Mothers' willingness to pay for HPV vaccines in Anambra state, Nigeria: a cross sectional contingent valuation study

Pursuance of a Yoruba name for cervical cancer in Southwest Nigeria: a case study

OBJECTIVES

Participants' comprehension of research process affects the quality of research output, which is the reason why translation of research instruments into local languages is standard practice. Literature has consistently reported that in Africa, knowledge about cervical cancer is low but paradoxically, expressed, and actual uptake of human papillomavirus vaccine for its prevention is high. This study explored the Yoruba names of cervical cancer among Yoruba people in Ibadan, Nigeria to guide the translation of cervical cancer research instruments to Yoruba language.

DESIGN

Exploratory case study design was used and data were obtained with 10 in-depth interviews and four focused group discussions. Data were analysed using content analysis.

SETTINGS

The study took place in Ibadan North local government area, Southwest Nigeria.

PARTICIPANTS

These were 4 traditional healers, 3 Yoruba linguists, 3 public health educators and 38 parents of adolescents.

MEASURES

These were Yoruba names for cervical cancer and their meanings.

RESULTS

Participants were aware of cervical cancer but only the traditional healers and public health educators had names for it. These names were highly varied. The public health educators gave names that were linked with different parts of the female reproductive system and external genital which were actually different medical conditions. Each traditional healer also had different names for cervical cancer, which either described the female body parts, or symptoms of female genital infections. These various names can lead to unnecessary misconceptions and misinformation about cervical cancer, its prevention, management, and research.

CONCLUSIONS

There was no consensus Yoruba name for cervical cancer among the study participants. Efforts to educate the Yoruba speaking populace about cervical cancer, its prevention, management and participation in its research can be frustrated if a generally accepted Yoruba name is not provided for this cancer. Stakeholders' collaboration is required to get an appropriate Yoruba name for cervical cancer.

Demand and willingness to pay for human papilloma virus vaccine for their daughters among mothers in Haryana, India: A contingent valuation study

OBJECTIVES

Cervical cancer accounts for 10 percent of cancer deaths among women in India. The human papillomavirus (HPV) vaccine can protect against infection but it is not included in India's universal immunisation programme. This study aimed to assess the demand and willingness to pay for the HPV vaccine among mothers of adolescent daughters.

METHODS

We conducted a contingent valuation exercise involving a hospital-based cross-sectional study to assess the demand for an HPV vaccine among mothers of adolescent daughters, their willingness to pay and its determinants. Participants were recruited at a tertiary care civil hospital in the city of Gurgaon in North India, and data was collected from December 2018 to February 2019. A questionnaire was administered to obtain demographic and awareness indicators. Payment cards were used to elicit the willingness to pay amount.

RESULTS

Out of 319 respondents, 79% were willing to pay for the vaccine. The mean maximum willingness to pay was INR 629 (USD 35), which was less than the vaccine market price of INR 2000-3000 (USD 117-175) per dose. Participant age and number of children significantly influenced demand, while family income and awareness of cervical cancer influenced willingness to pay for the HPV vaccine. Participants were willing to spend between 3% and 34% of their monthly income on the vaccine.

CONCLUSIONS

High demand and low willingness to pay for the HPV vaccine indicate low value perception of the health outcome among mothers of adolescent children in India. A strategy aimed at a price reduction of the vaccine and increasing its demand through improved awareness is important. At the same time, subsidising the vaccine in the short run is needed.

Parental Knowledge of HPV Infection, Cervical Cancer and the Acceptance of HPV Vaccination for their Children in Jos, Nigeria

Background

Despite the high prevalence of human papillomavirus (HPV) infections and cervical cancer in Nigeria, the utilization of the HPV vaccine as a highly effective preventive measure remains low. The aim of this study was to find out if parental knowledge of HPV infection and cervical cancer influenced the acceptance of HPV vaccines for their 9-14-year-old children.

Materials and Methods

This was a cross-sectional survey of 509 parents comprising 262 fathers and 247 mothers in 8 randomly selected communities in Jos, Plateau State Nigeria. A pretested semi-structured investigator-administered questionnaire, without identifiers, was used to collect information on parental knowledge of HPV, cervical cancer, HPV vaccine and its acceptance for their 9-14-year-old children. The data were analysed using SPSS version 23.0. Bivariate analysis was done using chi-square statistical test. Point estimates with corresponding 95% confidence interval (CI) were estimated with a value of P ≤ 0.05 was considered as statistically significant.

Results

Five hundred and nine parents were interviewed. The mean age of the respondents was 43.7 ± 9.43 years. Most of the participants (86.1%) had formal education from primary to tertiary level. Only 1.60%, 11.60% and 1.62% of respondents had knowledge of HPV, cervical cancer and HPV vaccines respectively, whereas 67.8% of parents were willing to pay for the cancer-preventing HPV vaccines out-of-pocket. There was no statistically significant associations between parental level of education (P = 0.056), parental knowledge of cancer of cervix (P = 0.483), religion of parents (P = 0.324) and the acceptance of HPV vaccination for their children. There was a statistically significant association between parental willingness to pay for HPV vaccines if not offered free (P = 0.001) with acceptance of vaccination. Vaccine acceptability was associated with positive attitude towards the vaccine (odds ratio [OR] = 4.178; 95% CI, 1.714-10.180; P = 0.002), whereas parental knowledge of HPV, cervical cancer and HPV vaccine did not show significant association with acceptability of HPV vaccination for their children.

