employed were the significant predictors of having greater awareness of HPV and related diseases. The HPV vaccine acceptance of the parents increased substantially in all sociodemographic groups after the provision of the educational information. The findings demonstrated that the vaccination rates of children of parents who have insufficient knowledge and awareness of HPV and vaccines are also very low. Effective educational interventions based on the specific sociodemographic characteristics of the patients should be given a stronger focus to improve vaccine acceptability among this population.
Collapse
Affiliation(s)
- Gulifeiya Abuduxike
- Department of Public Health, Faculty of Medicine, Near East University, Yakin Dogu Bulvari, 99138, Nicosia, Northern Cyprus.
| | - Ozen Asut
- Department of Public Health, Faculty of Medicine, Near East University, Yakin Dogu Bulvari, 99138, Nicosia, Northern Cyprus
| | - Sanda Cali
- Department of Public Health, Faculty of Medicine, Near East University, Yakin Dogu Bulvari, 99138, Nicosia, Northern Cyprus
| | - Songul Vaizoglu
- Department of Public Health, Faculty of Medicine, Near East University, Yakin Dogu Bulvari, 99138, Nicosia, Northern Cyprus
| |
Collapse
|
16
|
Jones A, Kawesa-Newell N. Using branded behaviour change communication to create demand for the HPV vaccine among girls in Malawi: An evaluation of Girl Effect's Zathu mini magazine. Vaccine 2022; 40 Suppl 1:A107-A115. [PMID: 34340857 DOI: 10.1016/j.vaccine.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/14/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
The HPV vaccine was introduced nationally in Malawi in 2019 and administered to 9-year-old girls. In order to drive uptake of the HPV vaccine Girl Effect utilised their youth brand, Zathu, to deliver messaging on the HPV vaccine. A Zathu 'mini magazine' was created specifically for 9-year-old girls to provide information, prompt household conversations and build empowerment around the HPV vaccine. This evaluation assessed the effectiveness of the Zathu mini magazine against two outcomes: (1) Girls are more informed & motivated to receive the HPV vaccine and (2) Girls talk to their caregivers about the HPV vaccine.A quasi-experimental approach was adopted using both qualitative and quantitative data collection to measure the results against these outcomes. The study found positive correlations between consumption of the Zathu mini magazine and awareness of cervical cancer, and positive attitudes towards the HPV vaccine among girls and parents in the exposed group compared to the non-exposed group. The Zathu mini magazine also encouraged household discussions on the HPV vaccine. Most significantly, consumption of the mini magazine was also positively correlated with uptake of the HPV vaccine among girls. This study highlights the value of girl-centred communications in demand generation for the HPV vaccine. There is potential to learn from and replicate this approach in other comparable settings.
Collapse
|
17
|
Davies C, Taba M, Deng L, Karatas C, Bag S, Ross C, Forster A, Booy R, Skinner SR. Usability, acceptability, and feasibility of a High-Density Microarray Patch (HD-MAP) applicator as a delivery method for vaccination in clinical settings. Hum Vaccin Immunother 2022; 18:2018863. [PMID: 35100525 PMCID: PMC9196792 DOI: 10.1080/21645515.2021.2018863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background High-density microarray patch (HD-MAP) vaccines may increase vaccine acceptance and use. We aimed to ascertain whether professional immunizers (PIs) and other healthcare workers (HCWs) in Australia, a High-Income Country (HIC), found the HD-MAP applicator usable and acceptable for vaccine delivery. Methods This feasibility study recruited PIs and HCWs to administer/receive simulated HD-MAP administration, including via self-administration. We assessed usability against essential and desirable criteria. Participants completed a survey, rating their agreement to statements about HD-MAP administration. A subset also participated in an interview or focus group. Survey data were analyzed using descriptive statistics, and interviews were transcribed and subject to thematic analysis. Results We recruited 61 participants: 23 PIs and 38 HCWs. Findings indicated high usability and acceptability of HD-MAP use across both groups by a healthcare professional or trained user and for self-administration with safety measures in place. Most administrations met essential criteria, but PIs, on average, applied the HD-MAP for slightly less time than the required 10-seconds, which the HCWs achieved. PIs perceived safety concerns about home administration but found layperson self-administration acceptable in an emergency, pandemic, and rural or remote settings. Conclusions Participants found HD-MAP administration usable and acceptable. Usability and acceptability are likely to be improved through end-user education and training. Professional immunizers and healthcare workers found high-density microarray patch devices highly usable and acceptable to administer vaccines. HD-MAPs may have advantages over intramuscular injections in clinical settings and in pandemics.
Vaccination with HD-MAP may improve acceptance for those with needle-related anxiety.
Collapse
Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - Melody Taba
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - Lucy Deng
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, Australia
| | - Ceylan Karatas
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Graduate School of Medicine, The University of Wollongong, Keiraville, Australia
| | - Shopna Bag
- Centre for Population Health, Western Sydney Public Health Unit, North Parramatta, Australia.,Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Charles Ross
- Vaxxas Pty Ltd, Translational Research Institute, Woolloongabba, Australia
| | - Angus Forster
- Vaxxas Pty Ltd, Translational Research Institute, Woolloongabba, Australia
| | - Robert Booy
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - S Rachel Skinner
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| |
Collapse
|
18
|
Amponsah-Dacosta E, Blose N, Nkwinika VV, Chepkurui V. Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services? Front Public Health 2022; 10:799984. [PMID: 35174123 PMCID: PMC8841655 DOI: 10.3389/fpubh.2022.799984] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/07/2022] [Indexed: 12/17/2022] Open
Abstract
Compared to other regions of the world, sub-Saharan Africa has made limited progress in the implementation and performance of nationwide human papillomavirus (HPV) vaccination programmes. Without urgent intervention, this will serve to undermine cervical cancer elimination efforts in this region. The primary intent of this narrative review is to highlight the programmatic successes and challenges of the school-based HPV vaccination programme in South Africa since its inception in 2014, with the aim of contributing to the evidence base needed to accelerate implementation and improve programme performance in other sub-Saharan African countries. As of 2020, the proportion of adolescent girls aged 15 years who had received at least one dose of the HPV vaccine at any time between ages 9–14 years was 75%, while 61% had completed the full recommended two-dose schedule. This gives some indication of the reach of the South African HPV vaccination programme over the past 6 years. Despite this, vaccine coverage and dose completion rates have persistently followed a downward trend, slowing progress toward attaining global elimination targets. There is evidence suggesting that declining public demand for the HPV vaccine may be a result of weakening social mobilization over time, inadequate reminder and tracking systems, and vaccine hesitancy. Another concern is the disproportionate burden of HPV and HIV co-infections among adolescent girls and young women in South Africa, which predisposes them to early development of invasive cervical cancer. Moving forward, national policy makers and implementers will have to explore reforms to current age eligibility criteria and vaccine dose schedules, as well as implement strategies to support vaccine uptake among populations like out-of-school girls, girls attending private schools, and HIV positive young women. Additional opportunities to strengthen the South African HPV vaccination programme can be achieved by scaling up the co-delivery of other adolescent health services such as comprehensive sexual and reproductive health and rights education, deworming, and health screening. This calls for reinforcing implementation of the integrated school health policy and leveraging existing adolescent health programmes and initiatives in South Africa. Ultimately, establishing tailored, adolescent-centered, integrated health programmes will require guidance from further operational research.
