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Murewanhema G, Moyo E, Dzobo M, Mandishora-Dube RS, Dzinamarira T. Human papilloma virus vaccination in the resource-limited settings of sub-Saharan Africa: Challenges and recommendations. Vaccine X 2024; 20:100549. [PMID: 39263366 PMCID: PMC11388769 DOI: 10.1016/j.jvacx.2024.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 07/09/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024] Open
Abstract
Human papillomaviruses (HPV) cause 99% of all cervical cancer cases globally, with the high-risk genotypes 16 and 18 causing at least 70% of these cases. An estimated 90% of the global cervical cancer burden occurs in low-to-middle-income countries (LMICs), particularly in sub-Saharan Africa (SSA). Primary prevention through the administration of efficacious HPV vaccines is key to the World Health Organization's global strategy for accelerating the elimination of cervical cancer as a disease of public health concern. The rollout of HPV vaccination in SSA is faced with several challenges, such as the high cost of vaccine procurement, a lack of funding and political will from the central governments of countries, and inadequate infrastructure for vaccine cold chain storage and transport. Stigma, misinformation, lack of education and awareness, and vaccine hesitancy constitute the social factors that affect the successful rollout or implementation of vaccination programs in SSA. Based on the challenges SSA faces in rolling out HPV vaccination, we recommend using strategies that address both the demand-side and supply-side obstacles to HPV vaccination uptake. These include costs and availability, fighting vaccine hesitancy, and increasing vaccine confidence.
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Affiliation(s)
- Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Zimbabwe
| | - Enos Moyo
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Mathias Dzobo
- School of Health Systems and Public Health, University of Pretoria, South Africa
| | - Rachel S Mandishora-Dube
- Department of Laboratory Diagnostics and Investigative Sciences, Medical Microbiology Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Zimbabwe
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria, South Africa
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Tobaiqy M, MacLure K. A Systematic Review of Human Papillomavirus Vaccination Challenges and Strategies to Enhance Uptake. Vaccines (Basel) 2024; 12:746. [PMID: 39066384 PMCID: PMC11281456 DOI: 10.3390/vaccines12070746] [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: 05/29/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Human papillomavirus (HPV) vaccination has revolutionized cervical cancer prevention. Clinical trials confirm that the quadrivalent (HPV types 6, 11, 16, 18) and bivalent (HPV types 16, 18) vaccines effectively prevent HPV infections and cervical neoplasia. The latest HPV vaccine protects against nine virus types responsible for 90% of cervical cancer cases globally. Despite their undoubted effectiveness in reducing morbidity and mortality associated with HPV infections, challenges in vaccine coverage and uptake persist. The current study aimed to identify the primary challenges associated with HPV vaccination, propose effective strategies to improve vaccination uptake, and compile relevant evidence into a comprehensive overview to inform policy and practice. A systematic review protocol, following PRISMA-P and PRISMA guidelines, was established. Articles were sourced from the Web of Science using keywords from a comprehensive review of HPV vaccination challenges and strategies. Studies published between 1 January 2020, and 1 May 2024, including RCTs and observational, qualitative, and cross-sectional studies, were included, while reviews, protocols, and commentaries were excluded. Titles, abstracts, and full texts were screened per PRISMA guidelines. The review identified five key strategies to improve HPV vaccination uptake: parental and school engagement, use of technology and multimedia tools, healthcare providers' role, multicomponent interventions, and targeted interventions for immigrant groups. This review emphasized the need for a multifaceted approach to improving vaccination rates, offering a robust foundation for policy and stakeholder initiatives.
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Affiliation(s)
- Mansour Tobaiqy
- Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah P.O. Box 45311, Saudi Arabia
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Bartosik M, Moranova L, Izadi N, Strmiskova J, Sebuyoya R, Holcakova J, Hrstka R. Advanced technologies towards improved HPV diagnostics. J Med Virol 2024; 96:e29409. [PMID: 38293790 DOI: 10.1002/jmv.29409] [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: 08/29/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
Persistent infection with high-risk types of human papillomaviruses (HPV) is a major cause of cervical cancer, and an important factor in other malignancies, for example, head and neck cancer. Despite recent progress in screening and vaccination, the incidence and mortality are still relatively high, especially in low-income countries. The mortality and financial burden associated with the treatment could be decreased if a simple, rapid, and inexpensive technology for HPV testing becomes available, targeting individuals for further monitoring with increased risk of developing cancer. Commercial HPV tests available in the market are often relatively expensive, time-consuming, and require sophisticated instrumentation, which limits their more widespread utilization. To address these challenges, novel technologies are being implemented also for HPV diagnostics that include for example, isothermal amplification techniques, lateral flow assays, CRISPR-Cas-based systems, as well as microfluidics, paperfluidics and lab-on-a-chip devices, ideal for point-of-care testing in decentralized settings. In this review, we first evaluate current commercial HPV tests, followed by a description of advanced technologies, explanation of their principles, critical evaluation of their strengths and weaknesses, and suggestions for their possible implementation into medical diagnostics.
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Affiliation(s)
- Martin Bartosik
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Ludmila Moranova
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Nasim Izadi
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Johana Strmiskova
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- National Centre for Biomolecular Research, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Ravery Sebuyoya
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- National Centre for Biomolecular Research, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Jitka Holcakova
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Roman Hrstka
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
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Krokidi E, Rao AP, Ambrosino E, Thomas PPM. The impact of health education interventions on HPV vaccination uptake, awareness, and acceptance among people under 30 years old in India: a literature review with systematic search. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1151179. [PMID: 37215327 PMCID: PMC10198780 DOI: 10.3389/frph.2023.1151179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
Background The HPV vaccine is used as one of the main prevention tools for HPV-related cancers globally, yet it is not part of the Indian National Immunization program. In light of the introduction of the indigenous vaccine, we examine the effectiveness of health education about uptake, acceptance, and awareness. Methods Research was performed in the following databases: PubMed, CINAHL, Scopus, and Embase to identify studies between 2008 and 2022. Studies were included if: they were conducted in India including primary data research and health education intervention, and participants were between 9 and 29 years old. Results Out of the 10.952 results, 7 studies were included. Four studies focused on adolescent girls, aged from 9 to 20 years old, and 3 on university students aged from 17 to 26 years. Five studies were implemented in urban areas and 2 in rural areas. Health education interventions proved to be effective in increasing uptake, awareness, and acceptance of the HPV vaccine. The barriers included among others: cost, lack of awareness, and cultural barriers. Conclusion Observations from this study outline immediate action for policymakers to educate and encourage the young population toward HPV vaccination. Future programs should be aimed at different population groups and be adjusted according to their special characteristics and needs. Attention should be given to the male population and marginalized groups. The involvement of various stakeholders proved to be beneficial, and it is highly recommended.
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Affiliation(s)
- Eleni Krokidi
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Arathi P. Rao
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Elena Ambrosino
- Institute for Public Health Genomics, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Pierre P. M. Thomas
- Institute for Public Health Genomics, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Odongo Ojok I, Ogwal JB, Wwesige B, Bongomin F, Akello F. Factors Associated with the Human Papillomavirus Vaccine Coverage in Gulu District, Uganda. Adolesc Health Med Ther 2023; 14:87-96. [PMID: 37041756 PMCID: PMC10083017 DOI: 10.2147/ahmt.s397734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/30/2023] [Indexed: 04/09/2023] Open
Abstract
Background Human papillomavirus (HPV) vaccination is an effective public health measure for the prevention of cancer of the cervix. We aimed to assess HPV vaccine coverage and associated factors in Gulu, Uganda. Methods In October 2021, we conducted a cross-sectional study among girls aged 9 to 13 years residing in Pece-Laroo Division, Gulu City, Uganda. HPV vaccine coverage was defined as receipt of at least a dose of the HPV vaccine. Results A total of 197 girls, with a mean age of 11±1.4 years, were enrolled. Most participants were of the Acholi tribe (89.3%, n=176), catholic (58.4%, n=115), and in primary 5 level of education (36%, n=71). Overall, 68(35%) participants had received the HPV vaccine. Factors associated with HPV vaccine utilization were, good knowledge of the HPV vaccine (adjusted odds ratio (aOR) =0.233, 95% confidence interval (95CI): 0.037-0.640, p=0.101), methods of HPV prevention (OR=0.320, 95CI: 0.112-0.914, p = 0.033), good knowledge of the importance of HPV vaccination (OR=0.458, 95% CI: 0.334-0.960, p=0.021), knowledge on frequency of HPV vaccination (OR=0.423, 95CI:0.173-0.733, p=0.059), and good mobilization (OR=0.443, 95% CI: 0.023-0.923, p=0.012). Conclusion In this community-based study, only one third of eligible girls received the HPV vaccine. Public health interventions are recommended exponentially to enhance the utilization of the HPV vaccine in this community.