Conclusion

Despite poor parental knowledge of HPV infection and cervical cancer, there was high acceptability of HPV vaccination for their children. HPV vaccination was acceptable to parents regardless of educational level or religion. Parents in Jos communities seems to have much faith in preventive vaccines as advertised by the health authorities. Accordingly, efforts should be geared towards ensuring availability, affordability and the provision of basic information regarding HPV vaccination in Northern Nigeria.

Human Papillomavirus Vaccination amongst Students in a Tertiary Institution in North Central Nigeria: A Cross-sectional Study on Sociodemographic Factors Associated with Its Awareness, Uptake and Willingness to Pay

BACKGROUND

Human papillomavirus (HPV) vaccine is effective in averting 70%-90% of all HPV-related diseases. The assessment of its awareness, uptake and willingness to pay (WTP) is important in Nigeria which is one of the developing countries where more than three-quarter of the global burden of HPV-related diseases occur. This study aimed to determine the sociodemographic factors associated with the awareness, uptake and WTP for HPV vaccine amongst undergraduates in a tertiary institution in North Central Nigeria.

METHODS

This was a cross-sectional study. Data were collected from randomly sampled respondents through a validated self-administered questionnaire. Descriptive statistics, Chi-square and logistic regression analyses were applied to data collected to determine the awareness, uptake and WTP for HPV vaccine and their association with sociodemographic factors. The results of inferential statistics were considered significant when P < 0.05.

RESULTS

A total of 240 respondents were recruited, 15.4% of the respondents had heard about HPV vaccine, 2.1% of them had received at least a dose of the vaccine, 0.4% of them had completed three doses and 35.0% of them were willing to pay for it. Marital status (adjusted odds ratio [AOR]: 10.2; 95% confidence interval [CI]: 2.840-36.635) and parity (AOR: 5.8; 95% CI: 2.314-14.565) were predictors of WTP for the HPV vaccine.

CONCLUSION

The evidence generated from this study suggests that there is a need to increase the awareness and uptake of the vaccine at the individual and population levels. The recent introduction of the HPV vaccine is a laudable step towards improving vaccine uptake. Public health authorities at the local, state and national levels should be empowered to develop tailored vaccine demand creation and advocacy strategies for HPV vaccine. Males should also be involved in the advocacy strategies and research on HPV vaccine.

Willingness to Pay for HPV Vaccine among Women Living with HIV in Nigeria

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.

Willingness to pay for cancer prevention, screening, diagnosis, and treatment: a systematic review

INTRODUCTION

Willingness to pay (WTP) studies examine the maximum amount of money an individual is willing to pay for a specified health intervention, and can be used to inform coverage and reimbursement decisions. Our objectives were to assess how people value cancer-related interventions, identify differences in the methodologies used, and review the trends in studies' publication.

AREAS COVERED

We extracted PubMed and EconLit articles published in 1997-2020 that reported WTP for cancer-related interventions, characterized the methodological differences and summarized each intervention's mean and median WTP values. We reviewed 1,331 abstracts and identified 103 relevant WTP studies, of which 37 (36%) focused on treatment followed by screening (26), prevention (21), diagnosis (7) and other interventions (12). The methods used to determine WTP values were primarily discrete-choice questions (n = 54, 52%), bidding games (15), payment cards (12) and open-ended questions (12). We found a wide variation in WTP reported values ranged from below $100 to over $20,000.

EXPERT OPINION

The WTP literature on oncology interventions has grown rapidly. There is considerable heterogeneity with respect to the type of interventions and diseases assessed, the respondents' characteristics, and the study methodologies. This points to the need to establish international guidelines for best practices in this field.

Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania

Background

Globally, approximately 19.7 million children remain under-vaccinated; many more receive delayed vaccinations. Sustained progress towards global vaccination targets requires overcoming, or compensating for, incrementally greater barriers to vaccinating hard-to-reach and hard-to-vaccinate children. We prospectively assessed pregnant women's valuations of routine childhood vaccinations and preferences for alternative incentives to inform interventions aiming to increase vaccination coverage and timeliness in southern Tanzania.

Methods

Between August and December 2017, 406 women in their last trimester of pregnancy were enrolled from health facilities and communities in the Mtwara region of Tanzania and asked contingent valuation questions about their willingness to vaccinate their child if they were (a) given an incentive, or (b) facing a cost for each vaccination. Interval censored regressions assessed correlates of women's willingness to pay (WTP) for timely vaccinations. Participants were asked to rank monetary and non-monetary incentive options for the timely vaccination of their children.