Collapse
Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- *Correspondence: Edina Amponsah-Dacosta ;
| | - Ntombifuthi Blose
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Varsetile Varster Nkwinika
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Virological Pathology, South African Vaccination and Immunisation Centre (SAVIC), Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Viola Chepkurui
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
19
|
Whitworth H, Changalucha J, Baisley K, Watson-Jones D. Adolescent Health Series: HPV infection and vaccination in sub-Saharan Africa: 10 years of research in Tanzanian female adolescents - narrative review. Trop Med Int Health 2021; 26:1345-1355. [PMID: 34310816 DOI: 10.1111/tmi.13660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cervical cancer is the leading cause of cancer-related morbidity and mortality in many sub-Saharan African (SSA) countries, including Tanzania. Most cervical cancer cases worldwide are attributable to infection of the cervix with Human Papillomavirus (HPV), a vaccine-preventable sexually transmitted infection (STI). Over the past 10 years, we have conducted a programme of HPV research in pre-adolescents and adolescents in Mwanza, the second-largest city in Tanzania, which is situated in a malaria-endemic region. In this narrative review article, we summarise the contribution of our work, alongside work of others, to improve the understanding of HPV epidemiology in SSA and development of setting-appropriate, evidence-based intervention strategies. We present evidence for very high prevalence and incidence of HPV infection among female SSA adolescents around the time of sexual debut, describe risk factors for HPV acquisition, and discuss associations between HPV, HIV and other STIs, which are also highly prevalent within this population. We summarise findings from early clinical trials of HPV vaccines in SSA, the first of which was an immunogenicity and safety trial conducted in Mwanza, Tanzania, and Dakar, Senegal. Within the trial, we evaluated for the first time the potential impact of malaria and helminth infection on vaccine-induced antibody responses in Tanzanian girls. We describe research evaluating optimal HPV vaccine delivery strategies within this setting, perceived requirements for and barriers to vaccine implementation among key informants from LMIC, vaccine acceptability among girls and parents, and opportunities for co-delivery of interventions alongside HPV vaccination to an adolescent population. Finally, we discuss country-level barriers to vaccine uptake in LMIC, and ongoing studies in Tanzania and other SSA countries of reduced-dose HPV vaccination schedules that may alleviate cost and logistical barriers to vaccine implementation.
Collapse
Affiliation(s)
- Hilary Whitworth
- Mwanza Intervention Trials Unit, National Institute of Medical Research, Mwanza, Tanzania
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - John Changalucha
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathy Baisley
- Mwanza Intervention Trials Unit, National Institute of Medical Research, Mwanza, Tanzania
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, National Institute of Medical Research, Mwanza, Tanzania
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
20
|
Hogben M, Dittus PJ, Leichliter JS, Aral SO. Social and behavioural research prospects for sexually transmissible infection prevention in the era of advances in biomedical approaches. Sex Health 2021; 17:103-113. [PMID: 32119815 DOI: 10.1071/sh19105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
In the past two decades, major advances in biomedical intervention approaches to prevent HIV and many sexually transmissible infections (STIs) have shown great promise. However, challenges to prevention remain in the area of achieving population-level impact for biomedical prevention approaches. In this paper we address what social and behavioural research approaches can contribute beyond well-known behaviour change and counselling interventions. We organise work into five areas. Adherence and disinhibition research is primarily into individual-level constructs pertaining to maximising intervention effectiveness. Coverage research represents a population-level construct germane to maximising efficient prioritisation for prevention. Research covering social determinants, a second population-level construct, contributes to both prioritisation and effectiveness. Finally, disparities and social inequities need to be incorporated into prevention, given the pervasive and persistent disparities found in rates of HIV and STIs and in their antecedents.
Collapse
Affiliation(s)
- Matthew Hogben
- Division of STD Prevention, Centers for Disease Control and Prevention, Mail Stop US12-2, Atlanta, GA 30333, USA; and Corresponding author.
| | - Patricia J Dittus
- Division of STD Prevention, Centers for Disease Control and Prevention, Mail Stop US12-2, Atlanta, GA 30333, USA
| | - Jami S Leichliter
- Division of STD Prevention, Centers for Disease Control and Prevention, Mail Stop US12-2, Atlanta, GA 30333, USA
| | - Sevgi O Aral
- Division of STD Prevention, Centers for Disease Control and Prevention, Mail Stop US12-2, Atlanta, GA 30333, USA
| |
Collapse
|
21
|
Dare AJ, Knapp GC, Romanoff A, Olasehinde O, Famurewa OC, Komolafe AO, Olatoke S, Katung A, Alatise OI, Kingham TP. High-burden Cancers in Middle-income Countries: A Review of Prevention and Early Detection Strategies Targeting At-risk Populations. Cancer Prev Res (Phila) 2021; 14:1061-1074. [PMID: 34507972 DOI: 10.1158/1940-6207.capr-20-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
Cancer incidence is rising in low- and especially middle-income countries (MIC), driven primarily by four high-burden cancers (breast, cervix, lung, colorectal). By 2030, more than two-thirds of all cancer deaths will occur in MICs. Prevention and early detection are required alongside efforts to improve access to cancer treatment. Successful strategies for decreasing cancer mortality in high-income countries are not always effective, feasible or affordable in other countries. In this review, we evaluate strategies for prevention and early detection of breast, cervix, lung, and colorectal cancers, focusing on modifiable risk factors and high-risk subpopulations. Tobacco taxation, human papilloma virus vaccination, cervical cancer screen-and-treat strategies, and efforts to reduce patient and health system-related delays in the early detection of breast and colorectal cancer represent the highest yield strategies for advancing cancer control in many MICs. An initial focus on high-risk populations is appropriate, with increasing population coverage as resources allow. These strategies can deliver significant cancer mortality gains, and serve as a foundation from which countries can develop comprehensive cancer control programs. Investment in national cancer surveillance infrastructure is needed; the absence of national cancer data to identify at-risk groups remains a barrier to the development of context-specific cancer control strategies.
Collapse
Affiliation(s)
- Anna J Dare
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory C Knapp
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anya Romanoff
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Akinwumi O Komolafe
- Department of Morbid Anatomy and Forensic Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin, Ilorin, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical College - Owo, Owo, Nigeria
| | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
22
|
Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, Ahmed HAW, Sun K. The Impact of Video-Based Educational Interventions on Cervical Cancer, Pap Smear and HPV Vaccines. Front Public Health 2021; 9:681319. [PMID: 34307280 PMCID: PMC8294697 DOI: 10.3389/fpubh.2021.681319] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 01/24/2023] Open
Abstract
Background: Video-based interventions have the potential to contribute to long-lasting improvements in health-seeking behaviours. Ghana's upsurge rate of information and communication technology usage presents an opportunity to improve the awareness of HPV vaccination and screening rates of cervical cancer among women in Ghana. This research aimed to assess the impact of video-based educational intervention centred on the Health Belief and Transtheoretical Models of behavioural changes in promoting HPV vaccination, cervical carcinoma awareness and willingness to have Pap smear test (PST) among women in Ghana. Methods: To achieve the intended sample size, convenient, purposive and stratified random sampling techniques were used. SPSS v. 23.0 was used in the data analysis. Percentages and frequencies were used to represent participants' demographic characteristics, knowledge of (1) cervical carcinoma, (2) human papillomavirus vaccine, and (3) Pap smear test. The chi-square test by McNemar was employed to evaluate variations in the post- and pre-intervention responses. A p-value < 0.05 was considered statistically significant. The level of significance was adjusted owing to multiple comparisons by using the Bonferroni's correction. Results: Before the intervention, 84.2% of the participant had some knowledge or information about cervical cancer, but after the intervention, 100% of the participant became aware of cervical cancer which represents 15.8% increment at a P < .001. The willingness to have a pap smear test increased from 35.8% to 94.2% (df = 58.4%, P < .001) after the educational intervention. The willingness to be vaccinated increased from 47.5% to 81.7% (df = 34.2%, P < .001) after the educational intervention. Six months after the intervention, participants were followed-up. 253 (42.2%) participants had gone for cervical cancer screening (Pap smear test) while 347 (57.8%) participants had not been screened. In terms of HPV vaccination, 192 participants (32.0%) had begun their HPV vaccination cycle. Conclusion: The study results show that health education, using videos, may be influential in perception changing, self-efficacy improvement and the understanding of cervical carcinoma screening and HPV vaccination.
