Programmatic issues in the implementation of an HPV vaccination program to prevent cervical cancer

The Case for Adolescent HIV Vaccination in South Africa: A Cost-Effectiveness Analysis

Despite comprising 0.7% of the world population, South Africa is home to 18% of the global human immunodeficiency virus (HIV) prevalence. Unyielding HIV subepidemics among adolescents threaten national attempts to curtail the disease burden. Should an HIV vaccine become available, establishing its point of entry into the health system becomes a priority. This study assesses the impact of school-based HIV vaccination and explores how variations in vaccine characteristics affect cost-effectiveness. The cost per quality adjusted life year (QALY) gained associated with school-based adolescent HIV vaccination services was assessed using Markov modeling that simulated annual cycles based on national costing data. The estimation was based on a life expectancy of 70 years and employs the health care provider perspective. The simultaneous implementation of HIV vaccination services with current HIV management programs would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the incremental cost effectiveness ratio (ICER) was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to duration of vaccine mediated protection and variations in vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values. School-based HIV vaccine services of adolescents, in addition to current HIV prevention and treatment health services delivered, would be cost-effective.

Scaling up human papillomavirus vaccination: a conceptual framework of vaccine adherence

This review article provides a conceptual framework for human papillomavirus (HPV) vaccine acceptance and adherence, with a focus on improving understanding of the sociocultural factors impacting vaccine adherence behaviour. We include a systematic review of the slowly expanding literature on HPV vaccine acceptability and uptake in developed nations, as well as the relatively few publications from poorer nations, where more than 80% of global cervical cancer related deaths occur and where the vaccine will probably have the largest impact. We suggest that this conceptual framework will not only improve our understanding of HPV vaccine uptake and adherence, but it may also guide future sociobehavioural research geared towards improving adherence to the HPV vaccine and other multi-step vaccines in a young population at risk for sexually transmissible infections.

Acceptance of human papillomavirus vaccination among first year female university students in Hong Kong

The present study assessed sexual behaviour, knowledge and attitudes among first year university students in order to identify factors that may affect their acceptance of human papillomavirus (HPV) vaccination. A cross-sectional survey was conducted at the Chinese University of Hong Kong in August 2006. The survey was a self-administered questionnaire comprising questions regarding general health, sexual behaviour, knowledge about HPV and cervical cancer, and attitudes towards vaccination. χ2, anova and logistic regression tests were used to identify associations between categories. Of 992 students, 63 (6.5%) reported having had sexual intercourse, 22.4% of whom had had more than one sexual partner and 36.5% had had unprotected sexual intercourse. A total of 70.8% of participants were willing to accept the HPV vaccine, with ‘willingness’ independently associated with age, having had sexual intercourse and beliefs regarding the effectiveness of vaccination (P < 0.05). Understanding the role of these influences can aid in the design of successful HPV education, prevention and vaccination programs.