Findings

All women expected to get their children vaccinated according to the recommended schedule, even without incentives. Nearly all women (393; 96.8 %) were willing to pay for vaccinations. The average WTP was Tanzania Shilling (Tsh) 3,066 (95 % confidence interval Tsh 2,523-3,610; 1 USD ∼ Tsh 2,200) for each vaccination. Women's valuations of timely vaccinations varied significantly with vaccine-related knowledge and attitudes, economic status, and rural vs urban residence. Women tended to prefer non-monetary over monetary incentives for the timely vaccination of their children.

Interpretation

Women placed a high value on timely childhood vaccinations, suggesting that unexpected system-level barriers rather than individual-level demand factors are likely to be the primary drivers of missed vaccinations. Systematic variation in the value of vaccinations across women reflects variation in perceived benefits and opportunity costs. In this setting, nonmonetary incentives and other interventions to increase demand and compensate for system-level barriers hold significant potential for improving vaccination coverage and timeliness.

ClinicalTrialsgov Protocol

NCT03252288.

Stated preferences for human papillomavirus vaccination for adolescents in selected communities in Ibadan, Southwest Nigeria: A discrete choice experiment

Administration of the human papillomavirus (HPV) vaccine in early adolescence is effective in preventing cervical cancer, a common cancer in sub-Saharan Africa. Nigeria is in the pre-introduction era of the HPV vaccine. Understanding the preferences of the population for the vaccine can help design the HPV immunization program to ensure high uptake of the vaccine. This study explored the preferences for the HPV vaccine among stakeholders in selected communities in Ibadan, Nigeria. A discrete choice experiment survey based on six attributes of the HPV vaccine (which were the number of doses, the efficacy of the vaccine, cost of the vaccine, location of the service point, other benefits of the vaccine apart from prevention of cervical cancer and the odds of a side effect from the vaccine) was carried out in five communities. Data were analyzed using conditional and mixed logit models. Seven hundred community members were recruited, 144 (20.7%) were adolescents and 248 (35.4%) were males. In line with expectations, respondents preferred vaccines with higher efficacy, less severe side effects and lower costs. Preference heterogeneity was identified for adolescents that were less price-sensitive and other community members who were less likely to prefer using schools as the service point. The high socioeconomic class preferred a vaccine that also prevents genital warts. There were variabilities in the preferences for the attributes of the HPV vaccine in the study communities. These variabilities need to be considered in the introduction of the HPV vaccine to ensure high uptake of the vaccine.

Willingness-to-pay for a booster dose of inactivated SARS-CoV-2 vaccine in Taizhou, China

This study was conducted to ascertain whether people in China would be willing to pay for an inactivated COVID-19 vaccine booster dose. An online survey estimating participants' willingness to pay (WTP) for a booster dose of COVID-19 vaccine was conducted in Taizhou, China. The participants received ane-mail or e-poster on WeChat. A total of 1576 subjects participated the survey. A total of 66.4% (1046/1576) of the respondents were willing to pay for a booster dose of COVID-19 vaccine for themselves. Using binary logistic regression analysis, the following factors were significantly related to a WTP for a booster dose of COVID-19 vaccine: 1) confidence in the safety of the COVID-19 vaccines (high vs. low, OR: 4.30, 95%CI: 1.61-11.43), 2) confidence in the preventive effectiveness of the COVID-19 vaccines against SARS-CoV-2 virus (moderate vs. little, OR: 1.76, 95%CI: 1.30-2.38; great vs. little, OR: 2.244, 95%CI: 1.62-3.12), and 3) COVID-19 vaccine hesitancy (unhesitant vs. very unhesitant, OR: 0.67, 95%CI: 0.45-1.02; hesitant vs. very unhesitant, OR: 0.29, 95%CI: 0.19-0.44; very hesitant vs. very unhesitant, OR: 0.09, 95%CI: 0.03-0.27). This study revealed that a moderate proportion of participants responded that they would be willing to pay for a booster dose of COVID-19 vaccine. These findings suggest the importance of a detailed assessment and a health education plan that better understands the population's risk perception as well as the potential health risks in China.

Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community

Background

Over 80% of new cervical cancer cases occur in women living in low- and middle-income countries. It is the second highest cause of female cancer deaths in Nigeria. School based vaccination programs are an effective strategy for delivering the HPV vaccine to adolescent girls. This study aims to understand the challenges to implementing school-based HPV vaccination programs, particularly in a remote rural setting where vaccine hesitancy is high.

Methods

A 22- item interviewer administered questionnaire was used to evaluate HPV knowledge and willingness to get the HPV vaccinate among 100 female secondary school students as part of an HPV vaccination pilot in a rural community in Kebbi State, Nigeria. Additionally, semi-structured interviews were used to assess community knowledge and attitudes on cervical cancer and HPV vaccination. Data collected were analyzed thematically to understand challenges and generate lessons for vaccine delivery in the study setting.

