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Xu MA, Choi J, Capasso A, DiClemente RJ. Improving HPV Vaccination Uptake Among Adolescents in Low Resource Settings: Sociocultural and Socioeconomic Barriers and Facilitators. Adolesc Health Med Ther 2024; 15:73-82. [PMID: 39100520 PMCID: PMC11296371 DOI: 10.2147/ahmt.s394119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/18/2024] [Indexed: 08/06/2024] Open
Abstract
Background Lower- and middle-income countries (LMICs) are disproportionately impacted by human papillomavirus (HPV) and would benefit from implementing the HPV vaccine. In the context of competing health priorities, utilizing scarce domestic infrastructure and human resources for HPV vaccination remains challenging for many LMICs. Given the high benefits of the HPV vaccine, the World Health Organization (WHO) is now encouraging for all countries, particularly LMICs, to introduce HPV vaccines into their routine immunization programs. Understanding the barriers and facilitators to HPV adolescent vaccine programs in LMICs may help strengthen how LMICs implement HPV vaccine programs, in turn, increasing HPV vaccine acceptance, uptake, and coverage. Objective To identify and assess barriers and facilitators to implementing adolescent HPV vaccination programs in LMICs. Methods This study comprised a review of literature assessing adolescent HPV vaccination in LMICs published after 2020 from a sociocultural perspective. Results Overall, the findings showed that LMICs should prioritize increasing HPV vaccine availability and HPV vaccine knowledge, particularly focusing on cancer prevention, as knowledge reduces misinformation and increases vaccine acceptance. Evidence suggests that factors promoting HPV vaccine uptake include fostering low vaccine hesitancy, integrating HPV vaccination as a primary school routine vaccination, and vaccinating both genders. A one-dose HPV vaccine may enable many LMICs to increase vaccine acceptance, uptake, and coverage while controlling financial, infrastructure, and human resource costs. Conclusion As HPV is one of the leading causes of death in many LMICs, implementing the HPV vaccine may be highly beneficial. Cohesive national HPV vaccine buy-in and understanding the success and challenges of prior LMIC HPV vaccine implementation is crucial to developing effective, efficient, and sustainable HPV vaccination programs.
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Affiliation(s)
- Mia Ann Xu
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Jasmin Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | | | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
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Hulland EN, Charpignon ML, El Hayek GY, Desai AN, Majumder MS. "What's in a name?": Using mpox as a case study to understand the importance of communication, advocacy, and information accuracy in disease nomenclature. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.24.24309420. [PMID: 38978677 PMCID: PMC11230329 DOI: 10.1101/2024.06.24.24309420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Historically, many diseases have been named after the species or location of discovery, the discovering scientists, or the most impacted population. However, species-specific disease names often misrepresent the true reservoir; location-based disease names are frequently targeted with xenophobia; some of the discovering scientists have darker histories; and impacted populations have been stigmatized for this association. Acknowledging these concerns, the World Health Organization now proposes naming diseases after their causative pathogen or symptomatology. Recently, this guidance has been retrospectively applied to a disease at the center of an outbreak rife with stigmatization and misinformation: mpox (f.k.a. 'monkeypox'). This disease, historically endemic to west and central Africa, has prompted racist remarks as it spread globally in 2022 in an epidemic ongoing today. Moreover, its elevated prevalence among men who have sex with men has yielded increased stigma against the LGBTQ+ community. To address these prejudicial associations, 'monkeypox' was renamed 'mpox' in November 2022. We used publicly available data from Google Search Trends to determine which countries were quicker to adopt this name change-and understand factors that limit or facilitate its use. Specifically, we built regression models to quantify the relationship between 'mpox' search intensity in a given country and the country's type of political regime, robustness of sociopolitical and health systems, level of pandemic preparedness, extent of gender and educational inequalities, and temporal evolution of mpox cases through December 2023. Our results suggest that, when compared to 'monkeypox' search intensity, 'mpox' search intensity was significantly higher in countries with any history of mpox outbreaks or higher levels of LGBTQ+ acceptance; meanwhile, 'mpox' search intensity was significantly lower in countries governed by leaders who had recently propagated infectious disease misinformation. Among infectious diseases with stigmatizing names, mpox is among the first to be revised retrospectively. While the adoption of a given disease name will be context-specific-depending in part on its origins and the affected subpopulations-our study provides generalizable insights, applicable to future changes in disease nomenclature.
