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Orya EE, Bello KK, Sampson S, Envuladu EA, Okagbue HI. Varying behavioral differences and correlates of HPV infection among young adolescents in Benue state, Nigeria. BMC Public Health 2024; 24:1548. [PMID: 38849788 PMCID: PMC11162061 DOI: 10.1186/s12889-024-19068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) infection is a significant public health concern globally, especially in low- and middle-income countries. In Africa, including Nigeria, HPV prevalence is high, contributing to a substantial burden of cervical cancer. Despite challenges, massive HPV vaccination campaigns in Africa show promise for preventing cervical cancer cases. In Benue State, Nigeria, limited research exists on several aspects of HPV knowledge and attitudes towards HPV among secondary school students. This study aims to bridge this gap by assessing HPV knowledge, prevention practices, willingness to uptake HPV vaccination, and associated attitudes and behaviors among secondary school students in the state. METHODS The cross-sectional study was conducted among adolescents aged 10-19 years in six secondary schools in three local government areas (LGAs) in Benue State, Nigeria. Two-stage sampling was used to select the LGAs and schools, with a final sample size of 591 students. The selected schools represent both junior and senior secondary school levels and span across the three senatorial districts of the state. Data were collected using a self-administered questionnaire covering sociodemographic characteristics, HPV knowledge, prevention practices, and willingness for HPV vaccination. Statistical analyses included univariate analyses and tests of association, with significance set at p < 0.05 or 0.001 depending on the level of the stringency of the evidence required. Data were analyzed using SPSS version 25. RESULTS Only 35.4% of the participants were males, and 86.8% were between the ages of 10 and 16. Only 24.7% acknowledged that HPV can be transmitted during sexual intercourse, and 36.2% recognized that HPV can be transmitted via skin-to-skin contact. 48.1% noted that HPV can cause cervical cancer. Half (50.9%) acknowledged that early sexual debut increases the risk of acquiring HPV, while only 28.1% recognized vaccination as a preventive strategy against HPV infection. Only 35% correctly stated the best time for the HPV vaccine. In assessing the practice of HPV prevention, 14.9% are in a sexual relationship and 10.3% admitted to not using condoms during sexual intercourse. Also, 11.8% have had STIs, and 27.2% have previously undergone HIV screening. Various bivariate analyses showed some varying behavioral differences and correlates of HPV infection among young adolescents in Benue State, Nigeria. CONCLUSIONS This study provides valuable insights into HPV knowledge, prevention practices, and willingness to uptake HPV vaccination among secondary school students in Benue State, Nigeria. The significance of the differences and correlates was discussed using themes. The research has unpacked complex relationships that could have public health implications for researchers and policymakers. Moreover, ten actionable policy recommendations were prescribed. Several interventions and areas for further study were proposed.
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Affiliation(s)
| | | | | | | | - Hilary I Okagbue
- Sydani Institute for Research and Innovation, Sydani Group, Abuja, Nigeria.
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Lubeya MK, Mwanahamuntu M, Chibwesha CJ, Mukosha M, Kawonga M. Selecting and Tailoring Implementation Strategies to Improve Human Papillomavirus Vaccine Uptake in Zambia: A Nominal Group Technique Approach. Vaccines (Basel) 2024; 12:542. [PMID: 38793793 PMCID: PMC11126122 DOI: 10.3390/vaccines12050542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The human papillomavirus (HPV) vaccine is effective in cervical cancer prevention. However, many barriers to uptake exist and strategies to overcome them are needed. Therefore, this study aimed to select and tailor implementation strategies to barriers identified by multiple stakeholders in Zambia. The study was conducted in Lusaka district between January and February 2023. Participants were purposively sampled from three stakeholder groups namely, adolescent girls, parents, and teachers and healthcare workers. With each of the stakeholders' groups (10-13 participants per group), we used the nominal group technique to gain consensus to tailor feasible and acceptable implementation strategies for mitigating the identified contextual barriers. The identified barriers included low levels of knowledge and awareness about the HPV vaccine, being out of school, poor community sensitisation, lack of parental consent to vaccinate daughters, and myths and misinformation about the HPV vaccine. The lack of knowledge and awareness of the HPV vaccine was a common barrier across the three groups. Tailored strategies included conducting educational meetings and consensus-building meetings, using mass media, changing service sites, re-examining implementation, and involving patients/consumers and their relatives. Our study contributes to the available evidence on the process of selecting and tailoring implementation strategies to overcome contextual barriers. Policymakers should consider these tailored strategies to mitigate barriers and improve HPV vaccine uptake.