Results

Knowledge of HPV and cervical cancer among junior secondary school aged girls was fair with a mean score of 66.05%. For senior secondary school aged girls, the knowledge score ranged from 70 to 100% with a mean of 96.25% indicating good knowledge of HPV and cervical cancer. All participants (n = 100) received the first vaccine dose but due to COVID-19, 33 participants were not able to complete the vaccine dosage within the recommended 6-month schedule. Of the parents who provided consent, none could afford the vaccine out of pocket. Challenges to vaccine delivery included operational costs exacerbated by lack of adequate health workforce and infrastructure in the study setting.

Conclusion

An exploration of sociocultural perspectives and contextual realities is crucial to understanding the complexities of HPV vaccine introduction from the perspective of the target audience, and the local community. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the vaccination program locally relevant. While school-based HPV immunization programs have been shown to be successful, adequate design, planning and monitoring is important. Additionally, considerations must be made to account for the high operational cost of vaccine delivery in rural, hard to reach areas where human resources and infrastructure are limited.

Women's Preference for Cervical Cancer Screening Methods in Iran: A Contingent Valuation Survey

Background: Cervical cancer is the fifth most deadly cancer in women in Iran. The present study aimed to investigate the monetary value of cervical cancer screening benefits from a social perspective. Methods: A cross-sectional study was conducted among 480 women aged 30 to 59 years in Mazandaran province, Iran, from 2020-21. The willingness to pay (WTP) for screening tests- Pap smear and simultaneous tests- was investigated using a researcher-made questionnaire based on the contingent valuation method (CVM) in 2 separate sample groups. The first group received basic information regarding cervical cancer (Scenario 1), while the second received complementary information in addition to basic knowledge (Scenario 2). Multivariate regression was applied to examine factors affecting WTP and the difference between the mean WTP in 2 scenarios was analyzed by a t-test. Results: The mean WTP of Pap smear and simultaneous tests was estimated at US$135.08 and US$160.19, respectively. There were significant and negative relationships between age and household size with the WTP of the Pap smear test. The number of people with income, household expenses, a chronic illness, and suggested base price indicated significant and positive effects on WTP of the Pap smear test. The number of people with income and household expenses showed significant and positive relationships with the WTP of simultaneous tests. There was no significant difference between the mean WTP of each group and the demand for screening tests was not elastic. Conclusion: The mean WTP of screening tests is notable when compared to their cost, demonstrating the need of concentrating on screening programs.

Facilitators and barriers of healthcare workers' recommendation of HPV vaccine for adolescents in Nigeria: views through the lens of theoretical domains framework

BACKGROUND

The human Papillomavirus (HPV) vaccine has demonstrated efficacy in the prevention of cervical cancer when given in early adolescence. The recommendation of the vaccine by health care workers (HCW) is crucial to the uptake of the vaccine by adolescents and the process of this recommendation is important as it determines subsequent uptake of the vaccine. Understanding of the facilitators and barriers of recommendation of this vaccine can help in the development of strategies to improve its recommendation rates and uptake. This study therefore explored the facilitators and barriers for the recommendation of HPV vaccine for adolescents by HCW in Ibadan, Nigeria using the Theoretical Domain Framework (TDF).

METHODS

Key informant interviews were conducted with 14 purposively selected HCW who were in charge of vaccination. Content analysis was used after deductive coding of the data using the domains of the TDF. Relevant concepts for facilitators and barriers of HPV vaccine recommendation and quotes were then identified.

RESULTS

Mean age of the HCW was 47.7 ± 6.5 years and they consisted of eight nurses, four medical doctors, one medical social worker and one health visitor. Ten domains of the TDF were represented among the facilitators and barriers against the recommendation of HPV vaccination by the HCW, except the goals; memory, attention, decision process; emotion; and behavioral regulation domains. The domains with the highest frequency of concepts were: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, intention and environmental context and resources. Domains with conflicting statements in the concept were: environmental context and resources, and beliefs about consequences. While those with perceived strength of concept were: social influences, reinforcement and optimism.

CONCLUSION

All the 10 identified domains of the TDF are potential areas of focus for strategies for improving the recommendation of HPV vaccine for adolescents by health care workers in Nigeria and other countries with similar sociocultural settings.

On Imported and Domestic Human Papillomavirus Vaccines: Cognition, Attitude, and Willingness to Pay in Chinese Medical Students

This study aimed to analyze the cognition, attitude, and willingness to pay (WTP) for imported and domestic human papillomavirus (HPV) vaccines in Chinese medical students.