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Affiliation(s)
- Erin N Hulland
- Computational Health Informatics Program, Boston Children's Hospital & Harvard Medical School, Boston, MA, United States
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
| | - Marie-Laure Charpignon
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ghinwa Y El Hayek
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
| | - Angel N Desai
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
- Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Health Medical Center, Sacramento, CA, United States
| | - Maimuna S Majumder
- Computational Health Informatics Program, Boston Children's Hospital & Harvard Medical School, Boston, MA, United States
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
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Montuori P, Gentile I, Fiorilla C, Sorrentino M, Schiavone B, Fattore V, Coscetta F, Riccardi A, Villani A, Trama U, Pennino F, Triassi M, Nardone A. Understanding Factors Contributing to Vaccine Hesitancy in a Large Metropolitan Area. Vaccines (Basel) 2023; 11:1558. [PMID: 37896961 PMCID: PMC10610669 DOI: 10.3390/vaccines11101558] [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: 08/18/2023] [Revised: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Vaccine hesitancy has become a major global concern, leading to a significant decrease in the vaccination rate, with the World Health Organization recognizing it as one of the top ten threats to public health. Moreover, the health cost generated is evaluated to be 27 billion dollars per year in the US alone. To investigate the association between demographic variables and knowledge, attitudes, and behaviours related to vaccination, a survey-based cross-sectional study was conducted with 1163 individuals. Three models were used to perform a multiple linear regression analysis. In Model I, knowledge about vaccinations was found to be associated with smoking habits, education, and marital status. In Model II, attitudes towards vaccinations were significantly associated with sex, smoking habits, education, marital status, and knowledge. In Model III, behaviours related to vaccination were associated with sex, smoking habits, having children, knowledge, and attitudes. One potential solution to improve behaviours related to vaccinations in the general population is to implement specific public health programs, which can be a cost-effective intervention. This study provides valuable insights into the determinants of knowledge, attitudes, and behaviours related to vaccinations in the general population.
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Affiliation(s)
- Paolo Montuori
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Immanuela Gentile
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Claudio Fiorilla
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Michele Sorrentino
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Benedetto Schiavone
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Valerio Fattore
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Fabio Coscetta
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Alessandra Riccardi
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Antonio Villani
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Ugo Trama
- General Directorate of Health, Campania Region, Centro Direzionale C3, 80143 Naples, Italy
| | - Francesca Pennino
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Maria Triassi
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
| | - Antonio Nardone
- Department of Public Health, "Federico II" University, Via Sergio Pansini nº 5, 80131 Naples, Italy
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Kutz JM, Rausche P, Gheit T, Puradiredja DI, Fusco D. Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review. BMC Public Health 2023; 23:974. [PMID: 37237329 PMCID: PMC10214362 DOI: 10.1186/s12889-023-15842-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Human Papilloma Virus (HPV) is the most common sexually transmitted infection worldwide. Globally, both men and women have a 50% risk of being infected at least once in their life. HPV prevalence is among the highest in sub-Saharan Africa (SSA), at an average of 24%. HPV causes different types of cancers, including cervical cancer (CC), which is the leading cause of cancer deaths among women in SSA. HPV-vaccination has been proven to be effective in reducing HPV induced cancers. SSA countries are delayed in reaching the WHO's target of fully vaccinating 90% of girls within the age of 15 by 2030. Our systematic review aims to identify barriers and facilitators of HPV-vaccination in SSA to inform national implementation strategies in the region. METHODS This is a mixed method systematic review based on the PRISMA statement and The Joanna Briggs Institute Reviewers' Manual. Search strategies were adapted to each selected database: PubMed/MEDLINE, Livivo, Google Scholar, Science Direct, and African Journals Online for papers published in English, Italian, German, French and Spanish between 1 December 2011 and 31 December 2021. Zotero and Rayyan were the software used for data management. The appraisal was conducted by three independent reviewers. RESULTS A total of 20 articles were selected for appraisal from an initial 536 articles. Barriers included: limited health system capacities, socio-economic status, stigma, fear and costs of vaccines, negative experience with vaccinations, COVID-19 pandemic, lack of correct information, health education (HE) and consent. Additionally, we found that boys are scarcely considered for HPV-vaccination by parents and stakeholders. Facilitators included: information and knowledge, policy implementation, positive experience with vaccinations, HE, stakeholders' engagement, women's empowerment, community engagement, seasonality, and target-oriented vaccination campaigns. CONCLUSIONS This review synthesizes barriers and facilitators of HPV-vaccinations in SSA. Addressing these can contribute to the implementation of more effective HPV immunization programs targeted at eliminating CC in line with the WHO 90/70/90 strategy. REGISTRATION AND FUNDING Protocol ID: CRD42022338609 registered in the International Prospective Register of Systematic Reviews (PROSPERO). Partial funds: German Centre for Infection research (DZIF) project NAMASTE: 8,008,803,819.