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Affiliation(s)
| | | | | | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Franceska Akello
- Department of Pediatrics and Child Health, Faculty of Medicine, Gulu University, Gulu, Uganda
- Correspondence: Franceska Akello, Department of Pediatrics and Child Health, Faculty of Medicine, Gulu University, P. O. Box 166, Gulu, Uganda, Tel +256-774697094, Email
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Park Y, Ki M, Lee H, Lee JK, Oh JK. Parental Factors Affecting Decision to Vaccinate Their Daughters against Human Papillomavirus. Cancer Prev Res (Phila) 2023; 16:133-138. [PMID: 36607702 DOI: 10.1158/1940-6207.capr-22-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/28/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
ABSTRACT Human papillomavirus (HPV) vaccination was introduced in the National Immunization Program (NIP) in Korea targeting girls aged 12 years to receive two doses of HPV vaccine to prevent cervical cancer. This study aimed to evaluate the factors that may influence parental decision to inoculate their daughters in Korea. A cross-sectional survey was conducted in 2020 by interviewing the parents of 2,000 nationally representative girls eligible for HPV NIP. By the daughters' status of HPV vaccination, the probabilities for each variable were compared with evaluate the factors that could affect parents' decision to inoculate their daughters with HPV vaccines. Compared with parents who were not vaccinated with HPV, parents who were vaccinated with HPV were 2.40 times more likely to decide to vaccinate their daughters with HPV. Parents who regularly undergo cervical cancer screening were 1.39 times more likely to decide to vaccinate their daughters with HPV than parents who do not receive regular checkups. Parents' perceived knowledge and perceived risk had a significant impact on their decision to vaccinate their daughters with HPV vaccines. Parents who had strong belief that HPV vaccine is safe in terms of adverse effects were 10 times more likely to decide to vaccinate their daughters against HPV. Parental factors including HPV-related health behavior and awareness were found to be associated with parental decision to vaccinate their daughters against HPV. To improve HPV vaccine uptake at 12 years, it is required to improve parental awareness on HPV through public communication supported by scientific-based evidence. PREVENTION RELEVANCE Parental HPV vaccination and maternal regular cervical cancer screening were positively associated with parental decision to vaccinate their daughters against HPV. Parents' perceived knowledge of HPV vaccination and perceived risk of cervical cancer play an important role in determining whether their 12-year-old daughters will be vaccinated against HPV.
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Affiliation(s)
- Yoon Park
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Moran Ki
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Kwan Lee
- Department of Obstetrics and Gyneocology, Guro Hospital, Korea University, Seoul, Korea
| | - Jin-Kyoung Oh
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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Mukherjee AG, Wanjari UR, Gopalakrishnan AV, Kannampuzha S, Murali R, Namachivayam A, Ganesan R, Renu K, Dey A, Vellingiri B, Prabakaran DS. Exploring the Molecular Pathogenesis, Pathogen Association, and Therapeutic Strategies against HPV Infection. Pathogens 2022; 12:25. [PMID: 36678374 PMCID: PMC9865103 DOI: 10.3390/pathogens12010025] [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: 11/03/2022] [Revised: 12/10/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The human papillomavirus (HPV), commonly documented as the cause of warts, has gained much interest recently due to its possible links to several types of cancer. HPV infection is discussed in this review from multiple angles, including its virology, epidemiology, etiology, immunology, clinical symptoms, and treatment. Recent breakthroughs in molecular biology have led to the development of new methods for detecting and treating HPV in tissue. There is no cure for HPV, and although vaccines are available to prevent infection with the most common HPV viruses, their utilization is limited. Destruction and excision are the primary treatment modalities. This review sheds light on the epidemiology, molecular pathogenesis, the association of several other pathogens with HPV, the latest treatment strategies available to treat the same, and an overview of the progress made and the obstacles still to be overcome in the fight against HPV infection.
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Affiliation(s)
- Anirban Goutam Mukherjee
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, India
| | - Uddesh Ramesh Wanjari
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, India
| | - Sandra Kannampuzha
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, India
| | - Reshma Murali
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, India
| | - Arunraj Namachivayam
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, India
| | - Raja Ganesan
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea
| | - Kaviyarasi Renu
- Centre of Molecular Medicine and Diagnostics, Department of Biochemistry, Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, India
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata 700073, India
| | - Balachandar Vellingiri
- Stem Cell and Regenerative Medicine/Translational Research, Department of Zoology, School of Basic Sciences, Central University of Punjab, Bathinda 151401, India
| | - D. S. Prabakaran
- Department of Radiation Oncology, College of Medicine, Chungbuk National University, Chungdae-ro 1, Seowon-gu, Cheongju 28644, Republic of Korea
- Department of Biotechnology, Ayya Nadar Janaki Ammal College (Autonomous), Srivilliputhur Main Road, Sivakasi 626124, India
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Dsouza JP, Van den Broucke S, Pattanshetty S, Dhoore W. Factors explaining men's intentions to support their partner's participation in cervical cancer screening. BMC Womens Health 2022; 22:443. [PMID: 36369003 PMCID: PMC9652784 DOI: 10.1186/s12905-022-02019-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cervical cancer represents a high burden of disease. Many women in low- and middle-income countries face opposition from their partners and families to undergo cervical cancer screening. Identifying the social, cultural, and psychological factors that underly the opposition to screening by male partners is an important step towards reducing barriers for men to support their wives' participation in cervical screening. This study explored the role of structural and psychological factors deriving from theoretical models as determinants of Indian men's opposition to their partners being screened for cervical cancer. METHODS A survey among 500 sexually active males was conducted between April 2020 and August 2020 to measure knowledge of cervical cancer and screening, awareness of screening possibilities, attitude towards screening, perceived barriers to screening, and health literacy. Regression analysis was performed to assess which of the potential factors contributed to the intention to support their wives' screening. RESULTS The majority of participants had very poor knowledge and awareness about cervical cancer and screening procedures, tended towards a negative attitude towards screening, and perceived several structural barriers. Attitude towards the screening procedure and routine participation in general screening significantly predicted their intention to support their wives' screening for cervical cancer. Education moderated the association between knowledge and awareness and the intention to support their wives' screening. CONCLUSION As women often rely on their spouses' financial and emotional support of cervical screening, there is a need for men to be encouraged to support their wives' screening participation. Programs to encourage men to support their wives' cervical screening should focus on their attitude towards screening, educate about cervical cancer and screening procedures, and reduce perceived barriers.
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Affiliation(s)
- Jyoshma Preema Dsouza
- Psychological Sciences Research Institute, Université catholique de Louvain, Ottignies-Louvain-la-Neuve - Louvain-la-Neuve, Belgium.
- Institute of Health and Society, School of Public Health, 1200 Woluwe-Saint-Lambert, Belgium.
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Ottignies-Louvain-la-Neuve - Louvain-la-Neuve, Belgium
| | - Sanjay Pattanshetty
- Prasanna School of Public Health, Manipal Academy of Higher education, Manipal, India
| | - William Dhoore
- Institute of Health and Society, School of Public Health, 1200 Woluwe-Saint-Lambert, Belgium
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Beyen MW, Bulto GA, Chaka EE, Debelo BT, Roga EY, Wakgari N, Danusa KT, Fekene DB. Human papillomavirus vaccination uptake and its associated factors among adolescent school girls in Ambo town, Oromia region, Ethiopia, 2020. PLoS One 2022; 17:e0271237. [PMID: 35830389 PMCID: PMC9278730 DOI: 10.1371/journal.pone.0271237] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The Human Papillomavirus (HPV) vaccine has offered a great promise to reduce the cervical cancer burden; its utilization (uptake) however has been lagging. However, the levels and factors associated with the uptake of the vaccine have not been well investigated, especially in the local context.
Objective
To assess the uptake of human papillomavirus vaccination and its associated factors among adolescent school girls in ambo town, Oromia, Ethiopia, 2020.
Methods
An institution-based cross-sectional quantitative study design supplemented with the qualitative inquiry was employed to assess Human Papillomavirus vaccination uptake and its associated factors among 422 adolescent school girls in Ambo town, central Ethiopia from December 1–30, 2020. The collected data were coded, entered, and cleaned by using Epi info 7.2.3 and exported to SPSS version 25 for analysis. Descriptive statistics were used to compute summary statistics and proportions. Both bivariate and multivariable logistic regression was employed to identify factors associated with HPV vaccine uptake. Adjusted odds ratio and 95% confidence interval were used for the strength and directions of association. A P-value of < 0.05 was used to declare statistical significance. Qualitative findings have been analyzed with manual thematic analysis.