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Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2017, South Africa; (M.M.); (M.K.)
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
| | - Carla J. Chibwesha
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg 2193, South Africa;
| | - Moses Mukosha
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2017, South Africa; (M.M.); (M.K.)
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2017, South Africa; (M.M.); (M.K.)
- Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
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Carducci B, Dominguez G, Kidd E, Janes K, Owais A, Bhutta ZA. Pivoting school health and nutrition programmes during COVID-19 in low- and middle-income countries: A scoping review. J Glob Health 2024; 14:05006. [PMID: 38236689 PMCID: PMC10795858 DOI: 10.7189/jogh.14.05006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Background Preventive and promotive interventions delivered by schools can support a healthy lifestyle, positive development, and well-being in children and adolescents. The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to school health and nutrition programmes due to closures and mobility restrictions. Methods We conducted a scoping review to examine how school health and nutrition programmes pivoted during the COVID-19 pandemic, and to provide summative guidance to stakeholders in strategic immediate and long-term response efforts. We searched MEDLINE, Embase, PsycINFO, and grey literature sources for primary (observational, intervention, and programme evaluations) and secondary (reviews, best practices, and recommendations) studies conducted in low- and middle-income countries from January 2020 to June 2023. Programmes that originated in schools, which included children and adolescents (5-19.9 years) were eligible. Results We included 23 studies in this review. They varied in their adaptation strategy and key programmatic focus, including access to school meals (n = 8), health services, such as immunisations, eye health, and water, sanitation, and hygiene-related activities (n = 4), physical activity curriculum and exercise training (n = 3), mental health counselling and curriculum (n = 3), or were multi-component in nature (n = 5). While school meals, physical activity, and mental health programmes were adapted by out-of-school administration (either in the community, households, or virtually), all health services were suspended indefinitely. Importantly, there was an overwhelming lack of quantitative data regarding modified programme coverage, utilisation, and the impact on children and adolescent health and nutrition. Conclusions We found limited evidence of successful adaptation of school health and nutrition programme implementation during the pandemic, especially from Asia and Africa. While the adoption of the World Health Organization health-promoting school global standards and indicators is necessary at the national and school level, future research must prioritise the development of a school-based comprehensive monitoring and evaluation framework to track key indicators related to both health and nutrition of school-aged children and adolescents.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Georgia Dominguez
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
| | - Emily Kidd
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
| | - Karlie Janes
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre of Excellence in Women, and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Agha S, Bernard D, Francis S, Fareed A, Nsofor I. Determinants of Human Papillomavirus Vaccine Acceptance among Caregivers in Nigeria: A Fogg Behavior Model-Based Approach. Vaccines (Basel) 2024; 12:84. [PMID: 38250897 PMCID: PMC10820200 DOI: 10.3390/vaccines12010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Human papillomavirus (HPV) vaccine uptake among adolescent girls is critical to reducing the burden of HPV-related cancers in Nigeria. This study assesses the factors influencing caregivers' acceptance of HPV vaccination for their charges, using the Fogg Behavior Model (FBM) as a theoretical framework. We analyzed cross-sectional data from 1429 caregivers of girls aged 9-17 in six Nigerian states, using a survey instrument based on the FBM. Participants were recruited via Facebook and Instagram advertisements and interviewed through Facebook Messenger in August and September 2023. The study received ethical clearance from Nigeria's National Health Research Ethics Committee. We applied bivariate and multivariate analyses to assess the relationships between the caregiver's perception of how likely their adolescent girl was to get vaccinated in the next 12 months and motivation, ability, social factors (such as discussions with family and friends), injunctive norms, previous COVID-19 vaccination, and respondents' sociodemographic characteristics. Adjusted odds ratios derived from logistic regression analyses revealed that caregivers' motivation and ability, as well as social factors, were significantly associated with their perception that the adolescent girl in their care would get vaccinated within the next 12 months. Our findings suggest that behavioral interventions tailored to enhance motivation, ability, and social support among caregivers could significantly increase HPV vaccine uptake among adolescent girls in Nigeria.