Acceptance and Willingness to Pay for Vaccine Against Human Papilloma Virus (HPV) Among Parents of Boys in Central Vietnam

Human papilloma virus (HPV) vaccine for adolescents was recommended as an effective prevention strategy of HPV-related cancers. In Vietnam, HPV vaccination has not been introduced to male adolescent. This study was conducted to examine the acceptance of having boys vaccinated against HPV and its underlying reasoning, and to identify their parent's willingness to pay (WTP) for HPV vaccination in central Vietnam. 785 parents of boys were directly interviewed based on a structured questionnaire. Parent's acceptability of HPV vaccine for their sons was identified by one question with response on 3-point scale (agree, don't know, and disagree). Multivariate logistic regression model was used to determine contributing factors to participant's acceptance. Bidding game method was applied to elicit WTP values for HPV vaccination with initial bid of 161.2 USD. The results showed that 49.2% of parents agreed to have their sons vaccinated against HPV. Factors that influenced parent's acceptance including son's age older than 12 years (OR = 1.5; 95% CI: 1.08–1.98); being eldest son (OR = 1.6; 95% CI: 1.13–2.19), being mother (OR = 1.4; 95% CI: 1.01–1.91), parents with high educational level (OR = 1.7; 95% CI: 1.11–2.47) and their knowledge of HPV and HPV vaccine (OR = 1.8; 95% CI: 1.23–2.65). Average WTP value for full doses of HPV vaccine was 137.5 USD, ranging between 9 USD and 188.3 USD. Parents' knowledge of HPV and HPV vaccine was the only factor affecting WTP value (Rho: 0.11; p-value: 0.030). The findings suggest a strategy be introduced for HPV vaccination to male adolescents in Vietnam.

COVID-19 vaccine hesitancy and willingness to pay: Emergent factors from a cross-sectional study in Nigeria

Introduction

Prior to the COVID-19 pandemic, it took at least several years to develop vaccines for prevention of infectious diseases. The COVID-19 vaccine is the first to be developed within a period of one year. The expediency associated with the development of the COVID-19 vaccine has however been hampered by vaccine hesitancy and other relevant factors that could influence consequent immunisation. This study aimed at investigating factors associated with vaccine hesitancy and willingness to pay for COVID-19 vaccination.

Methods

A cross-sectional approach was used to undertake online and physical data collection with a validated questionnaire.

Results

A total of 1767 valid responses were received, female participants were in the minority (42.2%), majority (54.9%) of the study participants were between the ages of 18 and 30 years, and more than half (53.8%) of the participants were educated up to first degree level. Slightly above half (52.9%) of the study participants indicated that they were worried about side effects that may be associated with COVID-19 vaccines, and this may likely prevent them from taking the vaccine. A strong majority (85.1%) of the study participants indicated that COVID-19 vaccine should be administered at no cost to citizens. Only a quarter (26%) of the participants were willing to pay a fee for COVID-19 vaccination. Also, older participants and those that had been previously infected with COVID-19 were more likely to pay for COVID-19 vaccination.

Conclusion

This study provides critical insights which could influence immunisation efforts during the pandemic. An early understanding of population perceptions of the COVID-19 vaccine can be invaluable in designing successful campaigns. This is even more critical, given supply limitations, access issues and vaccines' inequity occasioned by the international scramble.

HPV vaccine acceptance in West Africa: A systematic literature review

Human papillomavirus (HPV) infections are mostly sexually transmitted and cause the greatest share of infection-associated cancers. Each year more than half a million women are diagnosed with cervical cancer and the mortality rate in West Africa is over ten times higher than that of Northern Europe. HPV vaccines are highly effective at preventing various strains of the infection. However, vaccine hesitancy and access issues have led to low HPV vaccine acceptance in certain countries. A search strategy was developed in PubMed and included an extensive list of keywords and related MeSH/subject headings to capture the many dimensions and expressions of vaccine access, confidence, trust and hesitancy related to HPV vaccination in West Africa. Thirty-five articles were included by full text. Most studies were conducted in Nigeria. Three were conducted in Mali, and one each in Côte d'Ivoire, Ghana and Senegal. The main concerns relating to the vaccine were inadequate information, cost and safety concerns. Several studies also mentioned fertility and promiscuity concerns. Despite over half of West African countries introducing an HPV vaccine pilot project, there is a scarcity of literature on HPV vaccine acceptance in the region. It is important to understand how cultural and gender dynamics in different settings can influence peoples' vaccination decisions. This can be done through in-depth local ethnographies, taking the views of all community members and influencers into account, and complemented by in-depth individual interviews and focus groups.

Willingness to pay for and acceptance of cervical cancer prevention methods: A systematic review and meta-analysis

Background: The Willingness to pay (WTP) for and acceptance of cervical cancer prevention (CCP) methods have an important role in the control of this type of cancer. Therefore, the aim of this study was to estimate the WTP and acceptance of CCP methods with the contingent valuation method (CVM). Methods: In this systematic review and meta-analysis study, the required information was collected by searching relevant keywords in PubMed, Scopus, Embase, Web of Knowledge, and their Persian equivalent in the Scientific Information Database (SID) and Elmnet databases during January 1, 2000 to June 30, 2020. All studies that reported the WTP and CCP methods with the CVM in English or Persian were included. The reporting quality of studies was assessed by strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Comprehensive meta-analysis (CMA: 2) software was used to conduct the meta-analysis. The content analysis method was used for qualitative data analysis. Results: Finally, 28 articles (with 49610 people) were included in the study. Most of the participants were women (35.7%). The HPV vaccine was the most common method of prevention (75%). The overall acceptance rate was 64% and the overall positive WTP rate was 66%. The average WTP was US$30.44, which accounts for about 0.84% of GDP per capita. The most significant effective factors included income, age, education, high-risk sexual behaviors, and awareness of cervical cancer, belief in the risk of cervical cancer, and belief about the effectiveness of prevention methods. The cost was the most important reason for the unwillingness to pay and accept. Conclusion: Results show that the WTP and acceptance rate of CCP methods are relatively high. It is recommended to reduce the cost of prevention methods, especially the HPV vaccine, and to increase awareness and improve the attitude of people. Also, it is recommended to consider other methods of estimation of WTP and other cancers in future studies.

