Policy Development for Human Papillomavirus Vaccine Introduction in Low-Resource Settings

Evidence on factors influencing HPV vaccine implementation in South Asia: A scoping review

Cervical cancer is a significant public health concern globally, with low and middle-income countries bearing the highest burden, specifically the South Asian region. Therefore, the current scoping review aimed to highlight the factors influencing the implementation of human papillomavirus (HPV) vaccination in South Asia. Adopting the 'Arksey and O'Malley and Levac et al.' methodology, multiple electronic databases were searched to identify relevant records. The results were narratively synthesised and discussed, adopting the Consolidated Framework for Implementation Research (CFIR) model. We identified 527 records, which were assessed for eligibility based on title, abstract, and full text by three reviewers, followed by data extraction of 29 studies included for analysis in the review. Implementing HPV vaccination programs in South Asia faces various challenges, such as economic, health system, financial, health literacy, and sociocultural factors that hinder their successful implementation. To successfully implement the vaccine, a tailored risk communication strategy is necessary for these countries. Knowledge gained from the experience of South Asian nations in implementing the HPV vaccine can assist in policymaking in similar healthcare for advancing the implementation of HPV vaccination.

Toward universal human papillomavirus vaccination for adolescent girls in Hong Kong: a policy analysis

Studies have assessed early population-level impact of human papillomavirus (HPV) vaccination programs for preventing cervical cancer. Through a case study in Hong Kong we examined stakeholder engagement and interactions to promote a universal HPV vaccination program using the Health Policy Triangle framework for structured health policy analysis. Using data from a document review and semi-structured in-depth interviews, we used thematic and stakeholder analyses to describe the process of policy formation. Given Hong Kong’s political and health system, and a mix of Chinese and Western values, stakeholders judged legitimacy of the process differently. We discuss their varied ethical stances and the role of research evidence for informing policy-making. For effective HPV vaccination policy and promotion of universal free HPV vaccination among adolescent girls, new strategies are needed to broaden acceptance of the process, to frame policies in terms of facts and values, and to connect research to policy-making and improve coalition-building.

Mothers' knowledge and attitudes about HPV vaccination to prevent cervical cancers

BACKGROUND

Cervical cancer which is one of the most preventable cancers is an important public health problem worldwide, and especially in developing countries. The aim of this study was to determine knowledge and attitudes about the HPV vaccination of mothers with 0- to 18-year old children.

MATERIALS AND METHODS

Written approval was taken from the local authorities. The study subjects consisted of 799 mothers who agreed to participate. The data were collected via a "Personal Information Form" which included 30 questions that were prepared by the researchers themselves in line with the literature. The data were collected by face to face interviews with the mothers. Analyses were performed using commercial software.

RESULTS

The mean age of the mothers who participated in the study was 32.0 ± 6.52, and 88.1% reported no information about HPV, and 83.5% no information about HPV vaccination. Only 0.7% of the mothers had daughters who had HPV vaccination, and 44.3% of the mothers who had sons were found out to be indecisive about having HPV vaccination. There was a significant corelation between the educational status of the mothers and their knowledge about HPV vaccination (p<0.05). However, there was no significant correlation in terms of economic conditions (p>0.05).

CONCLUSIONS

This study suggested that mothers had very little information on HPV and HPV vaccination. Knowledge of the disease and its vaccination is an essential factor for the success of the vaccination program. It is of great importance that mothers are trained in this subject by health professionals.

Indian parents prefer vaccinating their daughters against HPV at older ages

BACKGROUND

Increasing uptake of human papillomavirus (HPV) vaccine should be a priority in developing countries since they suffer 88% of the world's cervical cancer burden. In many countries studies show that age at vaccination is an important determinate of parental acceptability. This study explores parental preferences on age-to-vaccinate for adolescent school-going girls.

MATERIALS AND METHODS

The sample was selected using a two-stage probability proportional to size cluster sampling methodology. Questionnaires were sent home with a random sample of 800 adolescent girls attending 12 schools in Mysore to be completed by parents. Descriptive statistics including frequencies, percentages and proportions were generated for independent variables and bivariate analyses (Chi square test) were used to assess the relationship between independent and appropriate age-to-vaccinate.