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Affiliation(s)
- Sohail Agha
- Behavior Design Lab, Stanford University, Stanford, CA 94305, USA
- Behavioral Insights Lab, Seattle, WA 98136, USA; (D.B.); (S.F.); (I.N.)
| | - Drew Bernard
- Behavioral Insights Lab, Seattle, WA 98136, USA; (D.B.); (S.F.); (I.N.)
| | - Sarah Francis
- Behavioral Insights Lab, Seattle, WA 98136, USA; (D.B.); (S.F.); (I.N.)
| | | | - Ifeanyi Nsofor
- Behavioral Insights Lab, Seattle, WA 98136, USA; (D.B.); (S.F.); (I.N.)
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Dugan M, Stein GS, Carney JK, Clifford-Bova S. Evidence-Based Storytelling for a Strategic Roadmap to Promote Cancer Prevention via Adolescent HPV Vaccination in Northern New England. Crit Rev Eukaryot Gene Expr 2024; 34:69-102. [PMID: 38505874 DOI: 10.1615/critreveukaryotgeneexpr.2024052382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Vaccination rates for the human papillomavirus (HPV) among rural youth in northern New England lag those of more urbanized areas. Reasons include a lack of available medical offices, time constraints, perceptions of vaccines and HPV, and, to a smaller degree, delays caused by the COVID-19 pandemic. We have a responsibility to increase vaccinations in these communities. To do so, vaccination experts recommend addressing the three C's of vaccination hesitation: confidence, complacency, and convenience. With this framework as our foundation, in this article we detail a plan to address these important elements, and we add several more C's: clinics, communication, collaboration, community, capacity, and commitment to the list as we discuss the essential pieces-human, infrastructural, and perceptual-needed to create and promote successful, community-supported, school-based HPV vaccination clinics to serve youths aged nine to 18. We then integrate research and storytelling science into an innovative Persuasion Playbook, a guide for local opinion leaders to use in creating evidence-based, pro-vaccine messages on the community level to promote the clinics via evidence-based, pro-vaccination messages.
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Affiliation(s)
- Matthew Dugan
- Department of Biochemistry, University of Vermont, Burlington, VT 05405, USA
| | - Gary S Stein
- Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT 05405; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT 05405
| | - Jan Kirk Carney
- Department of Biochemistry, University of Vermont, Burlington, VT 05405, USA
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Moucheraud C, Whitehead HS, Songo J, Szilagyi PG, Hoffman RM, Kaunda-Khangamwa BN. Malawian caregivers' experiences with HPV vaccination for preadolescent girls: A qualitative study. Vaccine X 2023; 14:100315. [PMID: 37251590 PMCID: PMC10208880 DOI: 10.1016/j.jvacx.2023.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Many low- and middle-income countries have introduced the human papillomavirus (HPV) vaccine, but uptake remains extremely low. Malawi has the second-highest incidence of cervical cancer globally, and launched a national HPV vaccination program in 2019. We sought to understand attitudes about, and experiences with, the HPV vaccine among caregivers of eligible girls in Malawi. Methods We conducted qualitative interviews with 40 caregivers (parents or guardians) of preadolescent girls in Malawi to understand their experiences with HPV vaccination. We coded the data informed by the Behavioural and Social Drivers of vaccine uptake model and recommendations from WHO's Strategic Advisory Group of Experts Working Group on Vaccine Hesitancy. Results In this sample, 37% of age-eligible daughters had not received any HPV vaccine doses, 35% had received 1 dose, 19% had received 2 doses, and 10% had an unknown vaccination status. Caregivers were aware of the dangers of cervical cancer, and understood that HPV vaccine is an effective prevention tool. However, many caregivers had heard rumors about the vaccine, particularly its alleged harmful effect on girls' future fertility. Many caregivers, especially mothers, felt that school-based vaccination was efficient; but some caregivers expressed disappointment that they had not been more engaged in the school-based delivery of HPV vaccine. Caregivers also reported that the COVID-19 pandemic has been disruptive to vaccination. Conclusions There are complex and intersecting factors that affect caregivers' motivation to vaccinate their daughters against HPV, and the practical challenges that caregivers may encounter. We identify areas for future research and intervention that could contribute to cervical cancer elimination: better communicating about vaccine safety (particularly to address concerns about loss of fertility), leveraging the unique advantages of school-based vaccination while ensuring parental engagement, and understanding the complex effects of the COVID-19 pandemic (and vaccination program).