Result
The proportion of HPV vaccination uptake among school girls in this study was 44.4%. Hearing about HPV vaccine [AOR = 2.50, 95%CI: (1.045–5.959)], availability of awareness creation [AOR = 2.53, 95%CI: (1.507–4.258)], and favorable attitude [AOR = 2.049, 95%CI: (1.153–3.64)] were the key identified factors associated with vaccination uptake. In addition, poor perception, fear of side effects, and misunderstanding were among the major factors identified by qualitative findings.
Conclusion
There was low uptake of HPV vaccination among the school Adolescents in the study area. Availability of awareness creation programs, favorable attitude towards HPV vaccine, and hearing about HPV vaccine was significantly associated with the uptake of the HPV vaccination. Therefore, awareness creation and behavior change education are mandatory to scale up the vaccination.
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Affiliation(s)
| | - Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Eshetu Ejeta Chaka
- Epidemiology and Biostatistics Unit, Department of Public Health, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Bikila Tefera Debelo
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
- * E-mail:
| | - Ephrem Yohannes Roga
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Kababa Temesgen Danusa
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Daniel Belema Fekene
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
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Torres-Rojas FI, Mendoza-Catalán MA, Alarcón-Romero LDC, Parra-Rojas I, Paredes-Solís S, Leyva-Vázquez MA, Cortes-Arciniega JE, Bracamontes-Benítez CJ, Illades-Aguiar B. HPV molecular detection from urine versus cervical samples: an alternative for HPV screening in indigenous populations. PeerJ 2021; 9:e11564. [PMID: 34178456 PMCID: PMC8214846 DOI: 10.7717/peerj.11564] [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: 12/28/2020] [Accepted: 05/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cervical cancer (CC) is the fourth leading cause of death from neoplasms in women and is caused by the human papilloma virus (HPV). Several methods have been developed for the screening of cervical lesions and HPV; however, some socio-cultural factors prevent women from undergoing gynecological inspection, which results in a higher risk of mortality from cervical cancer in certain population groups as indigenous communities. This study aimed to compare the concordance in HPV detection from urine and cervical samples, to propose an alternative to cervical scraping, which is commonly used in the cervical cancer screening. Methodology The DNA from cervical scrapings and urine samples was extracted using the proteinase K method followed by precipitation with alcohol, phenol andchloroform; a modification of the proteinase K method was developed in the management of urine sediment. Viral genotyping was performed using INNOLipa. Results The study population consisted of 108 patients from an indigenous population at southern Mexico, 32 without squamous intraepithelial lesions (NSIL) and 76 with low squamous intraepithelial lesions (LSIL). The majority of NSIL cervical scrapes were negative for HPV (90.63%), whereas more than half of LSIL cases were high-risk HPV positive (51.32%), followed by multiple infection by HR-HPV (17.11%), and multiple infection by LR- and HR-HPV (9.21%). No statistically significant relationship between the cytological diagnosis and the HPV genotypes detected in the urine samples was observed. A concordance of 68.27% for HPV positivity from urine and cervical samples was observed. Similarly, a concordance of 64.52% was observed in the grouping of HPVs by oncogenic risk. HR-HPV was detected in 71% of the urine samples from women with LSIL diagnosis, which suggests that HR-HPV detected in a urine sample could indicate the presence or risk of developing SIL. Conclusion HR-HPV detection in urine samples could be an initial approach for women at risk of developing LSIL and who, for cultural reasons, refuse to undergo a gynecological inspection.
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Affiliation(s)
- Francisco I Torres-Rojas
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Miguel A Mendoza-Catalán
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Luz Del C Alarcón-Romero
- Laboratorio de Citopatología e Histoquímica. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Isela Parra-Rojas
- Laboratorio de Investigación en Obesidad y Diabetes, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Marco A Leyva-Vázquez
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Jair E Cortes-Arciniega
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Carlos J Bracamontes-Benítez
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Berenice Illades-Aguiar
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
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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.
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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
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12
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Dubé E, Wilson S, Gagnon D, Deeks SL, Dubey V. " It takes time to build trust": a survey Ontario's school-based HPV immunization program ten years post-implementation. Hum Vaccin Immunother 2020; 17:451-456. [PMID: 32643527 DOI: 10.1080/21645515.2020.1775456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Describe Ontario's school-based human papillomavirus (HPV) vaccination program from the perspective of local public health units (PHUs). METHODS In 2018, Vaccine Preventable Diseases (VPD) managers at each of Ontario's 35 PHUs were invited to participate in an online survey regarding the organization and delivery of their HPV vaccination program. Questions were asked on the school-based program, training and support of vaccine providers, communication and promotion, assessing coverage rates and perceptions of the program's strengths and challenges. Descriptive statistics were generated for close-ended items. A thematic content analysis was performed for open-ended items. RESULTS Eighteen PHUs (54%, n = 19/35) responded. All responding PHUs provided the HPV vaccine in publicly funded schools but only 6 reported being permitted to provide HPV vaccine in private schools. Fact sheets, Q&As or other written information locally developed by the PHUs were the main tools used to communicate with parents (n = 17), students (n = 13), school personnel (n = 13) and school board officials (n = 9). The most frequently reported barriers were: limited program resources, negative perceptions held by parents and/or school staff regarding the HPV vaccine, logistical issues (e.g., getting the consents forms returned, collaboration with schools for vaccine delivery) and the fact that HPV vaccination is not mandatory under Ontario legislation. CONCLUSION Local public health units that implement HPV vaccine programs in schools identified logistical barriers, public perceptions about the HPV vaccine and the voluntary nature of the program as the main barriers.
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Affiliation(s)
- Eve Dubé
- Département des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec (INSPQ) , Québec, Canada.,Axe Maladies infectieuses et immunitaires, Centre de Recherche du CHU de Québec-Université Laval , Québec, Canada.,Université Laval , Québec, Canada
| | - Sarah Wilson
- Department of Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Ontario, Canada.,Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada.,ICES , Ontario, Canada
| | - Dominique Gagnon
- Département des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec (INSPQ) , Québec, Canada
| | - Shelley L Deeks
- Department of Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Ontario, Canada.,Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada
| | - Vinita Dubey
- Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada.,Toronto Public Health and the Canadian Immunization Research Network , Ontario, Canada
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13
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Rubin DHF, Ross JDC, Grad YH. The frontiers of addressing antibiotic resistance in Neisseria gonorrhoeae. Transl Res 2020; 220:122-137. [PMID: 32119845 PMCID: PMC7293957 DOI: 10.1016/j.trsl.2020.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 12/21/2022]
Abstract
The sexually transmitted infection gonorrhea, caused by the Gram-negative bacterium Neisseria gonorrhoeae, can cause urethritis, cervicitis, and systemic disease, among other manifestations. N. gonorrhoeae has rapidly rising incidence along with increasing levels of antibiotic resistance to a broad range of drugs including first-line treatments. The rise in resistance has led to fears of untreatable gonorrhea causing substantial disease globally. In this review, we will describe multiple approaches being undertaken to slow and control this spread of resistance. First, a number of old drugs have been repurposed and new drugs are being developed with activity against Neisseria gonorrhoeae. Second, vaccine development, long an important goal, is advancing. Third, new diagnostics promise rapid detection of antibiotic resistance and a shift from empiric to tailored treatment. The deployment of these new tools for addressing the challenge of antibiotic resistance will require careful consideration to provide optimal care for all patients while extending the lifespan of treatment regimens.
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Affiliation(s)
- Daniel H F Rubin
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jonathan D C Ross
- Department of Sexual Health and HIV, Birmingham University Hospitals NHS Foundation Trust, Birmingham, UK
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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14
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de Cock C, van Velthoven M, Milne-Ives M, Mooney M, Meinert E. Use of Apps to Promote Childhood Vaccination: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e17371. [PMID: 32421684 PMCID: PMC7265109 DOI: 10.2196/17371] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/13/2020] [Accepted: 03/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Vaccination is a critical step in reducing child mortality; however, vaccination rates have declined in many countries in recent years. This decrease has been associated with an increase in the outbreak of vaccine-preventable diseases. The potential for leveraging mobile platforms to promote vaccination coverage has been investigated in the development of numerous mobile apps. Although many are available for public use, there is little robust evaluation of these apps. OBJECTIVE This systematic review aimed to assess the effectiveness of apps supporting childhood vaccinations in improving vaccination uptake, knowledge, and decision making as well as the usability and user perceptions of these apps. METHODS PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Education Resources Information Center (ERIC) databases were systematically searched for studies published between 2008 and 2019 that evaluated childhood vaccination apps. Two authors screened and selected studies according to the inclusion and exclusion criteria. Data were extracted and analyzed, and the studies were assessed for risk of bias. RESULTS A total of 28 studies evaluating 25 apps met the inclusion criteria and were included in this analysis. Overall, 9 studies assessed vaccination uptake, of which 4 reported significant benefits (P<.001 or P=.03) of the implementation of the app. Similarly, 4 studies indicated a significant (P≤.054) impact on knowledge and on vaccination decision making. Patient perceptions, usability, and acceptability were generally positive. The quality of the included studies was found to be moderate to poor, with many aspects of the methodology being unclear. CONCLUSIONS There is little evidence to support the use of childhood vaccination apps to improve vaccination uptake, knowledge, or decision making. Further research is required to understand the dichotomous effects of vaccination-related information provision and the evaluation of these apps in larger, more robust studies. The methodology of studies must be reported more comprehensively to accurately assess the effectiveness of childhood vaccination apps and the risk of bias of studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/16929.