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Affiliation(s)
- Jean-Marc Kutz
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Pia Rausche
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Tarik Gheit
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Dewi Ismajani Puradiredja
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Daniela Fusco
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.
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Oketch SY, Ochomo EO, Orwa JA, Mayieka LM, Abdullahi LH. Communication strategies to improve human papillomavirus (HPV) immunisation uptake among adolescents in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open 2023; 13:e067164. [PMID: 37012006 PMCID: PMC10083777 DOI: 10.1136/bmjopen-2022-067164] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVES Developing countries face the greatest cervical cancer disease burden and mortality with suboptimal immunisation uptake. This review explores the communication strategies adopted, successes, challenges and lessons learnt in sub-Saharan countries to enhance human papillomavirus (HPV) immunisation. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Hinari, Cochrane Library, Trip database, CINAHL, Web of Science, Scopus and seven grey resources were searched through May 2022. ELIGIBILITY CRITERIA We included observational studies addressing communication strategies for HPV immunisation uptake. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search, screen and code included studies. Data extraction and assessment of risk of bias were done in duplicate to enhance validity of the results. Meta-analysis was conducted using the random-effects model. Findings were summarised and synthesised qualitatively. RESULTS Communication intervention to facilitate decision-making achieved uptake rate of 100% (95% CI 0.99% to 1.00%), followed by intervention to enable communication, which achieved 92% (95% CI 0.92% to 0.92%). Communication intervention to inform and educate achieved 90% (95% CI 0.90% to 0.90%).Targeting both healthcare workers and community leaders with the communication intervention achieved 95% (95% CI 0.91% to 0.98%), while teachers and school boards achieved 92% (95% CI 0.84% to 1.01%). Targeting policymakers achieved 86% (95% CI 0.78% to 0.93%).Based on the method of communication intervention delivery, use of training achieved an uptake rate of 85% (95% CI 0.84% to 0.87%); similarly, drama and dance achieved 85% (95% CI 0.84% to 0.86%). However, use of information, education and communication materials achieved 82% (95% CI 0.78% to 0.87%). CONCLUSION HPV vaccine communication is critical in ensuring that the community understands the importance of vaccination. The most effective communication strategies included those which educate the population about the HPV vaccine, facilitate decision-making on vaccine uptake and community ownership of the vaccination process immunisation. PROSPERO REGISTRATION NUMBER CRD42021243683.