Awareness, acceptability and uptake of cervical cancer vaccination services among female secondary school teachers in Enugu, Nigeria: a cross-sectional study

INTRODUCTION

cervical cancer is a major cause of morbidity and mortality in women and vaccination of adolescents with human papilloma virus (HPV) vaccines is a major preventive strategy for this cancer. Despite the usefulness of cervical cancer vaccines, significant gaps still exist in the level of awareness and acceptability of the vaccine among women. This study aimed to determine the level of awareness, acceptability, and identify the factors associated with the uptake of this vaccine by female secondary school teachers in Enugu, Nigeria.

METHODS

a cross-sectional study of 377 female teachers in Enugu metropolis was undertaken between July and October 2017. A structured interviewer-administered pretested questionnaire was used for data collection and SPSS used for analysis.

RESULTS

less than half (41.9%) of the respondents had good knowledge of the cervical cancer vaccine. The majority of the respondents (93.6%) accepted the vaccine and will recommend it for their children and students. Only 14.6% and 9.0% of the respondents have taught their students about cervical cancer or HPV vaccines and had a programme in their school that addresses cervical cancer or cervical cancer vaccination respectively. Only 3.4% of the respondents have been vaccinated while 5.6% of their children or relatives have received the HPV vaccine. Previous vaccination of participants (p = 0.000), existing programmes addressing cervical cancer in schools of respondents (p = 0.000), participants having taught students about cervical cancer (p = 0.025) and high economic status (p = 0.013) significantly increased the likelihood of participants vaccinating their adolescent daughters/relatives. Extremes of age (p = 0.001) and being the head of their families (p = 0.002) significantly reduced the likelihood of the daughters/relatives to be vaccinated. Only previous history of vaccination of the respondents predicted the vaccination of their children and relatives (AOR = 6.069; 95% CI; < 0.0001-0.041).

CONCLUSION

the overall knowledge of the HPV vaccine was low but the acceptability was high among respondents who were aware of the vaccines. Vaccine uptake among children/family members of the respondents was low. The introduction of cervical cancer vaccination education of the teachers in the secondary schools will help improve cervical cancer vaccination and the uptake among adolescent´s populations in the country.

Men's willingness to support HPV vaccination and cervical cancer screening in Nigeria

Cervical cancer is the second most common female cancer in Nigeria, even though it can be prevented by vaccination and screening. The uptake of these preventive services is extremely low due to lack of spousal support and cost. Human papilloma virus (HPV) vaccines and cervical screening require finance as health services are mostly paid out of pocket. This study explored Nigerian men's willingness to encourage and pay for family member to obtain HPV vaccine and cervical screening. This is a cross-sectional study of 352 men aged 18-65 years living in 12 communities in the 6-geopolitical region. We found poor perception of HPV risk, and believed their family was not susceptible to cervical cancer. However, the majority (>80%) believed HPV vaccine and cervical screenings are important. Additionally, a good number (>58%) would encourage and pay for their family member to receive HPV vaccine and cervical screening. Residency, educational level and monthly income were significantly associated with willingness to encourage their family to receive HPV vaccine and cervical screening. Also, age group, marital status, residency, educational level and monthly income were significantly associated with the willingness to pay for HPV vaccine and cervical cancer screening. Majority were willing to encourage and pay for their family member to get vaccinated and receive cervical screening. This supports the findings that lack of male involvement may be an overlooked obstacle to cervical cancer prevention in developing countries.

Health systems constraints and facilitators of human papillomavirus immunization programmes in sub-Saharan Africa: a systematic review

Given the vast investments made in national immunization programmes (NIPs) and the significance of NIPs to public health, it is important to understand what influences the optimal performance of NIPs. It has been established that well-performing NIPs require enabling health systems. However, systematic evidence on how the performance of health systems impacts on NIPs is lacking, especially from sub-Saharan Africa. We conducted a qualitative systematic review to synthesize the available evidence on health systems constraints and facilitators of NIPs in sub-Saharan Africa, using human papillomavirus immunization programmes as a proxy. Fifty-four articles published between 2008 and 2018 were found to be eligible. Data extraction was guided by an analytical model on the interface between NIPs and health systems. A cross-cutting thematic analysis of the extracted data was performed. This systematic review provides evidence necessary for informing ongoing health systems strengthening initiatives in sub-Saharan Africa. There is evidence to suggest that NIPs in sub-Saharan Africa have surmounted significant health systems constraints and have achieved notable public health success. This success can be attributed to strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist in service delivery, vaccine communication, community engagement, the capacity of the health workforce and sustainable financing. These constraints could derail further progress if not addressed through health systems strengthening efforts. There is a need to expand the research agenda to include the comprehensive evaluation of health systems constraints and facilitators of NIPs within sub-Saharan Africa.