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Affiliation(s)
- Caroline de Cock
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Michelle van Velthoven
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Madison Milne-Ives
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Mary Mooney
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Edward Meinert
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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15
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Lin Y, Su Z, Chen F, Zhao Q, Zimet GD, Alias H, He S, Hu Z, Wong LP. Chinese mothers' intention to vaccinate daughters against human papillomavirus (HPV), and their vaccine preferences: a study in Fujian Province. Hum Vaccin Immunother 2020; 17:304-315. [PMID: 32401617 DOI: 10.1080/21645515.2020.1756152] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Little is known regarding Chinese mothers' intention to vaccinate their daughters against human papillomavirus (HPV) since the HPV vaccine was approved for use in China in 2016. The aim was to explore maternal HPV vaccination acceptance, preference for 2-, 4- or 9-valent HPV vaccine and acceptance of domestically manufactured HPV vaccines. Study participants were mothers of primary school children in Southeastern region of Fujian. An online cross-sectional survey was undertaken between June and August 2019. Among the total of 3,586 completed responses (response rate 28.5%), the intention to vaccinate daughter against HPV was high (83.3%). Higher maternal education and perceived benefit and barriers were associated with greater intention to vaccinate. Among mothers who did not intend to vaccinate their daughters, the three most common reasons were daughter being too young to receive HPV vaccination (40.6%), fear of side effects (31.9%) and vaccine price is too high (16.0%). The largest proportion (41.4%) preferred their daughter to be vaccinated with the 9-valent HPV vaccine (9vHPV). Greater preference for 9vHPVwas strongly associated with higher maternal education level and annual household income. The majority of mothers expressed a preference for imported HPV vaccine (56.3%). Our result indicates that lower intentions to vaccinate daughters against HPV among less educated and lower-income mothers may lead to significant social inequalities in HPV vaccine uptake in the country.
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Affiliation(s)
- Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University , Fuzhou, Fujian Province, China.,Department of Nutrition, Harvard T.H. Chan School of Public Health , Boston, MA, USA
| | - Zhitai Su
- Yongding Health Inspection Bureau , Longyan City, Fujian Province, China
| | - Fulian Chen
- Longyan Health Inspection Bureau , Longyan City, Fujian Province, China
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen, Fujian, PR China
| | - Gregory D Zimet
- Department of Pediatrics, School of Medicine, Indiana University , Indianapolis, IN, USA
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - Shuqiong He
- Prenatal Diagnosis Center, Fujian Provincial Maternity andChildren's Hospital of Fujian Medical University , Fuzhou, Fujian Province, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University , Fuzhou, Fujian Province, China
| | - Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
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Van Velthoven MH, Milne-Ives M, de Cock C, Mooney M, Meinert E. Use of Apps to Promote Childhood Vaccination: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e16929. [PMID: 32022694 PMCID: PMC7055758 DOI: 10.2196/16929] [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] [Received: 11/06/2019] [Accepted: 11/28/2019] [Indexed: 12/02/2022] Open
Abstract
Background The decline in the uptake of routine childhood vaccinations has resulted in outbreaks of vaccine-preventable diseases. Vaccination apps can be used as a tool to promote immunization through the provision of reminders, dissemination of information, peer support, and feedback. Objective The aim of this review is to systematically review the evidence on the use of apps to support childhood vaccination uptake, information storage, and record sharing. Methods We will identify relevant papers by searching the following electronic databases: PubMed, Embase by Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Education Resources Information Center (ERIC). We will review the reference lists of those studies that we include to identify relevant additional papers not initially identified using our search strategy. In addition to the use of electronic databases, we will search for grey literature on the topic. The search strategy will include only terms relating to or describing the intervention, which is app use. As almost all titles and abstracts are in English, 100% of these will be reviewed, but retrieval will be confined to papers written in the English language. We will record the search outcome on a specifically designed record sheet. Two reviewers will select observational and intervention studies, appraise the quality of the studies, and extract the relevant data. All studies will involve the use of apps relating to child vaccinations. The primary outcome is the uptake of vaccinations. Secondary outcomes are as follows: (1) use of app for sharing of information and providing vaccination reminders and (2) use of app for storage of vaccination information; knowledge and decision making by parents regarding vaccination (ie, risks and benefits of vaccination); costs and cost-effectiveness of vaccination apps; use of the app and measures of usability (eg, usefulness, acceptability, and experiences of different users: parents and health care professionals); use of technical standards for development of the app; and adverse events (eg, data leaks and misinformation). We will exclude studies that do not study an app. We anticipate a limited scope for meta-analysis and will provide a narrative overview of findings and tabular summaries of extracted data. Results This project was funded by the Sir David Cooksey Fellowship in Healthcare Translation at the University of Oxford, Oxford, United Kingdom. We will submit the full systematic review for publication in the Journal of Medical Internet Research. Conclusions This review will follow, where possible, the Cochrane Collaboration and the Centre for Review and Dissemination methodologies for conducting systematic reviews. We will report our findings based on guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review results will be used to inform the development of a vaccination app. International Registered Report Identifier (IRRID) PRR1-10.2196/16929
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Affiliation(s)
| | - Madison Milne-Ives
- Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Oxford, United Kingdom
| | - Caroline de Cock
- Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Oxford, United Kingdom
| | - Mary Mooney
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Edward Meinert
- Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Oxford, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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17
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Jarvis JD, Woods H, Bali A, Oronsaye E, Persaud N. Selection of WHO-recommended essential medicines for non-communicable diseases on National Essential Medicines Lists. PLoS One 2019; 14:e0220781. [PMID: 31398195 PMCID: PMC6688805 DOI: 10.1371/journal.pone.0220781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/23/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading cause of death worldwide. Inadequate and inequitable access to essential NCD medicines is a major concern, particularly in low- and middle-income countries. National Essential Medicines Lists (EMLs) are important policy tools that indicate which medicines are prioritized as essential within a country's health system. This study sought to analyze a wide range of national essential medicines lists (EMLs) for their inclusion of priority non communicable disease (NCD) interventions recommended by the World Health Organization (WHO). METHODS Three lists of WHO endorsed priority NCD interventions were included. A database with 137 national EMLs and the WHO EML was created from the WHO Repository and these EMLs were compared for listing of priority NCD interventions. RESULTS Across 137 countries with national EMLs, the median percentage of 20 Best Buys interventions listed was 90% (IQR 80-95) and 31 Package of essential noncommunicable disease interventions (PEN) interventions listed was 94% (IQR 90-97), of 9 HEARTS interventions was 100% (IQR 89-100), and of the 43 unique interventions across the three priority lists was 88% (IQR 84-93). Less than 80% of the 43 interventions were listed by 22 (16%) countries and less than half of the interventions were listed by 2 countries: Angola (35%) and Cambodia (23%). Interventions listed on the fewest number of national EMLs were: influenza vaccine, HPV vaccine, hepatitis B vaccine, cervical cancer chemotherapy, codeine, promethazine, senna, and oxygen. CONCLUSION Most NCD interventions have been prioritized in national policy in most cases. The majority of priority medicines for NCDs described within key WHO NCD technical packages are listed on nearly all national EMLs across 137 countries of all income levels. Most NCD interventions have been prioritized in national policy in most cases, but in some countries and for select interventions such as the HPV vaccine, prioritization may be reviewed.