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Affiliation(s)
- Sandra Y Oketch
- Research Department, African Institute for Development Policy, Nairobi, Kenya
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edwin O Ochomo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jeniffer A Orwa
- Department of Resource Development and Knowledge Management, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lilian M Mayieka
- Department of Resource Development and Knowledge Management, Kenya Medical Research Institute, Nairobi, Kenya
| | - Leila H Abdullahi
- Research Department, African Institute for Development Policy, Nairobi, Kenya
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Alsanafi M, Salim NA, Sallam M. Willingness to get HPV vaccination among female university students in Kuwait and its relation to vaccine conspiracy beliefs. Hum Vaccin Immunother 2023; 19:2194772. [PMID: 37005342 PMCID: PMC10088927 DOI: 10.1080/21645515.2023.2194772] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
A substantial burden of high-risk human papillomavirus (HPV) infections and HPV-related cancers can be mitigated by vaccination. The current study aimed to investigate the willingness of female students at the University of Kuwait to get HPV vaccination and its possible association with general vaccine conspiracy beliefs (VCBs). This cross-sectional survey study was conducted during September-November 2022 using a validated VCB scale as the survey instrument. The final sample comprised 611 respondents with a median age of 22 y and a majority of Arab ethnicity (n = 600, 98.2%). Only 360 respondents (56.9%) heard of HPV before participation and these students showed an above-average level of HPV knowledge (mean knowledge score of 12.7 ± 2.6 out of 16 as the maximum score), of whom only 33 self-reported HPV vaccine uptake (9.2%). The willingness to accept free-of-charge HPV vaccination was seen among 69.8% of the participants, with 20.1% who were hesitant and 10.1% who were resistant. The acceptance of HPV vaccination if payment is required was 23.1%. Reasons for HPV vaccine hesitancy/resistance included complacency to the HPV disease risks, lack of confidence in HPV vaccination, and inconvenience. The embrace of VCBs was associated with significantly higher odds of HPV vaccine hesitancy/resistance. The current study showed the detrimental impact of endorsing vaccine conspiracy beliefs manifested in lower intention to get HPV vaccination among female university students in Kuwait. This should be considered in vaccine promotion efforts aiming to reduce the burden of HPV cancers.
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Affiliation(s)
- Mariam Alsanafi
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
- Department of Pharmaceutical Sciences, Public Authority for Applied Education and Training, College of Health Sciences, Safat, Kuwait
| | - Nesreen A Salim
- Prosthodontic Department, School of Dentistry, The University of Jordan, Amman, Jordan
- Prosthodontic Department, Jordan University Hospital, Amman, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan
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Shitu BF, Atnafu DD, Agumas Y. Public School Adolescents Had Increased Odds of Being Willing to Uptake HPV Vaccinations Owing to Sociodemographic and Healthcare Access Features in Bahir Dar City, Ethiopia. BIOMED RESEARCH INTERNATIONAL 2023; 2023:2663815. [PMID: 37090189 PMCID: PMC10115532 DOI: 10.1155/2023/2663815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 04/25/2023]
Abstract
Background Cervical cancer is one of the most prevalent and fatal malignancies in women worldwide. Despite the fact that vaccination is an effective method in reducing cervical cancer, its uptake varies between public and private school adolescents and remains a challenge in low- and middle-income countries, including Ethiopia. Empirical evidence on how much variation there is among public and private school adolescent in their willingness to uptake human papillomavirus (HPV) vaccination is also limited. Thus, the aim of this study was to compare levels of willingness to uptake HPV vaccination among public and private school female adolescents and associated factors in Bahir Dar City, Ethiopia. Methods A comparative cross-sectional study was conducted on 844 adolescents aged 10 to 19 in primary schools in Bahir Dar, Ethiopia. Multistage sampling was used. A self-administered, structured, and pretested questionnaire was used to collect data. The determinants of willingness to accept HPV vaccination were identified using logistic regression, and exploratory factor analyses were performed to determine load and mean. The level of statistical significance was determined using a P - value of 0.05. Results The overall proportion of willing to uptake HPV vaccination was 50.6% (95% CI: 47.4-54), whereas in public and private primary schools, the magnitude was 61% (95% CI: 56.3-65.4%) and 40.2% (95% CI: 35.6-44.9), respectively. In terms of willingness to uptake HPV vaccination, the odds were likely to be significantly higher among those whose mothers had a postsecondary education (AOR = 2.0, 95% CI: 1.29-3.05), a high cue to action (AOR = 1.92, 95% CI: 1.20-3.05), and high self-efficacy (AOR = 2.34, 95% CI: 1.58-3.48). High perceived barriers likely decreased the willingness to uptake HPV vaccination (AOR = 0.49, 95% CI: 0.34-0.70). Conclusion Adolescent girls in public primary schools were more likely to uptake HPV vaccination than those in private provided that income status and socioeconomic factors became less important. Willingness to uptake HPV vaccination was found to be low as compared to the WHO target for Ethiopian context and was influenced by maternal education status, perceived barriers, cues to action, and self-efficacy. As a result, greater emphasis should be placed on implementing a school-based and maternal educational program on cervical cancer prevention and control focusing on the behavioral contexts.
