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Spencer JC, Spees LP, Biddell CB, Odebunmi OO, Ilyasova AA, Yanguela J, Lich KH, Mills SD, Higgins CR, Ozawa S, Wheeler SB. Inclusion of marginalized populations in HPV vaccine modeling: A systematic review. Prev Med 2024; 182:107941. [PMID: 38522627 DOI: 10.1016/j.ypmed.2024.107941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Models simulating the potential impacts of Human Papillomavirus (HPV) vaccine have been used globally to guide vaccination policies and programs. We sought to understand how and why marginalized populations have been incorporated into HPV vaccine simulation models. METHODS We conducted a systematic search of PubMed, CINAHL, Scopus, and Embase to identify studies using simulation models of HPV vaccination incorporating one or more marginalized population through stratification or subgroup analysis. We extracted data on study characteristics and described these overall and by included marginalized groups. RESULTS We identified 36 studies that met inclusion criteria, which modeled vaccination in 21 countries. Models included men who have sex with men (MSM; k = 16), stratification by HIV status (k = 9), race/ethnicity (k = 6), poverty (k = 5), rurality (k = 4), and female sex workers (k = 1). When evaluating for a marginalized group (k = 10), HPV vaccination was generally found to be cost-effective, including for MSM, individuals living with HIV, and rural populations. In studies evaluating equity in cancer prevention (k = 9), HPV vaccination generally advanced equity, but this was sensitive to differences in HPV vaccine uptake and use of absolute or relative measures of inequities. Only one study assessed the impact of an intervention promoting HPV vaccine uptake. DISCUSSION Incorporating marginalized populations into decision models can provide valuable insights to guide decision making and improve equity in cancer prevention. More research is needed to understand the equity impact of HPV vaccination on cancer outcomes among marginalized groups. Research should emphasize implementation - including identifying and evaluating specific interventions to increase HPV vaccine uptake.
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Affiliation(s)
- Jennifer C Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America.
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Olufeyisayo O Odebunmi
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Anna A Ilyasova
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Juan Yanguela
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah D Mills
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Colleen R Higgins
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sachiko Ozawa
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Patikorn C, Cho JY, Lambach P, Hutubessy R, Chaiyakunapruk N. Equity-Informative Economic Evaluations of Vaccines: A Systematic Literature Review. Vaccines (Basel) 2023; 11:622. [PMID: 36992206 PMCID: PMC10057152 DOI: 10.3390/vaccines11030622] [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: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
The Immunization Agenda 2030 prioritizes the populations without access to vaccines. Health equity has been increasingly incorporated into economic evaluations of vaccines to foster equitable access. Robust and standardized methods are needed to evaluate the health equity impact of vaccination programs to ensure monitoring and effective addressing of inequities. However, methods currently in place vary and potentially affect the application of findings to inform policy decision-making. We performed a systematic review by searching PubMed, Embase, Econlit, and the CEA Registry up to 15 December 2022 to identify equity-informative economic evaluations of vaccines. Twenty-one studies were included that performed health equity impact analysis to estimate the distributional impact of vaccines, such as deaths averted and financial risk protection, across equity-relevant subgroups. These studies showed that the introduction of vaccines or improved vaccination coverage resulted in fewer deaths and higher financial risk benefits in subpopulations with higher disease burdens and lower vaccination coverage-particularly poorer income groups and those living in rural areas. In conclusion, methods to incorporate equity have been evolving progressively. Vaccination programs can enhance equity if their design and implementation address existing inequities in order to provide equitable vaccination coverage and achieve health equity.