Increasing Human Papillomavirus Vaccination and Cervical Cancer Screening in Nigeria: An Assessment of Community-Based Educational Interventions

We explored the impact of two community-based educational interventions on Nigerian adults' knowledge and intention to take or encourage human papillomavirus (HPV) vaccine and cervical screenings. Face-to-face presentation and printed pamphlet intervention were delivered to 266 men and women aged 18 to 65 years in 12 locations in urban setting. At baseline, the majority (80%) had poor knowledge of HPV, and less than 12% had ever received or have a family member who had received HPV vaccine or cervical screening. Postintervention, there was significant increase (>70%) in the participants knowledge and intention to take or encourage HPV vaccination and cervical screening. In addition, more than half were willing to pay for HPV vaccine and screening even when expensive. Gender-focused and context-specific low-cost community-based educational interventions are effective in increasing HPV vaccine and cervical screening in sub-Saharan Africa.

Identifying Perceived Barriers to Human Papillomavirus Vaccination as a Preventative Strategy for Cervical Cancer in Nigeria

Background:

Cervical cancer deaths are disproportionately higher in developing countries depicting one of the most profound health disparities existing today and is ranked as the second most frequent cancer among women in Nigeria. The Human Papillomavirus (HPV) vaccine as a primary prevention strategy is not widely used in Nigeria. This study investigated perceived barriers to HPV vaccination in a Nigerian community, targeting health workers’ perceptions.

Methods:

This descriptive study captured responses from a cross-sectional, convenience sample of adult health workers within Anambra State, Nigeria. An anonymous 42-item survey with multiple validated scales was developed based on the Theory of Planned Behavior model and previous studies. The self-administered survey was distributed by research assistants at study sites within Anambra State which were identified through local constituents by the regional zones Adazi-Ani, Onitsha, and Awka. Data analyses were performed using Microsoft Excel for descriptive statistics and R software for the logistic regression, with a statistical significance level of 5%. Subgroup analysis was performed for the baseline knowledge questionnaire to determine if there were any differences in correct responses based on demographics such as: Institution type, profession, age, sex, religion and parental status.

Results:

Responses were collected from 137 Nigerian health workers; 44% nurses, 14% physicians, 6% pharmacists and 31% other health workers. The majority of respondents were female (69%), between 18 and 39 years of age (78%), from urban settings (82%), and identified as having Christian religious beliefs (97%). The most significant barriers identified were lack of awareness (39%), vaccine availability (39%), and cost (13%). When asked baseline knowledge questions regarding HPV, females were more likely to answer incorrectly as compared to males. Significant differences were found for statements: (1) HPV is sexually transmitted (p = 0.008) and (2) HPV is an infection that only affects women (p = 0.004).

Conclusions:

Perceived barriers to HPV vaccination identified by Nigerian health workers include lack of awareness, vaccine availability/accessibility, cost, and concerns about acceptability. Ongoing efforts to subsidize vaccine costs, campaigns to increase awareness of HPV vaccine, and interventions to improve attainability could advance administration rates in Nigeria, and ultimately improve death rates due to cervical cancer in this population.

A Systematic Review of the Incremental Costs of Implementing a New Vaccine in the Expanded Program of Immunization in Sub-Saharan Africa

Background. The World Health Organization is planning a pilot introduction of a new malaria vaccine in three sub-Saharan African countries. To inform considerations about including a new vaccine in the vaccination program of those and other countries, estimates from the scientific literature of the incremental costs of doing so are important. Methods. A systematic review of scientific studies reporting the costs of recent vaccine programs in sub-Saharan countries was performed. The focus was to obtain from each study an estimate of the cost per dose of vaccine administered excluding the acquisition cost of the vaccine and wastage. Studies published between 2000 and 2018 and indexed on PubMed could be included and results were standardized to 2015 US dollars (US$). Results. After successive screening of 2119 titles, and 941 abstracts, 58 studies with 80 data points (combinations of country, vaccine type, and vaccination approach-routine v. campaign) were retained. Most studies used the so-called ingredients approach as costing method combining field data collection with documented unit prices per cost item. The categorization of cost items and the extent of detailed reporting varied widely. Across the studies, the mean and median cost per dose administered was US$1.68 and US$0.88 with an interquartile range of US$0.54 to US$2.31. Routine vaccination was more costly than campaigns, with mean cost per dose of US$1.99 and US$0.88, respectively. Conclusion. Across the studies, there was huge variation in the cost per dose delivered, between and within countries, even in studies using consistent data collection tools and analysis methods, and including many health facilities. For planning purposes, the interquartile range of US$0.54 to US$2.31 may be a sufficiently precise estimate.