Collapse
Affiliation(s)
- Emmanuel Kwateng Drokow
- Department of Radiation Oncology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital Henan, Zhengzhou, China
| | | | - Clement Agboyibor
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Evans Sasu
- Department of Radiotherapy, National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Cecilia Amponsem-Boateng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | | | - Hafiz Abdul Waqas Ahmed
- Department of Haematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital Henan, Zhengzhou, China
| | - Kai Sun
- Department of Haematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital Henan, Zhengzhou, China
| |
Collapse
|
23
|
Iliyasu Z, Galadanci HS, Muhammad A, Iliyasu BZ, Umar AA, Aliyu MH. Correlates of human papillomavirus vaccine knowledge and acceptability among medical and allied health students in Northern Nigeria. J OBSTET GYNAECOL 2021; 42:452-460. [PMID: 34155960 DOI: 10.1080/01443615.2021.1910639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prior to its planned introduction, we investigated predictors of baseline knowledge and acceptability of HPV vaccination among medical and allied health care students in Kano, northern Nigeria. A total of 410 medical, dental and allied health students completed structured validated questionnaires. Knowledge scores and acceptability of HPV vaccine were determined and adjusted odds ratios (AOR) for predictors of HPV knowledge and acceptability were derived from multivariate logistic regression models. Overall, 3.7% (n = 15), 30.7% (n = 126) and 65.6% (n = 269) of respondents had good, moderate, and poor knowledge of HPV, respectively. The majority 334 (81.5%) were willing to accept the HPV vaccine, but only 18 (4.4%) had received at least one dose of the vaccine. Knowledge of HPV was better among females, younger (<20 years) medical students, students at higher levels of study, sexually experienced students, and condom users. HPV vaccine acceptance was higher among female students in the faculty of allied health with a family history of cervical cancer and good or moderate knowledge of HPV. In conclusion, most students were willing to receive HPV vaccination, despite their sub-optimal level of knowledge and low vaccine uptake. We recommend piloting the HPV vaccine in health colleges and recruiting early adopters as peer educators and advocates.IMPACT STATEMENTWhat is already known on this subject? Human Papilloma Virus (HPV) vaccine has been introduced in over 80 countries in the past decade, but evidence suggests low awareness of HPV infection and the vaccine, especially in developing countries. Nigeria proposes to introduce the HPV vaccine as part of the routine immunisation program in early 2021.What do the results of this study add? The majority of medical and allied health students in Kano, Nigeria, were willing to receive HPV vaccination, despite their sub-optimal level of knowledge and low vaccine uptake. Vaccine acceptance was predicted by the respondent's sex, course of study, family history of cervical cancer and knowledge of HPV.What are the implications of these findings for clinical practice and/or further research? The findings could inform program implementation and evaluation as HPV vaccine uptake is scaled up across Africa.
Collapse
Affiliation(s)
- Zubairu Iliyasu
- Community Medicine Department, Bayero University, Kano, Nigeria
| | | | - Aisha Muhammad
- Community Medicine Department, Bayero University, Kano, Nigeria
| | | | - Amina A Umar
- Community Medicine Department, Bayero University, Kano, Nigeria
| | - Muktar H Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, TN, USA
| |
Collapse
|
24
|
Mitchell KR, Erio T, Whitworth HS, Marwerwe G, Changalucha J, Baisley K, Lacey CJ, Hayes R, de SanJosé S, Watson-Jones D. Does the number of doses matter? A qualitative study of HPV vaccination acceptability nested in a dose reduction trial in Tanzania. Tumour Virus Res 2021; 12:200217. [PMID: 34051389 PMCID: PMC8233223 DOI: 10.1016/j.tvr.2021.200217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background The multi-dose regimen is a known barrier to successful human papillomavirus (HPV) vaccination. Emerging evidence suggests that one vaccine dose could protect against HPV. While there are clear advantages to a single dose schedule, beliefs about vaccine dosage in low and middle income countries (LMICs) are poorly understood. We investigated acceptability of dose-reduction among girls, and parents/guardians of girls, randomised to receive one, two or three doses in an HPV vaccine dose-reduction and immunobridging study (DoRIS trial) in Tanzania. Methods Semi-structured interviews with girls (n = 19), and parents/guardians of girls (n = 18), enrolled in the study and completing their vaccine course. Results Most participants said they entrusted decisions about the number of HPV vaccine doses to experts. Random allocation to the different dose groups did not feature highly in the decision to participate in the trial. Given a hypothetical choice, girls generally said they would prefer fewer doses in order to avoid the pain of injections. Parental views were mixed, with most wanting whichever dose was most efficacious. Nonetheless, a few parents equated a higher number of doses with greater protection. Conclusion Vaccine trials and programmes will need to employ careful messaging to explain that one dose offers sufficient protection against HPV should emerging evidence from ongoing dose-reduction clinical trials support this. We interviewed girls, and parents/carers of girls, enrolled in an HPV Vaccine dose reduction trial. We found that enrolling in the trial in the context of community rumours required trust in the trial scientists. Scientists were trusted to decide on dosage; thus randomisation by dosage was not an acceptability issue. Girls preferred fewer vaccine doses in order to avoid injection-related pain. Parents/guardians generally wanted whichever dose regimen was most efficacious.
Collapse
Affiliation(s)
- K R Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley St, Glasgow, G3 7HR, UK.
| | - T Erio
- Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania.
| | - H S Whitworth
- Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - G Marwerwe
- Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania.
| | - J Changalucha
- Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania.
| | - K Baisley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - C J Lacey
- York Biomedical Research Institute & Hull York Medical School, University of York, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK.
| | - R Hayes
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - S de SanJosé
- Catalan Institute of Oncology, Avinguda de La Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain.
| | - D Watson-Jones
- Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| |
Collapse
|
25
|
Aduh U, Ewa AU, Sam-Agudu NA, Urhioke O, Kusimo O, Ugwu C, Fadare OA, Anyaike C. Addressing gaps in adolescent tuberculosis programming and policy in Nigeria from a public health perspective. Int J Adolesc Med Health 2021; 33:41-51. [PMID: 33913304 DOI: 10.1515/ijamh-2020-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Tuberculosis (TB) is a leading infectious cause of death globally. Of the estimated 10 million people who developed active TB in 2019, 1.8 million (18%) were adolescents and young adults aged 15-24 years. Adolescents have poorer rates of TB screening, treatment initiation and completion compared to adults. Unfortunately, there is relatively less programme, research and policy focus on TB for adolescents aged 10-19 years. This article reviews the scope of health services and the relevant policy landscape for TB case notification and care/treatment, TB/HIV management, and latent TB infection for adolescents in Nigeria. Additionally, it discusses considerations for TB vaccines in this population. CONTENT All Nigeria Federal Ministry of Health policy documents relevant to adolescent health services and TB, and published between 2000 and 2020 underwent narrative review. Findings were reported according to the service areas outlined in the Objectives. SUMMARY AND OUTLOOK Nine policy documents were identified and reviewed. While multiple policies acknowledge the needs of adolescents in public health and specifically in TB programming, these needs are often not addressed in policy, nor in program integration and implementation. The lack of age-specific epidemiologic and clinical outcomes data for adolescents contributes to these policy gaps. Poor outcomes are driven by factors such as HIV co-infection, lack of youth-friendly health services, and stigma and discrimination. Policy guidelines and innovations should include adaptations tailored to adolescent needs. However, these adaptations cannot be developed without robust epidemiological data on adolescents at risk of, and living with TB. Gaps in TB care integration into primary reproductive, maternal-child health and nutrition services should be addressed across multiple policies, and mechanisms for supervision, and monitoring and evaluation of integration be developed to guide comprehensive implementation. Youth-friendly TB services are recommended to improve access to quality care delivered in a patient-centered approach.
Collapse
Affiliation(s)
- Ufuoma Aduh
- World Health Organisation, Abuja, Nigeria
- Texila American University, Georgetown, Guyana
| | - Atana Uket Ewa
- Department of Paediatrics, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA
| | - Ochuko Urhioke
- National TB and Leprosy Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | - Chukwuma Anyaike
- National TB and Leprosy Control Programme, Federal Ministry of Health, Abuja, Nigeria
| |
Collapse
|
26
|
Derbie A, Mekonnen D, Misgan E, Alemu YM, Woldeamanuel Y, Abebe T. Low level of knowledge about cervical cancer among Ethiopian women: a systematic review and meta-analysis. Infect Agent Cancer 2021; 16:11. [PMID: 33568189 PMCID: PMC7876815 DOI: 10.1186/s13027-021-00350-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/28/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Cervical cancer is one of the leading causes of malignancies among women in Ethiopia. Knowing the disease could empower women to make an informed decision regarding participation with cervical cancer prevention strategies. There is scarcity of compiled data in the field. Therefore, this systematic review aimed to provide an overview of knowledge about cervical cancer among Ethiopian women. Methods We conducted a systematic review of peer-reviewed articles on the knowledge of cervical cancer. Articles were systematically searched using comprehensive search strings from PubMed/Medline, SCOPUS, and grey literature from Google Scholar. Two reviewers assessed study eligibility, extracted data, and the risk of bias independently. Meta-analysis was performed using STATA v 14 to pool the overall knowledge of the women about cervical cancer. Results We included 26 articles published between 2013 and 2020 covering a total of 14,549 participants. All the included articles had good methodological quality. The proportion of participants who had heard of cervical cancer varied from 4.6 to 87.7% with the pooled estimate at 56% (95% CI: 47–66). Similarly, the proportion of participants who knew that HPV is the main cause of cervical cancer lied between 0 and 49.7% with the pooled result at 21% (95% CI: 13–30). Likewise, the pooled prevalence to identify at least one risk factor, one symptom of cervical cancer and ever heard of cervical cancer screening was gauged at 52% (95% CI: 39–64), 43% (95% CI: 26–60), and 39% (95% CI: 24–55), respectively. The overall pooled prevalence of good knowledge about cervical cancer was at 43% (95% CI: 33–53). On top of this, the prevalence of previous screening practice among the participants was at 14% (95% CI: 9–20). Conclusions Knowledge about cervical cancer among Ethiopian women is quite poor. Therefore, health education to provide sufficient and unbiased information about HPV and cervical cancer in general is required to the public.