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Affiliation(s)
- Jordan D. Jarvis
- London School of Hygiene & Tropical Medicine, London, England, United Kingdom
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Hannah Woods
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Anjli Bali
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Efosa Oronsaye
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Nav Persaud
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
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18
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Affiliation(s)
- Janice E. Graham
- Department of Pediatrics (Infectious Diseases), Dalhousie University, Halifax, Canada
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19
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Salwa M, Abdullah Al-Munim T. Ethical issues related to human papillomavirus vaccination programs: an example from Bangladesh. BMC Med Ethics 2018; 19:39. [PMID: 29945621 PMCID: PMC6019993 DOI: 10.1186/s12910-018-0287-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Human Papilloma Virus (HPV) vaccine was introduced in Bangladesh through the arrangement of a demonstration project in Gazipur district in 2016, targeting grade five female students and non-school going girls (age range 10–12 years). HPV vaccination is expected to be eventually included in the nationwide immunization program if the demonstration project is successful. However, introduction and implementation of such a vaccination program raises various ethical concerns. This review paper illustrates a step by step assessment of the ethical concerns surrounding the HPV vaccination implementation in Bangladesh considering specific elements in administering and conducting the program as well as the intended results. Policy-makers, vaccine implementers, vaccine recipients, and an ethics specialist in Bangladesh were interviewed. Electronic database and websites have also been reviewed for relevant published literature and government statements. Main body of the abstract This program imparted inadequate knowledge about HPV and cervical cancer to the recipients and participants. There was lack of autonomous and informed choice of the girls and their parents about taking the vaccine. The program did not have any follow-up plan for the adverse effects in the long run. The impact of a female-only strategy in the larger societal context was overlooked. There was lack of awareness among the implementers about safeguarding the ethical issues pertaining to HPV vaccination. Conclusion Adolescent health education imparted in the scope of the vaccination program should contain adequate information about HPV, its mode of transmission, risk factors along with the importance of secondary prevention despite primary prevention. Adolescent boys should be given HPV related health education as well. The right of making informed choice should be appreciated and respected. More ethical discussion and debate should be done among the public health professionals of Bangladesh in order to increase awareness about ethical issues related to human health.
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Affiliation(s)
- Marium Salwa
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
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20
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Hanna E, Dany M, Abbas O, Kreidieh F, Kurban M. Updates on the use of vaccines in dermatological conditions. Indian J Dermatol Venereol Leprol 2018; 84:388-402. [PMID: 29794355 DOI: 10.4103/ijdvl.ijdvl_1036_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Numerous vaccines are being actively developed for use in dermatologic diseases. Advances in the fields of immunotherapy, genetics and molecular medicine have allowed for the design of prophylactic and therapeutic vaccines with immense potential in managing infections and malignancies of the skin. This review addresses the different vaccines available for use in dermatological diseases and those under development for future potential use. The major limitation of our review is its complete reliance on published data. Our review is strictly limited to the availability of published research online through available databases. We do not cite any of the authors' previous publications nor have we conducted previous original research studies regarding vaccines in dermatology. Strength would have been added to our paper had we conducted original studies by our research team regarding the candidate vaccines delineated in the paper.
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Affiliation(s)
- Edith Hanna
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed Dany
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ossama Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Firas Kreidieh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut Medical Center; Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon; Department of Dermatology, Columbia University, New York, USA
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21
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Oh JK, Jeong BY, Yun EH, Lim MK. Awareness of and Attitudes toward Human Papillomavirus Vaccination among Adults in Korea: 9-Year Changes in Nationwide Surveys. Cancer Res Treat 2018; 50:436-444. [PMID: 28494533 PMCID: PMC5912128 DOI: 10.4143/crt.2017.174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/06/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Human papillomavirus (HPV) vaccination has been included in the National Immunization Program in Korea since 2016. We aimed to evaluate changes in the awareness of and attitudes toward HPV vaccination, among adults in Korea since the first introduction of the vaccines in 2007. MATERIALS AND METHODS A nationwide population-based survey was conducted in 2016 for 1,200 nationally representative Korean men and women; the data obtained were compared with the data from the nationwide survey conducted in 2007. RESULTS A significant increase in the awareness of HPV infection (35.8%) and vaccination (36.9%) was observed in 2016 from 13.3% and 8.6% in 2007, respectively. Willingness to be vaccinated against HPV decreased from 55.0% in 2007 to 25.8% in 2016, and the proportion of respondents expressing uncertainty increased from 28.3% in 2007 to 43.3% in 2016. Only 12.1% of men and 22.0% of women knew about the free national HPV vaccination program for girls, launched in June 2016. Younger women, with higher income level, awareness of the HPV vaccine, and perception of the seriousness of infections had a higher willingness to be vaccinated. A high education level, awareness of HPV infection and vaccination, and perception of the seriousness of infection were positively associated with the willingness of respondents to vaccinate their daughters. CONCLUSION Raising the awareness of HPV infection and vaccination with appropriate knowledge is necessary for the successful implementation of the national HPV vaccination program.
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Affiliation(s)
- Jin-Kyoung Oh
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
- Cancer Risk Appraisal & Prevention Branch, National Cancer Center, Goyang, Korea
| | - Bo Yoon Jeong
- Cancer Risk Appraisal & Prevention Branch, National Cancer Center, Goyang, Korea
| | - E Hwa Yun
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
- Cancer Risk Appraisal & Prevention Branch, National Cancer Center, Goyang, Korea
| | - Min Kyung Lim
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
- Cancer Risk Appraisal & Prevention Branch, National Cancer Center, Goyang, Korea
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22
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Dubé E, Gagnon D, Ouakki M, Bettinger JA, Witteman HO, MacDonald S, Fisher W, Saini V, Greyson D. Measuring vaccine acceptance among Canadian parents: A survey of the Canadian Immunization Research Network. Vaccine 2017; 36:545-552. [PMID: 29233605 DOI: 10.1016/j.vaccine.2017.12.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/17/2017] [Accepted: 12/01/2017] [Indexed: 12/13/2022]
Abstract
Parental decision making about childhood vaccinations is complex and multidimensional. There is a perception that the number of parents having concerns regarding childhood vaccinations has been increasing in Canada. The aim of this study was to explore vaccine hesitancy among Canadian parents and to examine factors associated with a parent's intention to vaccinate his/her child. Informed by the Theory of Planned Behaviour (TPB) this study assesses potential associations between parents' knowledge, attitudes and beliefs toward vaccination and their intention to vaccinate their child in the future. A national sample of Canadian parents of children aged 24-59 months (N = 2013) was surveyed using an online survey methodology. Half of the surveyed parents strongly intended to have their child vaccinated in the future. Parents' information needs and searches as well as parents' trust in different institutions were associated with intention to vaccinate. Parents who reported having frequently looked for vaccine information, who considered that it was their role as parents to question vaccines, or who had previously experienced difficulty accessing vaccination services were less likely to strongly intend to vaccinate their child in the future. Parents who had a high level of trust in doctors and public health were most likely to strongly intend to vaccinate their child. Results of the multivariate analysis showed that positive attitudes (aOR = 8.0; 95% CI: 6.0, 10.4), higher perceived social support (aOR = 3.0; 95% CI: 2.3, 3.93), and higher perceived behavioural control (aOR = 1.8; 95% CI: 1.4, 2.43) were associated with parents' intention to vaccinate their child. Findings of this study suggest that trust-building interventions that promote pro-vaccine social norms and that address negative attitudes toward vaccination could enhance vaccine acceptance among Canadian parents.
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Affiliation(s)
- Eve Dubé
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada; Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada; Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada.
| | - Dominique Gagnon
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Manale Ouakki
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Holly O Witteman
- Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Québec, Canada; Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
| | - Shannon MacDonald
- Nursing Faculty, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - William Fisher
- Department of Psychology, University of Western Ontario, London, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Western Ontario, London, Ontario, Canada
| | - Vineet Saini
- Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, BC Children's Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
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Maza M, Schocken CM, Bergman KL, Randall TC, Cremer ML. Cervical Precancer Treatment in Low- and Middle-Income Countries: A Technology Overview. J Glob Oncol 2017; 3:400-408. [PMID: 28831448 PMCID: PMC5560450 DOI: 10.1200/jgo.2016.003731] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cervical cancer is the fourth leading cause of cancer-related death in women worldwide, with 90% of cases occurring in low- and middle-income countries (LMICs). There has been a global effort to increase access to affordable screening in these settings; however, a corresponding increase in availability of effective and inexpensive treatment modalities for ablating or excising precancerous lesions is also needed to decrease mortality. This article reviews the current landscape of available and developing technologies for treatment of cervical precancer in LMICs. At present, the standard treatment of most precancerous lesions in LMICs is gas-based cryotherapy. This low-cost, effective technology is an expedient treatment in many areas; however, obtaining and transporting gas is often difficult, and unwieldy gas tanks are not conducive to mobile health campaigns. There are several promising ablative technologies in development that are gasless or require less gas than conventional cryotherapy. Although further evaluation of the efficacy and cost-effectiveness is needed, several of these technologies are safe and can now be implemented in LMICs. Nonsurgical therapies, such as therapeutic vaccines, antivirals, and topical applications, are also promising, but most remain in early-stage trials. The establishment of evidence-based standardized protocols for available treatments and the development and introduction of novel technologies are necessary steps in overcoming barriers to treatment in LMICs and decreasing the global burden of cervical cancer. Guidance from WHO on emerging treatment technologies is also needed.