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Affiliation(s)
- Birhanu Feleke Shitu
- Department of Public Health, Addis Continental Institute of Public Health, Bahir Dar, Ethiopia
| | - Desta Debalkie Atnafu
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Yeshambel Agumas
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Boily MC, Barnabas RV, Rönn MM, Bayer CJ, van Schalkwyk C, Soni N, Rao DW, Staadegaard L, Liu G, Silhol R, Brisson M, Johnson LF, Bloem P, Gottlieb S, Broutet N, Dalal S. Estimating the effect of HIV on cervical cancer elimination in South Africa: Comparative modelling of the impact of vaccination and screening. EClinicalMedicine 2022; 54:101754. [PMID: 36583170 PMCID: PMC9793279 DOI: 10.1016/j.eclinm.2022.101754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background In 2020, the World Health Organization (WHO) launched its initiative to eliminate cervical cancer as a public health problem. To inform global efforts for countries with high HIV and cervical cancer burden, we assessed the impact of human papillomavirus (HPV) vaccination and cervical cancer screening and treatment in South Africa, on cervical cancer and the potential for achieving elimination before 2120, considering faster HPV disease progression and higher cervical cancer risk among women living with HIV(WLHIV) and HIV interventions. Methods Three independent transmission-dynamic models simulating HIV and HPV infections and disease progression were used to predict the impact on cervical cancer incidence of three scenarios for all women: 1) girls' vaccination (9-14 years old), 2) girls' vaccination plus 1 lifetime cervical screen (at 35 years), and 3) girls' vaccination plus 2 lifetime cervical screens (at 35 and 45 years) and three enhanced scenarios for WLHIV: 4) vaccination of young WLHIV aged 15-24 years, 5) three-yearly cervical screening of WLHIV aged 15-49 years, or 6) both. Vaccination assumed 90% coverage and 100% lifetime protection with the nonavalent vaccine (against HPV-16/18/31/33/45/52/58). Cervical cancer screening assumed HPV testing with uptake increasing from 45% (2023), 70% (2030) to 90% (2045+). We also assumed that UNAIDS 90-90-90 HIV treatment and 70% male circumcision targets are reached by 2030. We examined three elimination thresholds: age-standardised cervical cancer incidence rates below 4 or 10 per 100,000 women-years, and >85% reduction in cervical cancer incidence rate. We conducted sensitivity analyses and presented the median age-standardised predictions of outcomes of the three models (minimum-maximum across models). Findings Girls' vaccination could reduce age-standardised cervical cancer incidence from a median of 47.6 (40.9-79.2) in 2020 to 4.5 (3.2-6.3) per 100,000 women-years by 2120, averting on average ∼4% and ∼46% of age-standardised cumulative cervical cancer cases over 25 and 100 years, respectively, compared to the basecase. Adding 2 lifetime screens helped achieve elimination over the century among all women (2120 cervical cancer incidence: 3.6 (1.9-3.6) per 100,000 women-years), but not among WLHIV (10.8 (5.3-11.6)), and averted more cumulative cancer cases overall (∼45% over 25 years and ∼61% over 100 years compared to basecase) than girls' vaccination alone. Adding three-yearly cervical screening among WLHIV (to girls' vaccination and 2 lifetime cervical screens) further reduced age-standardised cervical cancer incidence to 3.3 (1.8-3.6) per 100,000 women-years overall and to 5.2 (3.9-8.5) among WLHIV by 2120 and averted on average 12-13% additional cumulative cancer cases among all women and 21-24% among WLHIV than girls' vaccination and 2 lifetime cervical screens over 25 years or longer. Long-term vaccine protection and using the nonavalent vaccine was required for elimination. Interpretation High HPV vaccination coverage of girls and 2 lifetime cervical screens could eliminate cervical cancer among women overall in South Africa by the end of the century and substantially decrease cases among all women and WLHIV over the short and medium term. Cervical cancer elimination in WLHIV would likely require enhanced prevention strategies for WLHIV. Screening of WLHIV remains an important strategy to reduce incidence and alleviate disparities in cervical cancer burden between women with and without HIV, despite HIV interventions scale-up. Funding World Health Organization. National Cancer Institute, National Institutes of Health. MRC Centre for Global Infectious Disease Analysis, UK Medical Research Council. National Institute of Child Health and Human Development research. Cancer Association of South Africa. Canadian Institutes of Health Research and the Fonds de recherche du Québec - Santé research.