Collapse
Affiliation(s)
- Awoke Derbie
- Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. .,Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Health Biotechnology, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Daniel Mekonnen
- Department of Medical Microbiology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Department of Health Biotechnology, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eyaya Misgan
- Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yihun Mulugeta Alemu
- Departent of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia.,Department of Medical Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Medical Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
27
|
Ebu NI, Abotsi-Foli GE, Gakpo DF. Nurses' and midwives' knowledge, attitudes, and acceptance regarding human papillomavirus vaccination in Ghana: a cross-sectional study. BMC Nurs 2021; 20:11. [PMID: 33407430 PMCID: PMC7789304 DOI: 10.1186/s12912-020-00530-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nurses and midwives play important roles in educating the public on cervical cancer prevention strategies. AIM This study sought to assess nurses' and midwives' knowledge of, attitudes towards, and acceptance of human papillomavirus (HPV) vaccination in relation to their background characteristics. METHODS A descriptive cross-sectional study using questionnaires was conducted with a convenience sample of 318 female nurses and midwives, ages 20 to 59, at the Korle-Bu Teaching Hospital in Ghana. The data were summarised using frequencies, percentages, chi-square tests, and Fisher's exact tests. RESULTS The results indicated that 41.5% (n = 132) of the participants had high levels of knowledge about cervical cancer risk factors, and 17.6% (n = 56) of the respondents had received at least one dose of the HPV vaccine. Reasons for receiving the HPV vaccination included advice from a colleague (12.9%, n = 41) and perceived threat of cervical cancer (11.7%, n = 37). Of the 262 respondents who had not been vaccinated, 24.45% (n = 78) strongly agreed and 28.0% (n = 89) agreed with the statement that there was limited information on HPV vaccination. Also, there were statistically significant associations between age (X2 = 23.746, p = 0.001), marital status (X2 = 14.758, p = 0.005), completed level of education (X2 = 21.692, p = 0.001), and duration of working at the hospital (X2 = 8.424, p = 0.038) and acceptance of HPV vaccination. CONCLUSIONS This study demonstrated gaps in knowledge about cervical cancer risk factors and attitudes towards HPV vaccination, indicating the need for targeted measures to improve knowledge and attitudes. Also, measures to increase acceptance of HPV vaccination among nurses and midwives should consider their sociodemographic characteristics.
Collapse
Affiliation(s)
- Nancy Innocentia Ebu
- Department of Adult Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana.
| | | | | |
Collapse
|
28
|
Zare E, Roozbeh N, Akbari PA, Teshnizi SH, Ghazanfarpour M, Abdi F. HPV and its high-risk genotypes in Middle Eastern countries: a meta-analysis. Future Virol 2020. [DOI: 10.2217/fvl-2019-0155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: HPV is the main cause of cervical cancer. Determining the geographic distribution of HPV genotypes is a major step in the implementation of cervical cancer screening. This study aimed to evaluate the prevalence of HPV and its high-risk genotypes in Middle Eastern countries. Materials & methods: MEDLINE, ISI Web of Science, PubMed, EMBASE, Scopus and ProQuest were searched from 2005 to 2018. The quality of the studies was determined by Strengthening the Reporting of Observational Studies in Epidemiology checklist. Fixed/random effects models were conducted to estimate the pooled prevalence. Results: The pooled prevalence of HPV was 12.3 and 5.2%. The prevalence of HPV in Africa (22%) was higher than that in Eurasia (8.3%) and Asia (12.6%). The prevalence of HPV was 14.4, 8.3, 22 and 10.2% in Iran, Turkey, Egypt and Arab countries, respectively. The prevalence of high-risk-HPV in the above-mentioned countries was 6.5, 6.2, 6.5 and 3.7%. Conclusion: Prevalence of HPV was increased in the Middle East. This highlights the need for public education, screening and vaccination programs.
Collapse
Affiliation(s)
- Elham Zare
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasibeh Roozbeh
- Mother and Child Welfare Research Center, Hormozgan Universiy of Medical Sciences, Bandar Abbas, Iran
| | - Pouran Akhavan Akbari
- Department of Midwifery, Nursing and Midwifery Faculty, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Saeed Hosseini Teshnizi
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Fatemeh Abdi
- Non-communicable Diseases Research Center,Alborz University of Medical Sciences, Karaj, Iran
| |
Collapse
|
29
|
Ampofo AG, Gyamfuaah SA, Opoku NS, Owusu SO, Ibitoye MB. A pilot study of a video-based educational intervention and knowledge of cervical cancer among senior high school students in Ghana: A before-after study. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
30
|
Ezeanochie M, Olasimbo P. Awareness and uptake of human papilloma virus vaccines among female secondary school students in Benin City, Nigeria. Afr Health Sci 2020; 20:45-50. [PMID: 33402891 PMCID: PMC7750089 DOI: 10.4314/ahs.v20i1.8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background There is no Government endorsed HPV vaccine immunisation program in Nigeria. The Vaccine has been available at the University of Benin Teaching Hospital (UBTH) in Benin City for more than 7 years. Objectives The aim was to evaluate awareness about HPV, the prevalence of HPV immunisation and its associated factors among the study population. Methods A cross-sectional study using interviewer-administered questionnaires among 215 females attending secondary schools in Benin city, Nigeria. Participants were selected using multi-stage stratified sampling. The primary outcome measure was HPV immunisation of the girls. Results The majority of the participants were between 14 to 18 years (58.6%). Almost all the participants (>97%) had not heard of HPV, HPV Vaccines and Cervical cancer. In addition, 2 (0.9%) persons correctly identified that the virus can be transmitted sexually while only 1 person (0.5%) had received the HPV vaccine. The respondents all agreed that they needed to be enlightened about HPV, HPV vaccines and Cervical cancer. Majority (49.3%) of the girls suggested that this could be done through the mass media (49.3%) or their parents (32.1%). Conclusion HPV immunisation, knowledge of HPV vaccines and Cervical cancer among the study population was very low. We recommend interventions in Schools to increase knowledge about cervical cancer and HPV vaccines.
Collapse
Affiliation(s)
- Michael Ezeanochie
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Edo state, Nigeria
| | - Peter Olasimbo
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Edo state, Nigeria
| |
Collapse
|
31
|
Hogben M, Leichliter J, Aral SO. An Overview of Social and Behavioral Determinants of STI. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
32
|
Ficht AL, Lapidos-Salaiz I, Phelps BR. Eliminating cervical cancer: Promising developments in primary prevention. Cancer 2019; 126:242-246. [PMID: 31557324 DOI: 10.1002/cncr.32507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/02/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Allison L Ficht
- Bureau for Global Health, US Agency for International Development, Arlington, Virginia
| | - Ilana Lapidos-Salaiz
- Bureau for Global Health, US Agency for International Development, Arlington, Virginia
| | - B Ryan Phelps
- Bureau for Global Health, US Agency for International Development, Arlington, Virginia
| |
Collapse
|
33
|
George C, Roberts R, Brennen D, Deveaux L, Read SE. Knowledge and awareness of Human Papillomavirus (HPV) and HPV vaccines among Caribbean youth: the case of the Bahamas. Hum Vaccin Immunother 2019; 16:573-580. [PMID: 31464555 PMCID: PMC7227632 DOI: 10.1080/21645515.2019.1661205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
There is a high burden of cervical cancer in the Caribbean region, particularly in the Bahamas, yet there are few studies of Human Papillomavirus (HPV) and HPV vaccine in the region. The objective of this study was to assess the knowledge and awareness of HPV and the HPV vaccine among school-aged youth (15–18 years) living in the Bahamas. Cross-sectional data were obtained from the “Getting to Zero” HIV study in the Bahamas conducted in 2014/2015 (n = 1553). The questionnaire elicited information on knowledge of HPV and HPV vaccines, using previously validated scales. Data analysis included Chi-square tests and Mann Whitney U test. In this sample of school-aged youth, only 10.7% (146/1364) had ever heard of HPV. With respect to those who were sexually active (n = 685), only 10.7% had ever heard of HPV. For those who had heard of HPV, knowledge of HPV and HPV vaccines was assessed on an HPV Knowledge and HPV Vaccine Knowledge scale, respectively. There was no statistically significant difference in mean HPV knowledge score between males and females, or HPV vaccine knowledge scores, between males and females. There was a general lack of awareness of HPV and HPV vaccines among school-aged youth in the Bahamas. This is an important gap in the HPV vaccine strategy and cancer prevention, as this is the age at which most people acquire HPV. It emphasizes the importance of developing a careful implementation plan, with an evaluation of knowledge and attitudes, in order to have an effective HPV vaccine uptake.