RESULTS

HPV vaccination acceptability was high at 71%. While 5.3% of parents felt girls should be vaccinated by 10 years or younger; 38.3% said 11-15 years; 14.8% said 16-18 years; 5.8% suggested over 19 years; and 33% didn't know. Only 2.8% of parents would not vaccinate their daughters.

CONCLUSIONS

Delaying HPV vaccination until later ages may significantly increase uptake of the HPV vaccine in India.

Awareness, knowledge and beliefs about HPV, cervical cancer and HPV vaccines among nurses in Cameroon: an exploratory study

BACKGROUND

While it is known that sub-Saharan African countries face multiple obstacles such as cost in adopting vaccination against human papillomavirus (HPV), the crucial role nurses can play in implementing such programs has not been adequately examined.

OBJECTIVES

To investigate the knowledge and awareness of HPV, primary cause of cervical cancer and HPV vaccine among nurses working at four Cameroon Baptist Convention Health Services facilities, and to explore what factors influence nurses' willingness to inform and recommend HPV vaccine to adolescents and parents attending clinics.

DESIGN AND SETTING

A structured questionnaire survey was administered to a convenience sample of nursing staff working at the four health facilities.

RESULTS

Of 192 eligible nurses 76 (39.6%) participated in the study. There were moderately low levels of knowledge about HPV infection and prevention of cervical cancer, but a moderately high level of knowledge about HPV vaccine. Although 90.8% acknowledged that cervical cancer is directly linked to HPV infection, nearly 32% failed to identify it as a sexually transmitted infection (STI), while 43.4% believed it is an uncommon infection. Willingness to recommend the HPV vaccine was moderate, with 69.7% intentionally initiating discussions with patients about the subject. The most important factors considered when deciding to recommend the vaccine included effectiveness (56.6%) and side effects/safety (11.8%). Cost was less of a concern (6.6%), likely due to the availability of donated vaccine.

CONCLUSION

Despite high awareness about HPV, more education about the virus, cervical cancer and the vaccine are required to further increase nurses' willingness to recommend the vaccine and strengthen strategies for reaching adolescents through nurses in Cameroon.

Acceptance patterns and decision-making for human papillomavirus vaccination among parents in Vietnam: an in-depth qualitative study post-vaccination

BACKGROUND

The GAVI Alliance's decision in late 2011 to invite developing countries to apply for funding for human papillomavirus (HPV) vaccine introduction underscores the importance of understanding levels of HPV vaccine acceptance in developing country settings. In this paper, we present findings from qualitative research on parents' rationales for vaccinating or not vaccinating their daughters (vaccine acceptance) and their decision-making process in the context of an HPV vaccination demonstration project in Vietnam (2008-2009).

METHODS

We designed a descriptive qualitative study of HPV vaccine acceptability among parents of girls eligible for vaccination in four districts of two provinces in Vietnama. The study was implemented after each of two years of vaccinations was completed. In total, 133 parents participated in 16 focus group discussions and 27 semi-structured interviews.

RESULTS

Focus group discussions and in-depth interviews with parents of girls vaccinated revealed that they were generally very supportive of immunization for disease prevention and of vaccinating girls against HPV. The involvement of the National Expanded Program of Immunization in the demonstration project lent credibility to the HPV vaccine, contributing to high levels of acceptance. For parents who declined participation, concerns about side effects, the possibility that the vaccine was experimental, and the possible impact of the vaccine on future fertility rose to the surface. In terms of the decision-making process, many parents exhibited 'active decision-making,' reaching out to friends, family, and opinion leaders for guidance prior to making their decision.

CONCLUSION

Vietnam's HPV vaccination experience speaks to the importance of close collaboration with the government to make the most of high levels of trust, and to reduce suspicions about new vaccines that may arise in the context of vaccine introduction in developing country settings.