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Affiliation(s)
- Chanthawat Patikorn
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10540, Thailand
| | - Jeong-Yeon Cho
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, 1211 Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, 1211 Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84112, USA
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Biyazin T, Yilma A, Yetwale A, Fenta B, Dagnaw Y. Knowledge and attitude about human papillomavirus vaccine among female high school students at Jimma town, Ethiopia. Hum Vaccin Immunother 2022; 18:2036522. [PMID: 35236252 PMCID: PMC9009896 DOI: 10.1080/21645515.2022.2036522] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The Human Papilloma Virus (HPV) is the primary causative agent of cervical cancer. HPV vaccination against human papillomavirus is more effective against cervical cancer. Therefore, this study aimed to investigate the knowledge and attitudes toward the human papillomavirus vaccines among female high-school students. METHODOLOGY This cross-sectional study was conducted among female high-school students in Jimma town, Ethiopia. Study participants were selected using a simple random sampling method. Self-administered interviews were conducted using a structured questionnaire. Data were entered using Epi-data version 3.5, exported and analyzed using the statistical package for the social sciences (SPSS) version 21. The Chi-squared (χ2) test was performed to determine the statistical significance between the outcome variable and independent variables. RESULTS A total of 366 students participated in this study with a response rate of 94.8%. Only half (52.7%) and nearly one-third (31.4%) of the respondents had good knowledge and positive attitudes toward HPV vaccination, respectively. The predictors that included parents' educational status (χ2 = 1.479, P = .003), students participating in school mini-media (χ2 = 1.519, P = .036), students who had a smartphone (χ2 = 2.118, P = .008), availability of radio or television (TV) at home (χ2 = 2.163, P = .049), and students who received information from social-media (χ2 = 2.15, P = .025) were significantly associated with knowledge of the HPV vaccine. CONCLUSION Overall knowledge and attitude toward HPV vaccination were low. All concerned bodies should work jointly to enhance the knowledge and attitudes of female students toward Human Papilloma Virus vaccination.
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Affiliation(s)
- Tsegaw Biyazin
- Institute of Health, Faculty of Health Sciences, School of Midwifery Jimma, Jimma University, Jimma, Ethiopia
| | - Ashenafi Yilma
- Institute of Health, Faculty of Health Sciences, School of Midwifery, Jimma University, Jimma, Ethiopia
| | - Aynalem Yetwale
- Institute of Health, Faculty of Health Sciences, School of Midwifery, Clinical Midwifery, Jimma University, Jimma, Ethiopia
| | - Belete Fenta
- Institute of Health, Faculty of Health Sciences, School of Midwifery Ethiopia, MSc in Maternity Health, Jimma University, Jimma, Ethiopia
| | - Yalemtsehay Dagnaw
- Institute of Health, College of Health Sciences, Department of Nursing, Ethiopia, MSc in Pediatrics and Child Health, Mizan Tepi University, Mizan Tepi, Ethiopia
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Wondimu A, Postma MJ, van Hulst M. Cost-effectiveness analysis of quadrivalent and nonavalent human papillomavirus vaccines in Ethiopia. Vaccine 2022; 40:2161-2167. [DOI: 10.1016/j.vaccine.2022.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
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Portnoy A, Abbas K, Sweet S, Kim JJ, Jit M. Projections of human papillomavirus (HPV) vaccination impact in Ethiopia, India, Nigeria and Pakistan: a comparative modelling study. BMJ Glob Health 2021; 6:bmjgh-2021-006940. [PMID: 34725040 PMCID: PMC8562528 DOI: 10.1136/bmjgh-2021-006940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/18/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Cervical cancer is the second most common cancer among women in Ethiopia, India, Nigeria and Pakistan. Our study objective was to assess similarities and differences in vaccine-impact projections through comparative modelling analysis by independently estimating the potential health impact of human papillomavirus (HPV) vaccination. Methods Using two widely published models (Harvard and Papillomavirus Rapid Interface for Modelling and Economics (PRIME)) to estimate HPV vaccination impact, we simulated a vaccination scenario of 90% annual coverage among 10 cohorts of 9-year-old girls from 2021 to 2030 in Ethiopia, India, Nigeria and Pakistan. We estimated potential health impact in terms of cervical cancer cases, deaths and disability-adjusted life years averted among vaccinated cohorts from the time of vaccination until 2100. We harmonised the two models by standardising input data to comparatively estimate HPV vaccination impact. Results Prior to harmonising model assumptions, the range between PRIME and Harvard models for number of cervical cancer cases averted by HPV vaccination was: 262 000 to 2 70 000 in Ethiopia; 1 640 000 to 1 970 000 in India; 330 000 to 3 36 000 in Nigeria and 111 000 to 1 33 000 in Pakistan. When harmonising model assumptions, alignment on HPV type distribution significantly narrowed differences in vaccine-impact estimates. Conclusion Despite model differences, the Harvard and PRIME models yielded similar vaccine-impact estimates. The main differences in estimates are due to variation in interpretation around data on cervical cancer attribution to HPV-16/18. As countries make progress towards WHO targets for cervical cancer elimination, continued explorations of underlying differences in model inputs, assumptions and results when examining cervical cancer prevention policy will be critical.
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Affiliation(s)
- Allison Portnoy
- Center for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Kaja Abbas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Public Health Foundation of India, New Delhi, India
| | - Steven Sweet
- Center for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.,Vitalant Research Institute, San Francisco, California, USA
| | - Jane J Kim
- Center for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
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