Collapse
Affiliation(s)
- Clemon George
- University of Ontario Institute of Technology and Faculty of Medical Sciences, Oshawa, Ontario and the University of the West Indies, Cave Hill, Barbados
| | - Robin Roberts
- UWI School of Clinical Medicine and Research, Nassau, The Bahamas
| | | | | | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
34
|
Cooper S, Schmidt B, Ryan J, Leon N, Mavundza E, Burnett R, Tanywe AC, Wiysonge CS. Factors that influence acceptance of human papillomavirus (HPV) vaccination for adolescents: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 2019:CD013430. [PMCID: PMC6754167 DOI: 10.1002/14651858.cd013430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
This is a protocol for a Cochrane Review (Qualitative). The objectives are as follows: The objectives of the review are to: Identify, appraise, and synthesise qualitative studies exploring: parents’, caregivers’, or adolescents’ views, experiences, or decision‐making regarding HPV vaccination; or the factors influencing the acceptance of HPV vaccination arising from parents’, caregivers’, and adolescents’ accounts. Identify the factors influencing parents’, caregivers’ and adolescents’ acceptance of HPV vaccination. Explore how the findings of this review can enhance our understanding of the related intervention review (Abdullahi 2015 ).
Collapse
Affiliation(s)
- Sara Cooper
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownSouth Africa7505
| | - Bey‐Marrié Schmidt
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownSouth Africa7505
| | - Jill Ryan
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownSouth Africa7505
| | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitCape TownSouth Africa
| | - Edison Mavundza
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownSouth Africa7505
| | | | | | - Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownSouth Africa7505
| |
Collapse
|
35
|
Portillo-Romero AJ, León-Maldonado L, Allen-Leigh B, Brown B, Magis C, García-Fuentes NB, Salmerón J, Hurtado E, Torres-Ibarra L, Rivera-Paredez B, Hernández-López R, Yunes-Díaz E, Lazcano-Ponce E. HPV vaccine acceptance is high among adults in Mexico, particularly in people living with HIV. SALUD PUBLICA DE MEXICO 2019; 60:658-665. [PMID: 30699271 DOI: 10.21149/10182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/23/2018] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To measure HPV vaccine acceptance in diverse Mexican adult popula-tions, taking into account HIV status. MATERIALS AND METHODS A total of 1 329 men and women, with and without HIV, participated in one of three intervention studies, offering HPV vaccination, carried out in the states of Morelos, Tlaxcala and Mexico City; either the bivalent (Morelos n=103, Tlaxcala n=127) or quadrivalent HPV-vaccine (Mexico City n=1 099) was offered. RESULTS HPV vaccine was accepted by 80.3% of participants; acceptance was higher in people living with HIV than those without (84.4 vs. 78%, p=0.004). Women had greater HPV infection knowledge (p<0.0001) than men and slightly higher (p=0.4) vaccine acceptance. The main reason for vaccine non-acceptance among HIV-positive participants was their doctor recommended they not get vaccinated. CONCLUSIONS Acceptance of HPV-vaccine was high in men and women regardless of HIV status. Even higher rates of acceptability may be achieved by educating healthcare providers to recommend HPV vaccine to their patients.
Collapse
Affiliation(s)
| | - Leith León-Maldonado
- Conacyt- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Betania Allen-Leigh
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Brandon Brown
- School of Medicine, University of California. Riverside, California, United States of America
| | - Carlos Magis
- Atención Integral, Centro Nacional para la Prevención y Control del VIH/SIDA (Censida). Mexico City, Mexico
| | - Norma Beatriz García-Fuentes
- Coordinación Estatal del Programa de VIH, SIDA e ITS, Servicios de Salud de Morelos. Cuernavaca, Morelos, Mexico
| | - Jorge Salmerón
- Centro de Investigación de Políticas de Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México. Mexico City, Mexico.,Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Erika Hurtado
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Leticia Torres-Ibarra
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Berenice Rivera-Paredez
- Centro de Investigación de Políticas de Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México. Mexico City, Mexico.,Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Rubí Hernández-López
- Centro de Investigación de Políticas de Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México. Mexico City, Mexico.,Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Elsa Yunes-Díaz
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| |
Collapse
|
36
|
Foss HS, Oldervoll A, Fretheim A, Glenton C, Lewin S. Communication around HPV vaccination for adolescents in low- and middle-income countries: a systematic scoping overview of systematic reviews. Syst Rev 2019; 8:190. [PMID: 31370886 PMCID: PMC6670236 DOI: 10.1186/s13643-019-1100-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/05/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection causes cervical cancer. More than 80% of those diagnosed with cervical cancer live in low- and middle-income countries (LMICs). The World Health Organization recommends vaccination as a public health measure against cervical cancer. Communication interventions are able to change how people think about vaccination and are thus instrumental in addressing vaccine hesitancy. Our aim was to provide a broad scoping overview of the available evidence on communication with adolescents, parents, and other stakeholders around HPV vaccination for adolescents, with a specific focus on LMICs. METHODS We conducted a systematic scoping overview of systematic reviews addressing a range of questions regarding communication around HPV vaccination. We considered reviews published between 2007 and 2018 focusing on communication around HPV vaccination and that searched for qualitative or quantitative studies for inclusion. We searched the Epistemonikos database which includes reviews from multiple electronic databases. Two overview authors screened titles and abstracts and examined potentially eligible reviews in full text. Data extraction was performed by one overview author and verified by a second. We assessed the reliability of the included reviews using an adapted version of AMSTAR 2. RESULTS We included twelve reviews in our overview. Four reviews assessed the effectiveness of communication interventions. These interventions intended to inform or educate about HPV and HPV vaccination, such as videos and fact sheets, or to remind or recall, such as text message reminders. Eight reviews assessed factors associated with HPV vaccination uptake, including communication-related factors such as whether the vaccine was recommended by a physician and people's knowledge regarding the vaccine. Nine reviews searched for studies from LMICs, but most found only a small number of studies from these countries. CONCLUSIONS The small number of studies identified from LMICs is of concern as these countries face the largest burden of disease related to HPV. This scoping overview also found and excluded a number of reviews because of important methodological limitations, highlighting the need for future reviews to use appropriate methods. The overview indicates areas in which further primary studies are needed on HPV vaccination communication in LMICs. SYSTEMATIC REVIEW REGISTRATION Open Science Framework https://osf.io/agzb4/.
Collapse
Affiliation(s)
| | - Ann Oldervoll
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Atle Fretheim
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Claire Glenton
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Simon Lewin
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway.
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| |
Collapse
|
37
|
Kelly-Hanku A, Newland J, Aggleton P, Ase S, Aeno H, Fiya V, Vallely LM, Toliman PJ, Mola GD, Kaldor JM, Vallely AJ. HPV vaccination in Papua New Guinea to prevent cervical cancer in women: Gender, sexual morality, outsiders and the de-feminization of the HPV vaccine. PAPILLOMAVIRUS RESEARCH 2019; 8:100171. [PMID: 31212024 PMCID: PMC6595234 DOI: 10.1016/j.pvr.2019.100171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/02/2019] [Accepted: 06/07/2019] [Indexed: 01/25/2023]
Abstract
Papua New Guinea has among the highest estimated burden of cervical cancer globally, but currently lacks national cervical screening or human papillomavirus (HPV) vaccination programmes. The Papua New Guinean government is committed to introducing the HPV vaccine for primary prevention, but locally-relevant research evidence is not available to guide implementation. Experience from earlier Papua New Guinean health programmes suggests that appropriate engagement with local health cosmologies and cultures for health/wellbeing, illness/disease, and recognition of the role of ‘outsiders’ in preventing, promoting or contributing to sickness, are essential to the successful introduction of biomedical interventions in this setting. We describe findings from a multi-site qualitative study undertaken in three provinces in Papua New Guinea (2012-14). Twenty-one gender specific focus group discussions and 82 semi-structured interviews, with a total of 208 participants, were conducted. There was strong community support for the introduction of the HPV vaccine for cervical cancer prevention in Papua New Guinea. Significantly, and despite being officially discussed in the context of a planned future intervention focusing on vaccinating young girls to prevent cervical cancer, the intervention was de-feminised, where both girls and boys were supported to be vaccinated in any HPV programme in Papua New Guinea. First study of HPV vaccine acceptability in Papua New Guinea and the Pacific. Evidence of strong support for the vaccination of both girls and boys against HPV in Papua New Guinea. Local beliefs and concerns about HPV immunisation may impact acceptability in Papua New Guinea. Suspicion of Western medicine and health care workers reported in rural areas.
