Exploring Preventive Healthcare in a High-Risk Vulnerable Population

What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries

OBJECTIVES

The aim of this study was to map and compare stakeholders' perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries.

DESIGN

In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening.

SETTING

The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania.

PARTICIPANTS

Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers.

METHODS

Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis.

RESULTS

120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers' lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women's fear, shame and lack of priority to preventive healthcare were identified as psychological barriers.

CONCLUSION

The study provides an overview of stakeholders' perceived barriers towards vulnerable women's cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women's psychological barriers had several similarities.

Sexual Behaviors and Human Papillomavirus Vaccination in a Heterosexually Active Adult Population at Increased Risk for HIV Infection

Human papillomavirus (HPV) is the most common sexually acquired infection in the US. Vaccination is effective against infection with high-risk HPV strains, yet HPV vaccine coverage is lower in the US than the national target. This study aimed to determine the relationship between sexual behaviors and HPV vaccination in a heterosexually active population at increased risk for HIV infection. Data from 380 participants aged 18-45 years obtained from the National HIV Behavioral Surveillance system increased risk heterosexuals cycle 5 (2019) in Houston, Texas, was analyzed. RDS-Analyst was used to generate population-based descriptive statistics. Modified Poisson regression models clustered on recruitment chain were conducted in SAS 9.4 to assess the relationship between sexual behaviors and HPV vaccination. Only 11.5% of participants had received at least one dose of the HPV vaccine. Regarding behaviors within the past 12 months, 44.8% reported having condomless casual sex, 51.3% reported having concurrent sexual partnerships while in their most recent relationship, 14.5% reported exchanging sex, and participants had an average of 4-5 sex partners. Further, those who exchanged sex had a significantly lower prevalence of HPV vaccine uptake when compared to those who did not exchange sex (adjusted prevalence ratio 0.23; confidence interval 0.10-0.52), while all other measures of sexual behavior were not significantly associated with HPV vaccination. More research is needed to understand the relationship between exchange sex and low prevalence of vaccination, specifically in women who bear the highest burden of poor HPV-related morbidity and mortality.

Awareness of human papillomavirus and reported human papillomavirus vaccine uptake in a high-risk population

Introduction

Disparities in human papillomavirus (HPV) awareness and HPV vaccine uptake are likely exacerbated among racial/ethnic minority populations living in low-income areas. This study aims to determine the prevalence and correlates of HPV awareness and HPV vaccine uptake in an urban, low-income, racial/ethnic minority population.

Methods

Secondary data analyses were performed in 2021 using 380 participants aged 18-45 years from the 2019 National HIV Behavioral Surveillance for high-risk heterosexuals, which monitors HIV risk behaviors among individuals living in high-poverty, high HIV prevalence neighborhoods. Prevalence estimates and modified Poisson regression models were used to assess the relationship between HPV awareness and HPV vaccine uptake, and sociodemographic characteristics.

Results

Only 53% of participants had heard of HPV and 11.5% had received at least one dose of the HPV vaccine. Those who were female, non-Hispanic White or other, had public health insurance, lived above the federal poverty level, had experienced homelessness and incarceration, and had usual source of healthcare showed higher awareness of HPV while those who were younger, female, non-Hispanic White or other, recently incarcerated, had a usual source of healthcare, and had a healthcare encounter in the past year showed higher prevalence of HPV vaccine uptake.

Conclusions

Prevalence of HPV vaccination in this high-risk population was low and there was a lack of preventive care utilization. Further research is needed on how to effectively target these populations to not only increase vaccine uptake, but to mitigate barriers that contribute to low awareness and suboptimal vaccination uptake in high-risk heterosexual populations.