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Affiliation(s)
- Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Ruanne V. Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Minttu M. Rönn
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Cara J. Bayer
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA, USA
| | - Cari van Schalkwyk
- The South African Department of Science and Innovation/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Nirali Soni
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Darcy W. Rao
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA, USA
| | - Lisa Staadegaard
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Gui Liu
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA, USA
| | - Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Marc Brisson
- Centre de Recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Paul Bloem
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Sami Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Khosa LA, Meyer JC, Motshwane FMM, Dochez C, Burnett RJ. Vaccine Hesitancy Drives Low Human Papillomavirus Vaccination Coverage in Girls Attending Public Schools in South Africa. Front Public Health 2022; 10:860809. [PMID: 35685759 PMCID: PMC9171038 DOI: 10.3389/fpubh.2022.860809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Girls aged ≥9 years attending South African public sector schools are provided with free human papillomavirus (HPV) vaccination, through a schools-based programme. HPV vaccine misinformation spread via social media in 2014, was identified as a barrier to obtaining parental informed consent in some districts, including Sedibeng District, which subsequently had the lowest HPV vaccination coverage in Gauteng Province in 2018. This study investigated vaccine hesitancy in caregivers of girls in Grade 4 to 7 aged ≥9 years attending public schools in Sedibeng District. A cross-sectional survey using a self-administered questionnaire was conducted among caregivers of age-eligible girls attending all public schools in Sedibeng District with first dose HPV vaccination coverage of <70%. The questionnaire included demographics; HPV vaccination status of girls; reasons for not being vaccinated; and a 5-item tool measuring the determinants of vaccine hesitancy (5C scale), using a 7-point Likert scale. Data were coded and captured on Microsoft Excel®. Except for collective responsibility which was reverse scored, the other 5C items (confidence, complacency, constraints, and calculation) were captured as follows: 1 = strongly disagree, 2 = moderately disagree, 3 = slightly disagree, 4 = neutral, 5 = slightly agree, 6 = moderately agree and 7 = strongly agree. Descriptive and inferential statistical analyses were conducted using Epi InfoTM. Of the principals of all schools with <70% HPV vaccination coverage, 69.6% (32/46) gave permission. The response rate from caregivers of girls present on the day of data collection was 36.8% (1,782/4,838), with 67.1% (1,196/1,782) of respondents reporting that their daughters had received ≥1 dose of HPV vaccine. Only 63.1% (370/586) of respondents with unvaccinated daughters answered the question on reasons, with 49.2% (182/370) reporting reasons related to vaccine hesitancy. Statistically significant differences between caregivers of vaccinated and unvaccinated daughters were identified for four of the five determinants of vaccine hesitancy: confidence (vaccinated group higher), complacency (unvaccinated group higher), constraints (unvaccinated group higher) and collective responsibility (vaccinated group higher). This is the first South African study to (a) report results of the 5C scale, which was found to be very useful for predicting vaccination uptake; and (b) confirm that the relatively low HPV vaccination coverage in Sedibeng District is largely driven by reasons related to vaccine hesitancy.