Collapse
Affiliation(s)
- Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia.
| | - Jamee Newland
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Australia; Sociology Department, Australian National University, Australia
| | - Sophie Ase
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Herick Aeno
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Voletta Fiya
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Lisa M Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Pamela J Toliman
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Glen Dl Mola
- Department of Obstetrics and Gynaecology, University of Papua New Guinea, Papua New Guinea
| | - John M Kaldor
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Andrew J Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| |
Collapse
|
38
|
Topazian HM, Kundu D, Peebles K, Ramos S, Morgan K, Kim CJ, Richter KL, Brewer NT, Peris M, Smith JS. HPV Vaccination Recommendation Practices among Adolescent Health Care Providers in 5 Countries. J Pediatr Adolesc Gynecol 2018; 31:575-582.e2. [PMID: 30017958 DOI: 10.1016/j.jpag.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/06/2018] [Accepted: 06/25/2018] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVE To assess adolescent health care providers' recommendations for, and attitudes towards human papillomavirus (HPV) vaccination in 5 countries. DESIGN In-depth interviews of adolescent health care providers, 2013-2014. SETTING Five countries where HPV vaccination is at various stages of implementation into national programs: Argentina, Malaysia, South Africa, South Korea, and Spain. PARTICIPANTS Adolescent health care providers (N = 151) who had administered or overseen provision of adolescent vaccinations (N = Argentina: 30, Malaysia: 30, South Africa: 31, South Korea: 30, Spain: 30). MAIN OUTCOME MEASURES Frequency of HPV vaccination recommendation, reasons providers do not always recommend the vaccine and facilitators to doing so, comfort level with recommending the vaccine, reasons for any discomfort, and positive and negative aspects of HPV vaccination. RESULTS Over half of providers 82/151 (54%) recommend HPV vaccination always or most of the time (range: 20% in Malaysia to 90% in Argentina). Most providers 112/151 (74%) said they were comfortable recommending HPV vaccination, although South Korea was an outlier 10/30 (33%). Providers cited protection against cervical cancer 124/151 (83%) and genital warts 56/151 (37%) as benefits of HPV vaccination. When asked about the problems with HPV vaccination, providers mentioned high cost 75/151 (50% overall; range: 26% in South Africa to 77% in South Korea) and vaccination safety 28/151 (19%; range: 7% in South Africa to 33% in Spain). Free, low-cost, or publicly available vaccination 59/151 (39%), and additional data on vaccination safety 52/151 (34%) and efficacy 43/151 (28%) were the most commonly cited facilitators of health provider vaccination recommendation. CONCLUSION Interventions to increase HPV vaccination should consider a country's specific provider concerns, such as reducing cost and providing information on vaccination safety and efficacy.
Collapse
Affiliation(s)
- Hillary M Topazian
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Debanjali Kundu
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Kathryn Peebles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Silvina Ramos
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - Karen Morgan
- Perdana University, Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia; Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chan Joo Kim
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, St. Paul's Hospital, Seoul, Korea
| | - Karin L Richter
- Department of Medical Virology, University of Pretoria, National Health Laboratory Service, Pretoria, South Africa
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Mercè Peris
- Cancer Epidemiology Research Programme, Institut Català d'Oncologia, Barcelona, Spain
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
| |
Collapse
|
39
|
Delany-Moretlwe S, Kelley KF, James S, Scorgie F, Subedar H, Dlamini NR, Pillay Y, Naidoo N, Chikandiwa A, Rees H. Human Papillomavirus Vaccine Introduction in South Africa: Implementation Lessons From an Evaluation of the National School-Based Vaccination Campaign. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:425-438. [PMID: 30143561 PMCID: PMC6172125 DOI: 10.9745/ghsp-d-18-00090] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022]
Abstract
Evaluation of the campaign confirmed its feasibility in this setting: it achieved high coverage, few adverse events, and mostly positive media coverage. However, challenges occurred in data and cold chain management. Future implementation requires improved partnerships between government ministries, simplified informed consent, and closer monitoring of social media messaging. Background: In April 2014, a national school-based human papillomavirus (HPV) vaccination program was rolled out in South Africa, targeting Grade 4 girls aged ≥9 years. A bivalent HPV vaccine with a 2-dose (6 months apart) schedule was used. At the request of the National Department of Health (NDoH), we conducted an external assessment of the first-dose phase of the vaccination program to evaluate program coverage and vaccine safety and identify factors that influenced implementation. Methods: We based our cross-sectional and mixed-methods approach on a process evaluation framework, which included a review of key planning and implementation documents and monitoring data; observation at vaccination sites; key informant interviews (N=34); and an assessment of media coverage and content related to the campaign. Findings: There was overall success in key measures of coverage and safety. Over 350,000 Grade 4 girls were vaccinated in more than 16,000 public schools across South Africa, which translated to 94.6% of schools reached and 86.6% of age-eligible learners vaccinated. No major adverse events following immunization were detected. We attributed the campaign's successes to careful planning and coordination and strong leadership from the NDoH. The primary challenges we identified were related to obtaining informed consent, vulnerabilities in cold chain capacity, and onsite management of minor adverse events. While campaign planners anticipated and prepared for some negative media coverage, they did not expect the use of social media for spreading misinformation about HPV vaccination. Conclusions: The first phase of the national school-based HPV vaccination campaign was successfully implemented at scale in this setting. Future implementation will require improvement in the storage and monitoring of vaccine doses, better communication of role expectations to all stakeholders, and streamlined consent processes to ensure program sustainability.
Collapse
Affiliation(s)
- Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Karen F Kelley
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Shamagonam James
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Fiona Scorgie
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | | | | | - Yogan Pillay
- National Department of Health, Pretoria, South Africa
| | - Nicolette Naidoo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Admire Chikandiwa
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
40
|
Perez S, Zimet GD, Tatar O, Stupiansky NW, Fisher WA, Rosberger Z. Human Papillomavirus Vaccines: Successes and Future Challenges. Drugs 2018; 78:1385-1396. [DOI: 10.1007/s40265-018-0975-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
41
|
Vu M, Yu J, Awolude OA, Chuang L. Cervical cancer worldwide. Curr Probl Cancer 2018; 42:457-465. [DOI: 10.1016/j.currproblcancer.2018.06.003] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
|
42
|
Awareness of cervical cancer and willingness to be vaccinated against human papillomavirus in Mozambican adolescent girls. PAPILLOMAVIRUS RESEARCH 2018; 5:156-162. [PMID: 29665430 PMCID: PMC6046684 DOI: 10.1016/j.pvr.2018.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/27/2023]
Abstract
Sub-Saharan Africa concentrates the largest burden of cervical cancer worldwide. The introduction of the HPV vaccination in this region is urgent and strategic to meet global health targets. This was a cross-sectional study conducted in Mozambique prior to the first round of the HPV vaccine demonstration programme. It targeted girls aged 10–19 years old identified from schools and households. Face-to-face structured interviews were conducted. A total of 1147 adolescents were enrolled in three selected districts of the country. Most girls [84% (967/1147)] had heard of cervical cancer, while 76% believed that cervical cancer could be prevented. However only 33% (373/1144) of girls recognized having ever heard of HPV. When girls were asked whether they would accept to be vaccinated if a vaccine was available in Mozambique, 91% (1025/1130) answered positively. Girls from the HPV demonstration districts showed higher awareness on HPV and cervical cancer, and willingness to be vaccinated. This study anticipates high acceptability of the HPV vaccine in Mozambique and high awareness about cervical cancer, despite low HPV knowledge. These results highlight that targeted health education programmes are critical for acceptance of new tools, and are encouraging for the reduction of cervical cancer related mortality and morbidity in Mozambique. Cervical cancer incidence rates in Mozambique are among the highest in the world. Introduction of HPV vaccination in Mozambique is an urgent and necessary strategy to meet global targets on women´s health. The awareness on cervical cancer, and anticipated acceptance of HPV vaccination was assessed in Mozambican adolescent girls. The study anticipates high acceptability of HPV vaccine and adequate awareness about cervical cancer. These results are timely in the context towards the implementation of the HPV vaccine at a national scale in Mozambique.