Health professionals' willingness to pay and associated factors for cervical cancer screening program at College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia

Introduction

Cervical cancer is a major public health problem in developing countries like Ethiopia. Cervical cancer screening service has been offered to high-risk groups in Ethiopia since 2013. However, there is no evidence on the willingness to pay for the screening. Therefore, we conducted this study to assess the female health professionals’ willingness to pay for cervical cancer screening at the College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia.

Methods

Institutional based cross-sectional study design was used to assess the health professionals’ willingness to pay for the cervical screening from March to April, 2018. Simple random sampling technique was used to select study participants from a list of female health professionals who has been working for the College of Medicine and Health Sciences, University of Gondar. The data were entered into EpiData version 3.1 and exported to STATA version 14 for analysis. Tobit models were used to identify factors which had statistical significant association with willingness to pay for cervical cancer screening service.

Results

A total of 392 respondents participated in the study with a response rate of 92.7%. The majority (83.4%) of participants were willing to pay for cervical cancer screening. The average amount of money they were willing to pay was ETB 194.7 (US$7.16) per service. Age ≥ 30 years, educational status, perceived seriousness of cervical cancer, perceived quality of cervical cancer screening service and monthly income were significantly associated with willingness to pay for cervical cancer screening.

Conclusion

High proportion of study participants were willing to pay for cervical cancer screening. Therefore, the policy makers can scale-up cervical cancer screening by setting appropriate fee for service charge. They can also raise awareness of cervical cancer and offer quality service in order to increase the benefits of the program.

Health professionals' willingness to pay and associated factors for human papilloma virus vaccination to prevent cervical cancer at College of Medicine and Health Sciences University of Gondar, Northwest Ethiopia

Objective

Preferences of health professionals’ for human papilloma virus vaccines was measured by monetary value through willingness to pay (WTP) approach that could help policy makers set priorities among alternative cervical cancer prevention methods in poor countries. The objective of this study was to assess the female health professionals’ willingness to accept and pay, and associated factors for human papilloma virus vaccination at College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia.

Results

The majority (85.97%) of health professionals’ were willing to pay for Human papilloma virus vaccine. On the average, the respondents were willing to pay 231.34 ETB (US$8.50) per human papilloma virus vaccination service. Age, educational status, knowledge about cervical cancer and its risk factors and monthly income were identified as significant factors to WTP for human papilloma virus vaccination. Policy makers shall consider human papilloma virus vaccine to prevent cervical cancer maintain health of women’s and do more on rising awareness of individuals about cervical cancer and its risk factors.

Cost-effectiveness of Human Papilloma Virus (HPV) vaccination in Nigeria: a decision analysis using pragmatic parameter estimates for cost and programme coverage

Background

World Health Organisation recommends routine Human Papilloma Virus (HPV) vaccination for girls when its cost-effectiveness in the country or region has been duly considered. We therefore aimed to evaluate cost-effectiveness of HPV vaccination in Nigeria using pragmatic parameter estimates for cost and programme coverage, i.e. realistically achievable in the studied context.

Methods

A microsimulation frame-work was used. The natural history for cervical cancer disease was remodelled from a previous Nigerian model-based study. Costing was based on health providers’ perspective. Disability adjusted life years attributable to cervical cancer mortality served as benefit estimate. Suitable policy option was obtained by calculating the incremental costs-effectiveness ratio. Probabilistic sensitivity analysis was used to assess parameter uncertainty. One-way sensitivity analysis was used to explore the robustness of the policy recommendation to key parameters alteration. Expected value of perfect information (EVPI) was calculated to determine the expected opportunity cost associated with choosing the optimal scenario or strategy at the maximum cost-effectiveness threshold.

Results

Combination of the current scenario of opportunistic screening and national HPV vaccination programme (CS + NV) was the only cost-effective and robust policy option. However, CS + NV scenario was only cost-effective so far the unit cost of HPV vaccine did not exceed $5. EVPI analysis showed that it may be worthwhile to conduct additional research to inform the decision to adopt CS + NV.

Conclusions

National HPV vaccination combined with opportunist cervical cancer screening is cost-effective in Nigeria. However, adoption of this strategy should depend on its relative efficiency when compared to other competing new vaccines and health interventions.

Dengue vaccine acceptance and willingness to pay

The introduction of new vaccines is accompanied by a variety of challenges. Among these, very important ones concern the questions whether the public is willing to accept and willing to purchase the vaccine. Here we discuss factors associated with these questions in the context of vaccines that are becoming available against dengue virus infection. We reviewed published studies available from PubMed and Embase, conducting a meta-analysis when possible and narrative review when the data did not qualify for meta-analysis. We found that attitude toward vaccination and socioeconomic level had significant associations with dengue vaccine acceptance. In addition, socioeconomic level, knowledge, attitude and practice regarding dengue fever, having personally experienced dengue fever and vaccine price were associated with willingness to pay for dengue vaccine. To improve acceptance and willingness to pay for dengue vaccine, well-designed introduction programs that address the associated factors in a context-specific manner are essential.