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Affiliation(s)
- Mauricio Maza
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
| | - Celina M. Schocken
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
| | - Katherine L. Bergman
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
| | - Thomas C. Randall
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
| | - Miriam L. Cremer
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
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Setiawan D, Oktora MP, Hutubessy R, Riewpaiboon A, Postma MJ. The health-economic studies of HPV vaccination in Southeast Asian countries: a systematic review. Expert Rev Vaccines 2017; 16:933-943. [PMID: 28730914 DOI: 10.1080/14760584.2017.1357472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The cervical cancer-related burden is an important problem in Southeast Asian (SEA) countries. However, only 3 out of 11 countries implement the comprehensive prevention program. Areas covered: This is a retrospective review from all relevant studies until 2015 from two main databases, MEDLINE/Pubmed and Embase in order to provide an evidence on the health economics of HPV vaccination in the region. Expert commentary: The implementation of HPV vaccination will generate substantial health and economic benefit in SEA countries since the number of cervical cancer cases in this region are generally high. Therefore, a clear recommendation on how HPV vaccination should be implemented in a country, for example on how many doses will be used, how much cost is required or is it a school based- or clinical based-delivery, is critically required.
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Affiliation(s)
- Didik Setiawan
- a PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands.,b Faculty of Pharmacy , Universitas Muhammadiyah Purwokerto , Purwokerto , Indonesia
| | - Monika Puri Oktora
- a PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Raymond Hutubessy
- c Initiative for Vaccine Research , World Health Organization , Geneva , Switzerland
| | - Arthorn Riewpaiboon
- d Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy , Mahidol University , Thailand
| | - Maarten J Postma
- a PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands.,e Institute of Science in Healthy Aging & healthcaRE (SHARE) , University Medical Center Groningen (UMCG) , Groningen , The Netherlands
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Jamshidi Makiani M, Minaeian S, Moghaddam SA, Moosavi SA, Moeini Z, Zamani V, Karbalaei Sabbagh M, Forghani H. Relative frequency of human papillomavirus genotypes and related sociodemographic characteristics in women referred to a general hospital in Tehran, 2014- 2015: A cross-sectional study. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.5.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Setiawan D, Luttjeboer J, Pouwels KB, Wilschut JC, Postma MJ. Immunogenicity and safety of human papillomavirus (HPV) vaccination in Asian populations from six countries: a meta-analysis. Jpn J Clin Oncol 2017; 47:265-276. [PMID: 28042137 DOI: 10.1093/jjco/hyw192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/05/2016] [Indexed: 11/14/2022] Open
Abstract
Cervical cancer is a serious public-health problem in Asian countries. Since human papillomavirus (HPV) infection is the main risk factor for cervical cancer, HPV vaccination is considered a promising strategy to prevent cervical cancer. However, comprehensive immunogenicity and safety information for Asian populations is lacking. We searched four electronic databases including PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov. We reviewed selected manuscripts and extracted the pooled relative risk (RR) from immunogenicity and safety information on HPV vaccination among women in Asian countries. We identified two quadrivalent-vaccine studies and eight bivalent-vaccine studies conducted in Asian countries. Analysis across these studies suggested that the HPV vaccines significantly enhanced HPV16- and HPV18-specific antibody among both uninfected (RR 85.69; 95% confidence interval (CI) 31.51-233.04 and 62.77; 95% CI 37.4-105.51) and infected individuals (RR 8.60; 95% CI 6.95-10.64 and RR 8.13; 95% CI 5.96-11.11). Furthermore, HPV vaccination among Asian populations has a favorable safety profile, with only slightly higher risks of local (RR: 1.89; 95% CI 1.65-2.17) and systemic (RR: 1.33; 95% CI 1.18-1.50) adverse events in vaccinated individuals compared with controls. For Asian populations, HPV vaccines enhance the level of HPV16- and HPV18-specific antibodies for both uninfected and infected individuals. Also, the risk of adverse events related to vaccination are acceptable. More data are needed to establish vaccine efficacy with regard to prevention of HPV infection and further outcomes including cervical intraepithelial neoplasia (CIN) and cervical cancer.
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Affiliation(s)
- Didik Setiawan
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Faculty of Pharmacy, University of Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Jos Luttjeboer
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Koen B Pouwels
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Jan C Wilschut
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen.,Department of Epidemiology, UMCG, Groningen, The Netherlands
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Jamshidi Makiani M, Minaeian S, Amini Moghaddam S, Moosavi SA, Moeini Z, Zamani V, Karbalaei Sabbagh M, Forghani H. Relative frequency of human papillomavirus genotypes and related sociodemographic characteristics in women referred to a general hospital in Tehran, 2014-2015: A cross-sectional study. Int J Reprod Biomed 2017; 15:305-310. [PMID: 28744526 PMCID: PMC5510584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papilloma virus (HPV) is one of the major public health problems and the main causes of cervical cancer. The prevalence HPV infection in developing countries with low financial resources is high. OBJECTIVE This study aimed to determine the relative frequency of HPV genotypes and its sociodemographic characteristics in women referred to a general hospital in Tehran, Iran from 2014-2015. MATERIALS AND METHODS This cross-sectional study was performed in 400 women with Pap smear samples, referring to to a general hospital in Tehran, Iran from 2014-2015. The detection of 28 HPV genotypes was performed by using the Multiplex PCR technique. The sociodemographic survey was conducted for each HPV positive woman. RESULTS HPV-positive infection was detected in 155 (38.75%) women aged 17-85 years. HPV 16 (19.1%) was the most prevalent type, followed by HPV 39 (12.5%) and HPV 18 (8.9%). The highest rate of HPV infection was observed at the age of 36 years (7.7%). The level of education and economic situation of each woman were showed most of HPV-positive women had a high school diploma (34.6%) and average economic situation (67,9%). 60.9% of these women were a housewife, and 67.3% lived in the capital . CONCLUSION Determination of HPV genotype and risk factor related to HPV infection in each geographical region can lead to the production of effective vaccines against the HPV virus. It can also be useful for disease management and high sensitivity diagnosis of cervical intraepithelial neoplasia.
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Affiliation(s)
- Mahin Jamshidi Makiani
- Department of Infectious Disease, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Sara Minaeian
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Soheila Amini Moghaddam
- Department of Gynecology Oncology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Zahra Moeini
- Department of Biology, Islamic Azad University of Damghan, Damghan, Iran.
| | - Vajihe Zamani
- Department of Obstetrics and Gynecology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Hosein Forghani
- Department of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Vermandere H, van Stam MA, Naanyu V, Michielsen K, Degomme O, Oort F. Uptake of the human papillomavirus vaccine in Kenya: testing the health belief model through pathway modeling on cohort data. Global Health 2016; 12:72. [PMID: 27846857 PMCID: PMC5111174 DOI: 10.1186/s12992-016-0211-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 10/23/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many studies investigate HPV vaccine acceptability, applying health behavior theories to identify determinants; few include real uptake, the final variable of interest. This study investigated the utility of the Health Belief Model (HBM) in predicting HPV vaccine uptake in Kenya, focusing on the importance of promotion, probing willingness to vaccinate as precursor of uptake and exploring the added value of personal characteristics. METHODS Longitudinal data were collected before and after a pilot HPV vaccination program in Eldoret among mothers of eligible girls (N = 255). Through pathway modeling, associations between vaccine uptake and the HBM constructs, willingness to vaccinate and adequate promotion were examined. Adequate promotion was defined as a personal evaluation of promotional information received. Finally, baseline cervical cancer awareness and socio-demographic variables were added to the model verifying their direct, mediating or moderating effects on the predictive value of the HBM. RESULTS Perceiving yourself as adequately informed at follow-up was the strongest determinant of vaccine uptake. HBM constructs (susceptibility, self-efficacy and foreseeing father's refusal as barrier) only influenced willingness to vaccinate, which was not correlated with vaccination. Baseline awareness of cervical cancer predicted uptake. CONCLUSIONS The association between adequate promotion and vaccination reveals the importance of triggers beyond personal control. Adoption of new health behaviors might be more determined by organizational variables, such as promotion, than by prior personal beliefs. Assessing users' and non-users' perspectives during and after implementing a vaccination program can help identifying stronger determinants of vaccination behavior.
