Association of human papillomavirus vaccination with cervical cancer screening: A systematic review and meta-analysis

Barriers and facilitators to a combined strategy of HPV vaccination and cervical cancer screening among Mexican women

HPV-FASTER is an innovative public health intervention combining HPV vaccination and HPV-based screening in adult women at the same visit. FASTER-Tlalpan adapted the combined HPV-FASTER strategy in Tlalpan, Mexico City for women aged 25-45 years. To understand the barriers and facilitators to participation in a combined strategy, we conducted semi-structured interviews with 14 FASTER-Tlalpan participants. We used the constant comparative method for the analysis, as well as the socioecological model to organize the findings. At the intrapersonal level, barriers included the belief that only younger women are at risk for HPV, embarrassment about the pelvic exam, and lack of time, while facilitators were having information regarding the benefit of the combined strategy, perception of time saved by having both procedures at once, feeling reassured about their health, self-esteem regarding their health, and perceived severity of cervical cancer. Interpersonal-level barriers were experiences of stigma and prejudice, and lack of support from partners, while facilitators were family encouragement and peer-to-peer communications. Institutional-level barriers were lack of infrastructure and inconvenient hours at the health center, perceived high time burden, and low quality of care from providers, while facilitators included high-quality care by health center personnel, including partners in the combined strategy, and phone reminders. Community-level facilitators included willingness to participate. Public policy facilitators included mass information campaigns and free procedures. Our findings point to significant barriers which need to be addressed, along with facilitators which can be leveraged to scale up the combined strategy in similar settings.

Race/Ethnicity, Human Papillomavirus Vaccination Status, and Papanicolaou Test Uptake Among 27-45-Year-Old Women: A Cross-Sectional Analysis of 2019-2022 Behavioral Risk Factor Surveillance System Data

Purpose

The human papillomavirus (HPV) vaccine was recently approved for 27-45-year-olds. We examined the association between HPV vaccination status and having an up-to-date Papanicolaou (Pap) test for 27-45-year-old women across racial/ethnic groups.

Methods

We conducted a cross-sectional analysis using 2019-2022 Behavioral Risk Factor Surveillance System data. We performed weighted multivariable logistic regressions to examine the association between being unvaccinated, initiating, and completing the HPV vaccine series and Pap test uptake.

Results

Among 7,052 women, non-Hispanic White (NHW) women had the highest rate of HPV vaccine series completion (14.0%). Non-Hispanic Black (NHB) had the lowest rate of HPV vaccine series completion (9.2%) and the highest rate of up-to-date Pap tests (71.2%). Non-Hispanic Other (NHO) women had the lowest rate of up-to-date Pap tests (52.1%). Completing the HPV vaccine series was associated with increased odds of having an up-to-date Pap test (odds ratio [OR]: 1.66 95% confidence interval [CI]: 1.23-2.24). Among Hispanic and NHW women, HPV vaccine series completion was associated with increased odds of up-to-date Pap testing (Hispanic: OR: 2.16, 95% CI: 1.02-4.58; NHW: OR: 1.49, 95% CI: 1.01-2.21). HPV vaccine series initiation was associated with up-to-date Pap tests for NHB (OR: 2.75, 95% CI: 1.19-6.34) and NHO women (OR: 3.15, 95% CI: 1.56-6.37).

Conclusions

Unvaccinated women had decreased odds of up-to-date Pap testing. Shared clinical decision-making should be utilized to help 27-45-year-old women decide if they want to receive the HPV vaccine; culturally tailored efforts should be made to improve utilization of Pap testing across racial/ethnic groups.

Knowledge about cervical cancer in young Portuguese women: a cross-sectional study

Introduction

Health literacy is crucial to adherence to medical interventions in therapeutics, prevention, and diagnosis. The basis for literacy is knowledge. To accomplish the goals for the elimination of cervical cancer, one of the most prevalent and preventable cancers, we must understand the determinants of non-adherence and address them specifically to ensure patients' active participation.

Aim

To determine women's knowledge regarding the manifestations of cervical cancer and its prevention.

Materials and methods

We conducted a cross-sectional study in an urban population from northern Portugal. Women aged 18 to 30 years were randomly assigned to answer the Cervical Cancer Awareness Measure questionnaire, including questions of knowledge about the causes and symptoms of cervical cancer, prospecting for individual and social-related determinants.

Results

The total number of participants was 270, with a mean age of 24.7 years. Knowledge about symptoms scored 5.4 ± 2.6, with a maximum of 12 points, and knowledge about the causes scored 5.7 ± 1.9, with a maximum of 11 points. The correlation between both was 0.334. High education, high socio-economic status, self-perception of one's capacity to recognize symptoms, and knowledge about the HPV vaccine were associated with better knowledge.