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Affiliation(s)
- Corrina Moucheraud
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Drive S, Los Angeles, CA 90095, USA
| | - Hannah S. Whitehead
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - John Songo
- Partners in Hope, Area 36 Plot 8, Lilongwe, Malawi
| | - Peter G. Szilagyi
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Risa M. Hoffman
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Blessings N. Kaunda-Khangamwa
- MAC-Communicable Diseases Action Centre, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, Chipatala Avenue, Blantyre, Malawi
- School of Public Health, University of the Witwatersrand, Wits Education Campus, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
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Okolie EA, Nwadike BI. Spotlight on Human Papillomavirus Vaccination Coverage: Is Nigeria Making Any Progress? JCO Glob Oncol 2023; 9:e2300088. [PMID: 37319397 PMCID: PMC10497273 DOI: 10.1200/go.23.00088] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/23/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Elvis Anyaehiechukwu Okolie
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- Department of Public Health, David Umahi Federal University of Health Sciences, Uburu, Nigeria
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Akinsolu FT, Abodunrin O, Adewole IE, Olagunju M, Gambari AO, Raji DO, Idigbe IE, Njuguna DW, Salako A, Ezechi OC. Willingness to Pay for HPV Vaccine among Women Living with HIV in Nigeria. Vaccines (Basel) 2023; 11:vaccines11050928. [PMID: 37243032 DOI: 10.3390/vaccines11050928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is responsible for most cervical cancer cases globally, with women living with HIV having a higher risk of persistent HPV infection and HPV-associated disease. The HPV vaccine is a promising tool to reduce cervical cancer rates, but its uptake among women living with HIV in Nigeria is unknown. METHODS A facility-based, cross-sectional survey was conducted with 1371 women living with HIV to assess their knowledge of HPV, cervical cancer, and the HPV vaccine as well as their willingness to pay for the vaccine at the HIV treatment clinic at the Nigerian Institute of Medical Research, Lagos. To identify factors associated with the willingness to pay for the HPV vaccine, multivariable logistic regression models were developed. RESULTS This study found that 79.1% of participants had not heard of the vaccine, and only 29.0% knew its efficacy in preventing cervical cancer. In addition, 68.3% of participants were unwilling to pay for the vaccine, and the average amount they were willing to pay was low. Knowledge of HPV, the HPV vaccine, and cervical cancer and income were factors associated with the willingness to pay for the vaccine. Health workers were the primary source of information. CONCLUSIONS This study highlights the lack of knowledge and low willingness to pay for the HPV vaccine among women living with HIV in Nigeria and emphasizes the importance of improving education and awareness. Factors associated with the willingness to pay, such as income and knowledge, were identified. Practical strategies, such as community outreach and school-based education programs, could be developed to increase vaccine uptake. Further research is needed to explore additional factors influencing the willingness to pay.
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Affiliation(s)
- Folahanmi T Akinsolu
- Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan 212102, Nigeria
- Nigerian Institute of Medical Research, Lagos 100001, Nigeria
| | - Olunike Abodunrin
- Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan 212102, Nigeria
- Lagos State Health Management Agency, Lagos 100001, Nigeria
| | - Ifeoluwa E Adewole
- Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan 212102, Nigeria
| | - Mobolaji Olagunju
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210008, China
| | - Aisha O Gambari
- Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan 212102, Nigeria
- Nigerian Institute of Medical Research, Lagos 100001, Nigeria
| | - Dolapo O Raji
- Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan 212102, Nigeria
| | - Ifeoma E Idigbe
- Nigerian Institute of Medical Research, Lagos 100001, Nigeria
| | - Diana W Njuguna
- School of Nursing, Dedan Kimathi University of Technology, Nyeri 10100, Kenya
| | - Abideen Salako
- Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan 212102, Nigeria
- Nigerian Institute of Medical Research, Lagos 100001, Nigeria
| | - Oliver C Ezechi
- Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan 212102, Nigeria
- Nigerian Institute of Medical Research, Lagos 100001, Nigeria
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Rosen JG, Guillaume D, Mlunde LB, Njiro BJ, Munishi C, Mlay D, Gerste A, Holroyd TA, Giattas MR, Morgan C, Kyesi F, Tinuga F, Ishengoma J, Sunguya BF, Limaye RJ. Feasibility and sustainability of a school-based platform for integrated delivery of HPV vaccination with adolescent health services in Tanzania: qualitative insights from stakeholders. Health Policy Plan 2023; 38:486-495. [PMID: 36779391 PMCID: PMC10089057 DOI: 10.1093/heapol/czad014] [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: 08/26/2022] [Revised: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 02/14/2023] Open
Abstract