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Affiliation(s)
- Heleen Vermandere
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, ingang 75, UZP 114, 9000 Ghent, Belgium
| | | | - Violet Naanyu
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Kristien Michielsen
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, ingang 75, UZP 114, 9000 Ghent, Belgium
| | - Olivier Degomme
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, ingang 75, UZP 114, 9000 Ghent, Belgium
| | - Frans Oort
- Department of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
The primary health care approach advanced at Alma Ata to address social determinants of health was replaced by selective health care a year later at Bellagio. Subsequently, immunization was endorsed as a cost-effective technical intervention to combat targeted infectious diseases. Multilateral efforts to collaborate on immunization as a universal public health good ambiguously capture the interests of the world's governments as well as private, public, and not-for-profit institutions. Global assemblages of scientists, governments, industry and nongovernmental organizations now work in public-private partnerships to develop and make essential vaccines accessible, with vaccines marketed as single fix solutions for global health. Drawing from ethnographic fieldwork in France and Burkina Faso that followed the development, regulation, and implementation of the group A meningococcal conjugate vaccine for sub-Saharan Africa, in this article I describe events during and after the development of MenAfriVac. A technological success narrative steeped in collaborative capitalist rhetoric disguises neglected health care systems.
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Affiliation(s)
- Janice Graham
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
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31
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Gebremariam T. Human papillomavirus related cervical cancer and anticipated vaccination challenges in Ethiopia. Int J Health Sci (Qassim) 2016; 10:137-143. [PMID: 27004064 PMCID: PMC4791164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Cervical cancer is the leading cause of cancer deaths among women in Ethiopia. This may be due to the high prevalence of high-risk human papillomavirus (HR-HPV) genotypes in the population. So far, few studies have been done that showed the presence of HR-HPV genotypes. The HR-HPV-16, -18, -52, -56, -31 and -58 were the most common genotypes reported in Ethiopia. The introduction of HPV vaccines in Ethiopia is likely to go a long way in reducing cervical cancer deaths. However, there are few challenges to the introduction of the vaccines. The target population for HPV vaccination is at the moment not well-defined. Besides, the current HPV vaccines confer only type-specific (HPV-16 and -18) immunity, leaving a small proportion of Ethiopian women unprotected against other HR-HPV genotypes such as 52, 56, 31 and 58. Thus, future HPV vaccines such as the nanovalent vaccine may be more useful to Ethiopia as they will protect women against more genotypes.
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Affiliation(s)
- TeweldeTesfaye Gebremariam
- Correspondence: Tewelde Tesfaye GebremariamAssistant Professor, Department of Medical Microbiology and Immunology, Mekelle University, Ethiopia, P.O.Box: 1168 Mekelle, Ethiopia. Tel: +251344416690, Fax: +251344416681,
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Augusto EF, Santos LSD, Oliveira LDHDS. Human papillomavirus detection in cervical scrapes from women attended in the Family Health Program. Rev Lat Am Enfermagem 2015; 22:100-7. [PMID: 24553709 PMCID: PMC4292707 DOI: 10.1590/0104-1169.3189.2398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/30/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES to survey the prevalence of human papillomavirus, associated risk factors and genotype distribution in women who were referred to cervical cancer screening when attended in a Family Health Program. METHOD we conducted a cross-sectional survey, investigating 351 women. Polymerase chain reaction for DNA amplification and restriction fragment length polymorphism analysis were used to detect and typify the papillomavirus. RESULTS virus infection was detected in 8.8% of the samples. Among the 21 different genotypes identified in this study, 14 were high risk for cervical cancer, and the type 16 was the most prevalent type. The infection was associated with women who had non-stable sexual partners. Low risk types were associated with younger women, while the high risk group was linked to altered cytology. CONCLUSION in this sample attended a Family Health Program, we found a low rate of papillomavirus infection. Virus frequency was associated to sexual behavior. However, the broad range of genotypes detected deserves attention regarding the vaccine coverage, which includes only HPV prevalent types.
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Affiliation(s)
- Everton Faccini Augusto
- Secretaria de Estado de Saúde e Defesa Civil do Estado do Rio de Janeiro, Hospital Estadual Alberto Torres, Rio de JaneiroRJ, Brazil, MSc, RN, Hospital Estadual Alberto Torres, Secretaria de Estado de Saúde e Defesa Civil do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Larissa Silva dos Santos
- Universidade Federal Fluminense, NiteróiRJ, Brasil, Doctoral student, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - Ledy do Horto dos Santos Oliveira
- Universidade Federal Fluminense, Departamento de Microbiologia e Parasitologia, NiteróiRJ, Brazil, PhD, Full Professor, Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Prévention des cancers du col de l’utérus et du sein chez les femmes en situation de grande précarité : étude épidémiologique. Bull Cancer 2014; 101:663-8. [DOI: 10.1684/bdc.2014.1919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Parkhurst JO, Vulimiri M. Cervical cancer and the global health agenda: Insights from multiple policy-analysis frameworks. Glob Public Health 2013; 8:1093-108. [PMID: 24236409 PMCID: PMC3877944 DOI: 10.1080/17441692.2013.850524] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/04/2013] [Indexed: 12/31/2022]
Abstract
Cervical cancer is the second leading cause of cancer deaths for women globally, with an estimated 88% of deaths occurring in the developing world. Available technologies have dramatically reduced mortality in high-income settings, yet cervical cancer receives considerably little attention on the global health policy landscape. The authors applied four policy-analysis frameworks to literature on global cervical cancer to explore the question of why cervical cancer may not be receiving the international attention it may otherwise warrant. Each framework explores the process of agenda setting and discerns factors that either facilitate or hinder policy change in cases where there is both a clear problem and a potential effective solution. In combination, these frameworks highlight a number of crucial elements that may be needed to raise the profile of cervical cancer on global health agendas, including improving local (national or sub-national) information on the condition; increasing mobilisation of affected civil society groups; framing cervical cancer debates in ways that build upon its classification as a non-communicable disease (NCD) and an issue of women's rights; linking cervical cancer screening to well-funded services such as those for HIV treatment in some countries; and identifying key global policy windows of opportunity to promote the cervical cancer agenda, including emerging NCD global health discussions and post-2015 reviews of the Millennium Development Goals.
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Affiliation(s)
- Justin O. Parkhurst
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Madhulika Vulimiri
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
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"HPV? Never heard of it!": a systematic review of girls' and parents' information needs, views and preferences about human papillomavirus vaccination. Vaccine 2013; 31:5152-67. [PMID: 24029117 DOI: 10.1016/j.vaccine.2013.08.091] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/22/2013] [Accepted: 08/28/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Two human papillomavirus vaccines were licenced in 2006/2007 for cervical cancer prevention. National vaccination programmes for schoolgirls were subsequently introduced in some European countries, North America and Australia. To understand factors influencing vaccine uptake and to inform the development of appropriate UK educational materials, we aimed to synthesise evidence of girls' and parents' information needs, views and preferences regarding HPV vaccination. DESIGN Systematic review and mixed method synthesis of qualitative and survey data. DATA SOURCES Twelve electronic databases; bibliographies of included studies 1980 to August 2011. REVIEW METHODS Two reviewers independently screened papers and appraised study quality. Studies were synthesised collaboratively using framework methods for qualitative data, and survey results integrated where they supported, contrasted or added to the themes identified. RESULTS Twenty-eight qualitative studies and 44 surveys were included. Where vaccination was offered, uptake was high. Intention to decline was related to a preference for vaccinating later to avoid appearing to condone early sexual activity, concerns about vaccine safety and low perception of risk of HPV infection. Knowledge was poor and there were many misconceptions; participants tried to assess the potential benefits and harms of vaccination but struggled to interpret limited information about HPV in the context of existing knowledge about sexually transmitted infections and cancer. Conclusion Many girls and their parents have limited understanding to an extent that impinges on their ability to make informed choices about HPV vaccination and could impact on future uptake of cervical screening. This is a considerable challenge to those who design and provide information, but getting the messages right for this programme could help in developing patient information about other HPV related cancers.
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Gattoc L, Nair N, Ault K. Human papillomavirus vaccination: current indications and future directions. Obstet Gynecol Clin North Am 2013; 40:177-97. [PMID: 23732024 PMCID: PMC4416057 DOI: 10.1016/j.ogc.2013.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human papillomavirus (HPV) is one of the most common sexually transmitted infections affecting both men and women worldwide. The development of the prophylactic HPV vaccines is a significant pharmaceutical innovation with potential to reduce HPV-related morbidity. However, barriers to the universal use and acceptability of the HPV vaccines continue to exist in both economically privileged and disadvantaged countries. It may be decades before the impact of preventive vaccines on HPV-related diseases caused by the considerable burden of HPV infections will be seen. Collaborative efforts must continue to promote vaccine implementation.