Collapse
|
43
|
Factors influencing intention to obtain the HPV vaccine in South East Asian and Western Pacific regions: A systematic review and meta-analysis. Sci Rep 2018; 8:3640. [PMID: 29483541 PMCID: PMC5832144 DOI: 10.1038/s41598-018-21912-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/09/2018] [Indexed: 12/11/2022] Open
Abstract
Since licensing in 2006, there has been poor uptake of the HPV vaccine among the targeted population in the South East Asia Region (SEAR) and Western Pacific Region (WPR). A systematic review was conducted to identify the studies exploring the relationship between factors and intention for HPV vaccination among women in SEAR and WPR countries. Nineteen studies were identified as suitable for qualitative synthesis, and three as suitable for meta-analysis. Most women had a positive intention to have an HPV vaccine (range 57%-85%). Having a positive intention to vaccinate was significantly higher among women not aware of HPV infection (OR: 1.34, 95% CI: 1.02-1.76) and HPV vaccine (OR: 1.57, 95% CI: 1.26-1.96). Lower knowledge level and less confidence in safety and efficacy of the vaccine, negatively affected intention to vaccinate. Perceiving the vaccine to be expensive, low perception of contracting HPV infection and cervical cancer, and lack of concrete recommendations from healthcare providers also negatively affected intention to vaccinate. This review suggests the decision-making processes of women in SEAR and WPR is influenced by the cost of vaccination, perceived efficacy and safety of vaccine, provision of information on vaccination, and the awareness about HPV infection and the HPV vaccine.
Collapse
|
44
|
Santhanes D, Wong CP, Yap YY, San SP, Chaiyakunapruk N, Khan TM. Factors involved in human papillomavirus (HPV) vaccine hesitancy among women in the South-East Asian Region (SEAR) and Western Pacific Region (WPR): A scoping review. Hum Vaccin Immunother 2018; 14:124-133. [PMID: 28933635 PMCID: PMC5791566 DOI: 10.1080/21645515.2017.1381811] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/19/2017] [Accepted: 09/15/2017] [Indexed: 01/23/2023] Open
Abstract
A scoping review was performed to identify factors that may lead to human papillomavirus (HPV) vaccine hesitancy among women in low- and middle-income countries in South East Asian Region (SEAR) and Western Pacific Region (WPR). A systematic search of English and non-English articles using Pubmed, EMBASE, PsycINFO, Cochrane, MEDLINE, and CINAHL plus was conducted. Only 63 studies conducted in SEAR and WPR were included from inception until December 2016. Results of these studies have shown that poor awareness and knowledge of practices on cervical cancer prevention was evident in both SEAR and WPR. Concerns on safety and efficacy of the vaccine, and costs in getting vaccinated were significant barriers. Most women stated that they needed more information, and strongly welcomed a physician's recommendation in both geographical regions. Women also felt they have a low risk of acquiring HPV infection and cervical cancer. Most women in SEAR and WPR were unable to decide on whether to accept HPV vaccination.
Collapse
Affiliation(s)
- Diviya Santhanes
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Che Pui Wong
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Yan Ye Yap
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Saw Pui San
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin, Madison, WI, USA
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Tahir Mehmood Khan
- School of Pharmacy, Department of Pharmacy Practice, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- College of Pharmacy, Department of Pharmacy, Abasyn University, Peshawar, Pakistan
| |
Collapse
|
45
|
Shapiro GK, Perez S, Naz A, Tatar O, Guichon JR, Amsel R, Zimet GD, Rosberger Z. Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey. BMJ Open 2017; 7:e017814. [PMID: 29025844 PMCID: PMC5652458 DOI: 10.1136/bmjopen-2017-017814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV), a sexually transmitted infection, can cause anogenital warts and a number of cancers. To prevent morbidity and mortality, three vaccines have been licensed and are recommended by Canada's National Advisory Committee on Immunisation (for girls since 2007 and boys since 2012). Nevertheless, HPV vaccine coverage in Canada remains suboptimal in many regions. This study will be the first to concurrently examine the correlates of HPV vaccine decision-making in parents of school-aged girls and boys and evaluate changes in parental knowledge, attitudes and behaviours over time. METHODS AND ANALYSIS Using a national, online survey utilising theoretically driven constructs and validated measures, this study will identify HPV vaccine coverage rates and correlates of vaccine decision-making in Canada at two time points (August-September 2016 and June-July 2017). 4606 participants will be recruited to participate in an online survey through a market research and polling firm using email invitations. Data cleaning methods will identify inattentive or unmotivated participants. ETHICS AND DISSEMINATION The study received research ethics board approval from the Research Review Office, Integrated Health and Social Services University Network for West-Central Montreal (CODIM-FLP-16-219). The study will adopt a multimodal approach to disseminate the study's findings to researchers, clinicians, cancer and immunisation organisations and the public in Canada and internationally.
Collapse
Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Samara Perez
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Juliet R Guichon
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rhonda Amsel
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zeev Rosberger
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Department of Oncology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
46
|
Perez S, Tatar O, Gilca V, Shapiro GK, Ogilvie G, Guichon J, Naz A, Rosberger Z. Untangling the psychosocial predictors of HPV vaccination decision-making among parents of boys. Vaccine 2017; 35:4713-4721. [DOI: 10.1016/j.vaccine.2017.07.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/05/2017] [Accepted: 07/13/2017] [Indexed: 01/27/2023]
|
47
|
Mboumba Bouassa RS, Prazuck T, Lethu T, Jenabian MA, Meye JF, Bélec L. Cervical cancer in sub-Saharan Africa: a preventable noncommunicable disease. Expert Rev Anti Infect Ther 2017; 15:613-627. [PMID: 28440679 DOI: 10.1080/14787210.2017.1322902] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Infections caused by high-risk human papillomavirus (HPV) are responsible for 7.7% of cancers in developing countries, mainly cervical cancer. This disease is steadily increasing in sub-Saharan Africa, with more than 75,000 new cases and 50,000 deaths yearly, further increased by HIV infection. Areas covered: The current status of cervical cancer associated with HPV in sub-Saharan Africa has been systematically revised. The main issues discussed here are related to the public health burden of cervical cancer in sub-Saharan Africa and predictions for the coming decades, including molecular epidemiology and determinants of HPV infection in Africa, and promising prevention measures currently being evaluated in Africa. Expert commentary: By the year 2030, cervical cancer will kill more than 443,000 women yearly worldwide, most of them in sub-Saharan Africa. The increase in the incidence of cervical cancer in Africa could counteract the progress made by African women in reducing maternal mortality and longevity. Nevertheless, cervical cancer is a potentially preventable noncommunicable disease, and intervention strategies to eliminate cervical cancer as a public health concern should be urgently implemented.