To meet lofty human papillomavirus (HPV) immunization goals in Tanzania, the Ministry of Health integrated HPV vaccination with adolescent health services using a school-based approach. A qualitative study was conducted in June-July 2021, examining the feasibility and sustainability of an integrated service package, HPV Plus. In-depth interviews with 46 programme implementers (i.e. health-care workers and teachers) and planning stakeholders (i.e. government officials and school administrators) in Dar es Salaam and Njombe Regions explored enablers and constraints to HPV Plus programme implementation, including resource and staffing requirements. Two facilitators and three barriers to HPV Plus feasibility and sustainability were identified from thematic analysis of interviews. Interviewed stakeholders emphasized the programme's feasibility, especially if the efficiencies offered by a school-based platform were optimized. Implementation facilitators included (1) optimized service delivery efficiency through a school-based platform and (2) resources saved by combining adolescent health services and HPV immunization into a single programme package. Key barriers to HPV Plus feasibility and sustainability were (1) time, space and resource constraints (e.g. commodity stockouts and challenges delivering the complete service package to large cohorts of students within allotted times); (2) human resource gaps and increased workloads within the health workforce and (3) insufficient referral mechanisms linking schools to health facilities. Scaling up HPV Plus will require proactive commodity procurement and security; resource mobilization to reach ambitious service delivery targets and close co-ordination of programme implementation with school administrators.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Dominique Guillaume
- Department of Community, Global, and Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD, USA
- Jhpiego, Baltimore, MD, USA
| | - Linda B Mlunde
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Castory Munishi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davis Mlay
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amelia Gerste
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Taylor A Holroyd
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Christopher Morgan
- Jhpiego, Baltimore, MD, USA
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Furaha Kyesi
- Immunization and Vaccine Development Program, Ministry of Health, United Republic of Tanzania, Dar es Salaam, Tanzania
| | - Florian Tinuga
- Immunization and Vaccine Development Program, Ministry of Health, United Republic of Tanzania, Dar es Salaam, Tanzania
| | - Joseline Ishengoma
- Regional Administration and Local Government, Office of the President, United Republic of Tanzania, Dar es Salaam, Tanzania
| | - Bruno F Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rupali J Limaye
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Choi J, Markham C, Tamí-Maury I, Kim S, Cuccaro P. Maternal perceptions of vaccinating boys against human papillomavirus (HPV) in Seoul, South Korea: A descriptive exploratory qualitative study. PLoS One 2023; 18:e0282811. [PMID: 36897868 PMCID: PMC10004501 DOI: 10.1371/journal.pone.0282811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
Human Papillomavirus (HPV) vaccination is of paramount importance to reduce HPV-associated cancers in both genders. In South Korea, the prophylactic vaccine is recognized as prevention of cervical cancer with little attention given to male HPV vaccination. The purpose of this study was to explore perceptions of male HPV vaccination and underlying factors for vaccine hesitancy among mothers of unvaccinated boys in Seoul, Korea using a qualitative method. We used a purposive sampling strategy to recruit mothers of unvaccinated middle school-aged boys living in one of the 25 districts in Seoul, supplemented by a snowball sampling approach. We conducted one-on-one telephone interviews with ten mothers using a semi-structured interview guide. Questions probed mothers' views on vaccinating boys against HPV and the reasons for not vaccinating their sons. We found that mothers were hesitant to vaccinate their sons against HPV due to high out-of-pocket costs, fear of side effects concerning the young age of their sons, and low awareness of HPV and HPV vaccine, all of which stemmed from the exclusion of male HPV vaccination in the national immunization program. Sociocultural factors, including vaccination norms, lack of HPV education, and values associated with sexually transmitted infections were also likely to negatively impact mothers' vaccination decision-making. Despite the barriers, mothers were willing to accept HPV vaccination when it was framed as cancer prevention for not only the sons but also their future spouses. In conclusion, reasons for Korean mothers' hesitancy for their sons' HPV vaccine uptake were multifaceted. Healthcare providers' role in emphasizing and conveying the importance of gender-neutral HPV vaccination will be essential to alleviate negative sentiments around the vaccine for boys and reduce their risk of compromised sexual health. As an effective public health strategy, tailored cancer prevention messages should be delivered heightening significant benefits of the HPV vaccine beyond the prevention of cervical cancer.
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Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Irene Tamí-Maury
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Sooyoun Kim
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
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