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Affiliation(s)
- Leda Gattoc
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Navya Nair
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Kevin Ault
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
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Mbizvo MT, Chou D, Shaw D. Today's evidence, tomorrow's agenda: implementation of strategies to improve global reproductive health. Int J Gynaecol Obstet 2013; 121 Suppl 1:S3-8. [PMID: 23490425 DOI: 10.1016/j.ijgo.2013.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Alliance for Women's Health deliberated on critical gaps and emerging issues related to women's health, focusing on contraception, safe abortion care, HIV, and cervical cancer prevention. Despite the health, socioeconomic, and development benefits of family planning, up to 222 million women have an unmet need for modern contraception. The number of unsafe abortions increased globally, 98% of which occurred in low-resource countries. Fragmentation of services for HIV and cervical cancer prevention and treatment fail to maximize opportunities to reach women within reproductive, maternal, and child health services. The FIGO 2012 PreCongress Workshop elaborated the role of societies of obstetricians-gynecologists in implementation of actions to increase access to modern methods of contraception to help individuals meet family planning intentions. Human rights principles underpin the imperative to ensure equitable access to a wide range of modern methods of contraception. The role of task shifting/sharing in different models of service delivery was elaborated. Actions from the International Conference on Population and Development on safe abortion care and integration of effective contraception were reaffirmed. A call was made to increase access to integrated HIV and cervical cancer prevention, screening, and management. Cross-cutting strategic approaches to accelerate progress include evidence-based information to stakeholders and continued education in these areas at all levels of training. A call was made to advocate for a budget line item for sexual and reproductive health, including family planning and engaging the demand side of family planning, while involving men to enhance uptake and continuation.
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Affiliation(s)
- Michael Takura Mbizvo
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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Belhadj H, Rasanathan JJK, Denny L, Broutet N. Sexual and reproductive health and HIV services: integrating HIV/AIDS and cervical cancer prevention and control. Int J Gynaecol Obstet 2013; 121 Suppl 1:S29-34. [PMID: 23477703 DOI: 10.1016/j.ijgo.2013.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
People living with HIV are at an increased risk of acquiring HPV and of developing evolutive cervical cancers (women) and penile and anal cancers (men). Low-cost screening-visual inspection with acetic acid, HPV DNA diagnostics and primary care level treatment, cryotherapy for cervical intraepithelial neoplasia (CIN 2), and primary prevention through HPV vaccination of girls aged 9-13 years-makes the goal of eliminating cervical cancer possible in the long term. Integration of cervical cancer screening and treatment into a sexual and reproductive health service package raises programmatic questions and calls for a continuum of care. The latter is only possible when adequate cytopathology skills and treatment for advanced cancer conditions are available. The present paper highlights the role of member societies of the International Federation of Gynecology and Obstetrics (FIGO) in developing the base for an integrated package that responds to women's sexual and reproductive health needs.
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Doroshenko A, Hatchette J, Halperin SA, MacDonald NE, Graham JE. Challenges to immunization: the experiences of homeless youth. BMC Public Health 2012; 12:338. [PMID: 22568937 PMCID: PMC3390266 DOI: 10.1186/1471-2458-12-338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 05/08/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Homelessness is a critical social issue, both a product of, and contributing to, poor mental and physical health. Over 150,000 young Canadians live on the streets. Homeless youth experience a high incidence of infectious diseases, many of which are vaccine preventable. Early departure from school and limited access to public health services makes them a particularly vulnerable high-risk group. This study explores challenges to obtaining essential vaccines experienced by homeless youth. METHODS A qualitative research study to explore knowledge, attitudes, beliefs, and experiences surrounding immunization of hard-to-reach homeless youth was designed. Participants were recruited for focus groups from Phoenix House and Shelter, a non-profit, community-based organization assisting homeless youth in Halifax, Nova Scotia, Canada. An experienced facilitator guided the recorded discussions. Transcripts of audiotapes were analyzed using a constant comparative method until data revealed a set of exemplars and themes that best captured participants' knowledge, attitudes, beliefs and experiences surrounding immunization and infectious diseases. RESULTS Important themes emerged from our analysis. Considerable variability in knowledge about immunization and vaccine preventable diseases was found. The homeless youth in the study had limited awareness of meningitis in contrast to a greater knowledge about sexually transmitted infections and influenza, gained during the H1N1/09 public health campaign. They recognized their poverty as a risk for contracting infectious diseases, along with their inability to always employ known strategies to prevent infectious diseases, due to circumstances. They showed considerable insight into the detrimental effects of poor hygiene, sleeping locations and risk behaviour. Interviewed homeless youth regarded themselves as good compliers of health professional advice and offered valuable suggestions to improve immunization in their population. CONCLUSIONS To provide effective public health interventions, it is necessary to consider the knowledge, attitudes, beliefs, and experiences of hard to reach, high risk groups. Our study shows that homeless youth are interested and capable in discussing immunization. Active targeting of homeless youth for public health immunization programs is needed. Working collaboratively with non-profit organizations that assist homeless youth provides an opportunity to increase their knowledge of infectious risks and to improve immunization strategies in this vulnerable group.
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Affiliation(s)
- Alexander Doroshenko
- Department of Pediatrics, Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Scott A Halperin
- Department of Pediatrics, Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Janice E Graham
- Department of Pediatrics, Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Departments of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
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Provider perceptions of barriers and facilitators of HPV vaccination in a high-risk community. Vaccine 2012; 30:4511-6. [PMID: 22561142 DOI: 10.1016/j.vaccine.2012.04.062] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 04/05/2012] [Accepted: 04/19/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Maximizing HPV vaccine uptake among those at highest risk for cervical cancer is critical. We explored healthcare provider perspectives on factors influencing HPV vaccination among adolescent girls in a community with high cervical cancer rates. METHODS From March to May 2009, we conducted in-depth interviews with 21 medical staff providing care to adolescent girls at two clinics in Los Angeles, CA, serving a predominantly Hispanic population with high cervical cancer rates. Interviews were recorded and transcribed data were reviewed for coding and thematic content related to potential barriers and facilitators of HPV vaccination. RESULTS Providers and medical staff overwhelmingly focused on parental beliefs as barriers to HPV vaccination. Perceived parental misconceptions acting as barriers included the belief that adolescents do not need vaccinations and that no-cost vaccine programs like Vaccines for Children are only available for younger children. Perceived parental concerns that the vaccine will promote sexual activity were prevalent, which prompted providers to frame HPV vaccine as a "routine" vaccine. However, the medical staff felt mothers with a friend or relative supportive of HPV vaccination were more likely to request the vaccine. The staff also noted that for Hispanic parents the "preferred" source of information is peers; if the "right people" in the community were supportive of HPV vaccine, parents were more willing to vaccinate. Other barriers included lack of immunization records among immigrant parents and a difficult-to-reach, mobile clientele. CONCLUSIONS Providers noted a number of barriers to HPV vaccination, including some perceived parental misconceptions that could be addressed with education about the need for adolescent vaccines and available free vaccine programs. Because community support appears particularly important to Hispanic parents, the use of promotoras - peer liaisons between health organizations and the community - may increase HPV vaccine uptake in this population.
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Awareness and acceptability of human papillomavirus vaccine: an application of the instrumental variables bivariate probit model. BMC Public Health 2012; 12:31. [PMID: 22240031 PMCID: PMC3292959 DOI: 10.1186/1471-2458-12-31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 01/13/2012] [Indexed: 11/16/2022] Open
Abstract
Background Although lower uptake rates of the human papillomavirus (HPV) vaccine among socioeconomically disadvantaged populations have been documented, less is known about the relationships between awareness and acceptability, and other factors affecting HPV vaccine uptake. The current study aimed to estimate the potential effectiveness of increased HPV vaccine awareness on the acceptability of HPV vaccination in a nationally representative sample of women, using a methodology that controlled for potential non-random selection. Methods This study used a population-based sample from the 2007 Health Information National Trends Survey, a cross-sectional study of the US population aged 18 years or older, and focused on the subsample of 742 women who have any female children under the age of 18 years in the household. An instrumental variables bivariate probit model was used to jointly estimate HPV vaccine awareness and acceptability. Results The proportion of HPV vaccine acceptability among the previously aware and non-aware groups was 58% and 47%, respectively. Results from the instrumental variables bivariate probit model showed that the estimated marginal effect of awareness on acceptability was 46 percentage points, an effect that was even greater than observed. Conclusions Among populations who are not currently aware of the HPV vaccine, the potential impact of raising awareness on acceptability of HPV vaccination is substantial. This finding provides additional support to strengthening public health programs that increase awareness and policy efforts that address barriers to HPV vaccination.
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