Collapse
Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- a Laboratoire de virologie, hôpital Européen Georges Pompidou , Assistance Publique-Hôpitaux de Paris , France.,b Department of Immunology, INSERM U970 , Université Paris Descartes, Sorbonne Paris-Cité , Paris , France
| | - Thierry Prazuck
- c Service des Maladies Infectieuses et Tropicales , Centre Hospitalier Régional Orléans La Source , Orléans , France
| | - Thérèse Lethu
- d Department of health and well-being , Global Health Objectives , Geneva , Switzerland
| | - Mohammad-Ali Jenabian
- e Departement des Sciences Biologiques et Centre de recherche BioMed , Universite du Quebec a Montreal (UQAM) , Montreal , QC , Canada
| | - Jean-François Meye
- f Service de Gynécologie Obstétrique, Centre Hospitalo-Universitaire d'Angondjé, Libreville et Faculté de Médecine de Libreville , Université des Sciences de la Santé , Libreville , Gabon
| | - Laurent Bélec
- a Laboratoire de virologie, hôpital Européen Georges Pompidou , Assistance Publique-Hôpitaux de Paris , France.,b Department of Immunology, INSERM U970 , Université Paris Descartes, Sorbonne Paris-Cité , Paris , France
| |
Collapse
|
48
|
Acceptability of multipurpose human papillomavirus vaccines among providers and mothers of adolescent girls: A mixed-methods study in five countries. PAPILLOMAVIRUS RESEARCH 2017; 3:126-133. [PMID: 28720446 PMCID: PMC5608022 DOI: 10.1016/j.pvr.2017.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 03/26/2017] [Accepted: 04/01/2017] [Indexed: 11/23/2022]
Abstract
Introduction Multipurpose vaccines (MPVs) could be formulated to prevent multiple sexually transmitted infections simultaneously. Little is known about acceptability of MPVs among vaccine health care providers (HCPs) or mothers of adolescent girls. Methods 151 adolescent vaccine providers and 118 mothers of adolescent girls aged 9–14 were recruited from five geographically-diverse countries: Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers’ preferences for single-purpose human papillomavirus (HPV) vaccine versus MPVs (including HPV+herpes simplex virus (HSV)−2, HPV+HIV, or HPV+HSV-2+HIV) via quantitative surveys. Maternal MPV attitudes were assessed in four focus group discussions (FGDs) in each country. Results Most providers preferred MPVs over single-purpose HPV vaccination, with preference ranging from 61% in Malaysia to 96% in South Africa. HPV+HSV-2+HIV was the most preferred MPV formulation (56–82%). Overall, 53% of the mothers preferred MPVs over single-purpose HPV vaccines, with strongest support in South Africa (90%) and lowest support in South Korea (29%). Convenience and trust in the health care system were commonly-cited reasons for MPV acceptability. Safety and efficacy concerns were common barriers to accepting MPVs, though specific concerns differed by country. Across FGDs, additional safety and efficacy information on MPVs were requested, particularly from trusted sources like HCPs. Conclusions Though maternal acceptability of MPVs varied by country, MPV acceptability would be enhanced by having HCPs provide parents with additional MPV vaccine safety and efficacy information. While most providers preferred MPVs, future health behavior research should identify acceptability barriers, and targeted provider interventions should equip providers to improve vaccination discussions with parents. We gauged acceptance of a multipurpose vaccine (MPV) concept to prevent HPV and STIs. Most vaccine providers were willing to administer an MPV for HPV, HSV-2, and HIV. Mothers of teen girls desired safety and efficacy evidence before accepting MPVs. In mothers, MPV acceptability differed by region and daughter's vaccination history.
Collapse
|
49
|
Radisic G, Chapman J, Flight I, Wilson C. Factors associated with parents' attitudes to the HPV vaccination of their adolescent sons : A systematic review. Prev Med 2017; 95:26-37. [PMID: 27932052 DOI: 10.1016/j.ypmed.2016.11.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 11/15/2016] [Accepted: 11/24/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of the study was to identify factors associated with human papilloma virus (HPV) vaccine acceptability in parents of adolescent boys. This information is critical to the development of approaches to optimise HPV vaccine uptake among this population group. METHODS We performed a systematic search of the literature in addressing factors influencing parental attitudes to and beliefs about HPV vaccine and its acceptability for use. The findings were organised within the framework of the Health Belief Model (HBM) and summarised using a semi quantitative method. RESULTS Eighteen studies met the inclusion criteria. Parental decisions were predominantly shaped by the perceived benefits of the vaccine; perceived risk of sons contracting the HPV infection, and having recommendations from health care providers. Fear of side effects and uncertainty about vaccine effectiveness, as well as cost and lack of healthcare, were barriers to HPV vaccination. Other factors such as knowledge, family characteristics, parent-child dialogue and egalitarian values appeared to be important when deciding whether to vaccinate boys. CONCLUSIONS HPV vaccine uptake among male adolescents is suboptimal. Future programs need to address the predictors of uptake by educating parents about the boys' high susceptibility to infection, the benefits of vaccination, and reduce concerns regarding perceived barriers. Additionally, uptake may be facilitated by encouraging health care provider endorsement, particularly in countries without government-funded immunisation programs.
Collapse
Affiliation(s)
- Gorjana Radisic
- Flinders Centre for Innovation in Cancer, Flinders University, School of Medicine, GPO Box 2100, Adelaide SA 5001, Australia; Cancer Council SA, 202 Greenhill Road, Eastwood, SA 5063, Australia.
| | - Janine Chapman
- Flinders Centre for Innovation in Cancer, Flinders University, School of Medicine, GPO Box 2100, Adelaide SA 5001, Australia; Cancer Council SA, 202 Greenhill Road, Eastwood, SA 5063, Australia.
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, Flinders University, School of Medicine, GPO Box 2100, Adelaide SA 5001, Australia; Cancer Council SA, 202 Greenhill Road, Eastwood, SA 5063, Australia.
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, Flinders University, School of Medicine, GPO Box 2100, Adelaide SA 5001, Australia; Cancer Council SA, 202 Greenhill Road, Eastwood, SA 5063, Australia.
| |
Collapse
|
50
|
Perez S, Tatar O, Shapiro GK, Dubé E, Ogilvie G, Guichon J, Gilca V, Rosberger Z. Psychosocial determinants of parental human papillomavirus (HPV) vaccine decision-making for sons: Methodological challenges and initial results of a pan-Canadian longitudinal study. BMC Public Health 2016; 16:1223. [PMID: 27919239 PMCID: PMC5139028 DOI: 10.1186/s12889-016-3828-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 11/08/2016] [Indexed: 01/09/2023] Open
Abstract
Background HPV vaccination decision-making is a complex process that is influenced by multiple psychosocial determinants. Given the change in policy recommendation to include males in routine HPV vaccination, our goals were to assess the HPV vaccination uptake in Canada, to understand where Canadian parents were situated in the HPV vaccine decision-making process for their son, how they changed over time and which psychosocial determinants were relevant for this process. Methods We used an online survey methodology and collected data from a nationally representative sample of Canadian parents of boys aged 9–16 at baseline (T1, February 2014) and at 9 months’ follow-up (T2). Our analyses were guided by the Precaution Adoption Process Model (PAPM), a theoretical health behavior model that classifies parents in one of six stages: unaware, unengaged, undecided, decided not to vaccinate, decided to vaccinate and those who had already vaccinated their sons. Rigorous methods were used to filter out careless responders: response variance, bogus items, psychometric antonyms and psychometric synonyms. Results At T1 and T2, we received 3,784 and 1,608 respectively completed questionnaires; after data cleaning 3,117 (T1) and 1,427 (T2) were retained. Less than 3% of boys were vaccinated at both time points. At both T1 and T2, most parents (over 70%) belonged to the earlier vaccination adoption stages: 57% were unaware (T1) and 15.3% (T2); 20.9% were unengaged (T1) and 32.4% (T2); and 9.1% were undecided (T1) and 25.2% (T2). At follow-up, 37.7% of participants did not move from their initial PAPM decision-making stage. Most parents (55%) preferred to receive information from their healthcare provider (HCP) but only 6% (T1) and 12% (T2) had actually spoken with a HCP about the HPV vaccine for their son. Conclusions HPV vaccination uptake in Canadian boys was very low in the absence of a publicly funded HPV vaccination programs for boys. Optimal HPV information preferences were identified and can be used in interventions to increase HPV knowledge and increase HPV vaccine uptake. Intentions to vaccinate or planning to speak to one’s HCP did not translate into action for most parents over the 9-month follow up; this finding is critical to consider to inform implementation strategies. Methodological challenges are described and suggestions for future research are offered. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3828-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, QC, H3A 1B1, Canada. .,Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road Room 214, Montreal, QC, H3T 1E4, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road Room 214, Montreal, QC, H3T 1E4, Canada
| | - Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, QC, H3A 1B1, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road Room 214, Montreal, QC, H3T 1E4, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec, 2400 D'Estimauville, Quebec, G1E 7G9, Canada
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, BC Women's Hospital and Health Centre, Room H203G, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Juliet Guichon
- Community Health Sciences, Faculty of Medicine, University of Calgary, 3280 Hospital Drive N.W, Calgary, AB, T2N 4N1, Canada
| | - Vladimir Gilca
- Institut National de Santé Publique du Québec, 2400 D'Estimauville, Quebec, G1E 7G9, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, QC, H3A 1B1, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road Room 214, Montreal, QC, H3T 1E4, Canada.,Louise Granofsky-Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, QC, H3T1E4, Canada
| |
Collapse
|