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Affiliation(s)
- Languta A. Khosa
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- *Correspondence: Johanna C. Meyer
| | - Feni M. M. Motshwane
- Child, Youth and School Health Cluster, Integrated School Health Programme, National Department of Health, Pretoria, South Africa
| | - Carine Dochez
- Network for Education and Support in Immunisation, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Rosemary J. Burnett
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Balogun FM, Omotade OO. Parental intention to vaccinate adolescents with HPV vaccine in selected communities in Ibadan, Southwest Nigeria: an application of Integrated Behavioral Model. Hum Vaccin Immunother 2022; 18:2069959. [PMID: 35561294 PMCID: PMC9359392 DOI: 10.1080/21645515.2022.2069959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Parents have important roles to play for adolescents to get the human papillomavirus (HPV) vaccine, an effective measure in the prevention of cervical and other HPV-related cancers. It is important to understand the intention of parents to have their adolescents vaccinated for optimal uptake of the vaccine in Nigeria. This study investigated the intention of parents in five selected communities to get their adolescents vaccinated with HPV vaccine in Ibadan, Nigeria using the Integrated Behavioral Model (IBM). Cross sectional study design was employed and 678 parents were interviewed. Pearson correlation, chi-square test and multiple regression were used for data analysis at α = 0.05. Mean age of the parents was 42.5 ± 10.0 years and 230(33.9%) were males. Almost all of the parents (96.8%) had the intention to vaccinate their adolescents with HPV vaccine. This intention was significantly correlated with experiential attitude (r = 0.74, p = <.01), instrumental attitude (r = 0.33, p = <.01), injunctive norm (r = 0.39, p = <.01), descriptive norm (r = 0.32, p = <.01), perceived control (r = 0.32, p = <.01) and self-efficacy (r = 0.46, p ≤ .01). A higher proportion of parents older than 65 years significantly had no intention to vaccinate their adolescents with HPV vaccine. Intention to vaccinate adolescents with HPV vaccine was predicted by experiential attitude (OR = 0.88, 95% CI: 0.80-0.95), personal agency (OR = 0.22, 95% CI: 0.15-0.29) and injunctive norm (OR = 0.08, 95% CI: 0.02-0.13). Parental intention to vaccinate adolescents with HPV vaccine was high among the parents in this study. The reluctance of older parents about HPV vaccine for adolescents requires further investigation.
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Affiliation(s)
- Folusho M Balogun
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Institute of Child Health, University College Hospital, Ibadan, Nigeria
| | - Olayemi O Omotade
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Institute of Child Health, University College Hospital, Ibadan, Nigeria
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Milondzo T, Meyer JC, Dochez C, Burnett RJ. Human Papillomavirus Vaccine Hesitancy Highly Evident among Caregivers of Girls Attending South African Private Schools. Vaccines (Basel) 2022; 10:vaccines10040503. [PMID: 35455252 PMCID: PMC9033046 DOI: 10.3390/vaccines10040503] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023] Open
Abstract
The viral spread of social media misinformation and disinformation regarding human papillomavirus (HPV) vaccination safety has resulted in widespread vaccine hesitancy and suboptimal HPV vaccination uptake. We previously reported that only 19.4% of age-eligible private school girls in South Africa in 2018 had received ≥1 HPV vaccine dose. Here, we report on reasons given by caregivers for why their daughters were unvaccinated. An online survey targeting caregivers of girls in grades 4–7 attending South African private schools was conducted. Caregivers of unvaccinated girls provided the most important reason for their daughter not being vaccinated by either selecting from a list of coded reasons or providing a free text reason. Free text reasons were analysed, coded and added to the list of coded reasons, which were categorised according to broad themes. Frequency distributions of reasons and categories were calculated. Most reasons were related to vaccine hesitancy (61.4%), followed by lack of access to the vaccine (21.3%) and lack of information (15.7%). HPV vaccination coverage among age-eligible girls can be improved by including private-sector schools in the South African HPV vaccination programme, training healthcare providers to advocate for HPV vaccination and extending HPV vaccination advocacy campaigns to include private-sector educators.