Discussion

Portuguese women present low knowledge about cervical cancer, potentially affecting their health through exposure to risk situations and non-adherence to routine screening.

Cervical screening among Chinese females in the era of HPV vaccination: a population-based survey on screening uptake and regular screening following an 18-year organized screening program

OBJECTIVE

China has a substantial disease burden of cervical cancer. To further understand preventive measures for reducing cervical cancer in China, this study aimed to correlate screening attendance and regular screening with human papillomavirus (HPV) vaccination among Chinese females.

METHODS

This prospective questionnaire-based survey recruited Chinese females aged 25 or above in Hong Kong by random digit dialing telephone interviews in 2022. The survey studied women's practice of cervical screening and adherence to regular screening. Variables including HPV vaccination status and attendance of physical check-ups were involved in the questionnaire. Screening uptake and screening adherence were the main outcomes, which were measured as the proportion of women who reported having attended a cervical screening and screened regularly, respectively.

RESULTS

Out of 906 valid respondents, the reported cervical screening uptake was over 70% among females aged 30 or above and particularly over 80% among women aged 35-59; however, the uptake was only 46% among those aged 25-29. Adherence to regular screening was 50%-60% across ages 25-59 years and dropped to approximately 40% for women older than 60 years. Both screening uptake and adherence were associated with HPV vaccination, with adjusted odds ratios of 2.37 and 2.23, respectively. A large proportion of regularly screened women may be overscreened for screening more frequently than recommended.

CONCLUSION

Responded Chinese females showed good cervical screening uptake but were moderately adherent to regular screening. Policymakers should emphasize the importance of regular screening and the recommended screening frequency by HPV vaccination status for better healthcare resource use.

Digital HPV education to increase vaccine uptake among low income women

Objective

The objective of this formative study was to gather women's perspectives in the design and communication modalities of a health kiosk set within a Planned Parenthood setting to promote patient education about the Human papillomavirus (HPV) and to motivate uptake of the HPV vaccine.

Methods

Twenty-four women aged 18-35 participated in in-depth one-on-one interviews at a Planned Parenthood health center, which were analyzed in code-associated categories using NVivo11 Pro.

Results

Most women showed receptivity to using an on-site health kiosk, as well as QR codes linked to text messages, to receive HPV-related health information outside of the clinic setting and reminders. Participants provided suggestions for kiosk design and communication modalities.

Conclusions

Among low-income women we interviewed at Planned Parenthood, increasing HPV vaccination rates necessitates engaging digital health tools which incorporate both the preferences and needs of vulnerable populations.

Innovation

Designing a point-of-service health kiosk that 1) draws on user preferences early in the design phase, 2) integrates multiple communication technologies, and 3) disseminates culturally grounded HPV vaccination decisions narratives that are tailored to vaccination awareness level is a promising approach in reducing barriers to HPV vaccine education and vaccine uptake among low-income women at safety-net clinics.

National HPV Vaccination Program in Poland-Public Awareness, Sources of Knowledge, and Willingness to Vaccinate Children against HPV

Since 1 June 2023, a nationwide HPV vaccination program was implemented in Poland. This study aimed to identify factors associated with public awareness of the national HPV vaccination program among adults in Poland and willingness to vaccinate children against HPV. This cross-sectional study was carried out between 14 and 17 July 2023 among 1056 adults in Poland. A self-prepared questionnaire was used. Among the respondents, 51.3% had heard about the free HPV vaccination program. The major source of knowledge on the national HPV vaccination program was TV (62%). Only 31.9% of respondents correctly indicated girls and boys aged 12 and 13 as the HPV-vaccination-eligible population. Willingness to vaccinate children against HPV was declared by 63.3% of respondents. Female gender (OR: 1.42; 95% CI: 1.11-1.81; p < 0.01), age 35-64 years (p < 0.05), having higher education (OR: 1.43; 95% CI: 1.11-1.84; p < 0.01), and living in cities with more than 500,000 residents (OR: 1.51; 95% CI: 1.01-2.28; p < 0.05) were significantly associated with higher odds to hear about the national HPV vaccination program. Age 50 years and over (p < 0.05), having higher education (OR: 1.43; 95% CI: 1.09-1.88; p < 0.05), living in cities with more than 500,000 residents (OR: 1.80; 95% CI: 1.14-2.83; p < 0.05), and no children under 18 in the home (OR: 1.39; 95% CI: 1.01-1.89; p < 0.05) were significantly associated with willingness to vaccinate children against HPV.