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Affiliation(s)
- Tracy Milondzo
- Department of Public Health, University of Limpopo, Polokwane 0727, South Africa;
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Carine Dochez
- Network for Education and Support in Immunisation, Department of Family Medicine and Population Health, University of Antwerp, 2000 Antwerp, Belgium;
| | - Rosemary J. Burnett
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Department of Virology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Correspondence:
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Amponsah-Dacosta E, Blose N, Nkwinika VV, Chepkurui V. Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services? Front Public Health 2022; 10:799984. [PMID: 35174123 PMCID: PMC8841655 DOI: 10.3389/fpubh.2022.799984] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/07/2022] [Indexed: 12/17/2022] Open
Abstract
Compared to other regions of the world, sub-Saharan Africa has made limited progress in the implementation and performance of nationwide human papillomavirus (HPV) vaccination programmes. Without urgent intervention, this will serve to undermine cervical cancer elimination efforts in this region. The primary intent of this narrative review is to highlight the programmatic successes and challenges of the school-based HPV vaccination programme in South Africa since its inception in 2014, with the aim of contributing to the evidence base needed to accelerate implementation and improve programme performance in other sub-Saharan African countries. As of 2020, the proportion of adolescent girls aged 15 years who had received at least one dose of the HPV vaccine at any time between ages 9–14 years was 75%, while 61% had completed the full recommended two-dose schedule. This gives some indication of the reach of the South African HPV vaccination programme over the past 6 years. Despite this, vaccine coverage and dose completion rates have persistently followed a downward trend, slowing progress toward attaining global elimination targets. There is evidence suggesting that declining public demand for the HPV vaccine may be a result of weakening social mobilization over time, inadequate reminder and tracking systems, and vaccine hesitancy. Another concern is the disproportionate burden of HPV and HIV co-infections among adolescent girls and young women in South Africa, which predisposes them to early development of invasive cervical cancer. Moving forward, national policy makers and implementers will have to explore reforms to current age eligibility criteria and vaccine dose schedules, as well as implement strategies to support vaccine uptake among populations like out-of-school girls, girls attending private schools, and HIV positive young women. Additional opportunities to strengthen the South African HPV vaccination programme can be achieved by scaling up the co-delivery of other adolescent health services such as comprehensive sexual and reproductive health and rights education, deworming, and health screening. This calls for reinforcing implementation of the integrated school health policy and leveraging existing adolescent health programmes and initiatives in South Africa. Ultimately, establishing tailored, adolescent-centered, integrated health programmes will require guidance from further operational research.
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Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- *Correspondence: Edina Amponsah-Dacosta ;
| | - Ntombifuthi Blose
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Varsetile Varster Nkwinika
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Virological Pathology, South African Vaccination and Immunisation Centre (SAVIC), Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Viola Chepkurui
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Abstract
Although rates of vaccination have increased worldwide, the rise in nonmedical exemptions for vaccination may have caused a resurgence of childhood vaccine-preventable diseases. Vaccine hesitancy plays an important role in the decreasing rates of vaccination and is considered by the World Health Organization as a top ten global threat to public health. Online vaccine misinformation is present in news outlets, websites, and social media, and its rapid and extensive dissemination is aided by artificial intelligence (AI). In combating online misinformation, public health experts, the medical community, and lay vaccination advocates can correct false statements using language that appeal to those who are undecided about vaccination. As the gatekeepers to online information, they can implement and enforce policy that limits or bans vaccine misinformation on their platforms. AI tools might also be used to address misinformation, but more research is needed before implementing this approach more broadly in health policy. This commentary examines the role that different online platforms appear to be playing in the spread of misinformation about vaccines. We also discuss the implications of online misinformation on attitudes about COVID-19 vaccine uptake and provide suggestions for ways to combat online misinformation.
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Affiliation(s)
| | - Sean D Young
- Department of Emergency Medicine, University of
California, Irvine, CA 92697, USA
- University of California Institute for Prediction Technology,
Department of Informatics, University of California,
Irvine, CA, USA
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Tankwanchi AS, Bowman B, Garrison M, Larson H, Wiysonge CS. Vaccine hesitancy in migrant communities: a rapid review of latest evidence. Curr Opin Immunol 2021; 71:62-68. [PMID: 34118728 DOI: 10.1016/j.coi.2021.05.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/30/2022]
Abstract
By refusing or delaying vaccination, vaccine hesitant individuals and communities undermine the prevention, and ultimately, elimination of communicable diseases against which safe and effective vaccines are available. We reviewed recent evidence of vaccine hesitancy within migrant communities in the context of increased human mobility and widespread anti-immigrant sentiment and manifest xenophobia. Among many immigrant parents and families, vaccine hesitancy is largely associated with fears and misinformation about vaccine harms, limited knowledge of both preventable diseases and vaccines, distrust of host countries' health systems and their attendant intentions, language barriers, and perceived incompatibility between vaccine uptake and migrants' religion. Hesitancy toward measles, influenza, and human papillomavirus vaccines are most discernible, and main migrant populations involved include Somalis and Poles.
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Affiliation(s)
| | - Brett Bowman
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle Garrison
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Heidi Larson
- Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle, WA USA; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Department of Global Health, Stellenbosch University, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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