Abstract

Human papillomavirus-vaccinated cohorts, irrespective of age, will likely reduce their subsequent screening requirements, thus opening opportunities for global cost reduction and program sustainability. The determinants of uptake and completion of a 3-dose human papillomavirus vaccination program by adult women in a European context were estimated. This was an intervention study. Study participants were women aged 25-45 years, attending opportunistic or population-based cervical cancer screening in Belgium, Denmark, Finland, France, Germany, Slovenia, Spain, Sweden, and the United Kingdom between April 2016 and May 2018. Study participants completed a questionnaire on awareness and attitudes on adult female human papillomavirus vaccination and were invited to receive free human papillomavirus vaccination. Main outcome measures were acceptance, uptake, and completion of vaccination schedule. Determinants of vaccine uptake were explored using multilevel logistic models in 2019. Among 3,646 participants, 2,748 (range by country=50%-96%) accepted vaccination, and 2,151 (range=30%-93%) received the full vaccination course. The factors associated with higher vaccine acceptance were previous awareness of adult female (OR=1.22, 95% CI=1.00, 1.48) and male (OR=1.59, 95% CI=1.28, 1.97) vaccination. Women in stable relationships (OR=0.56, 95% CI=0.45, 0.69) or with higher educational level (OR=0.76, 95% CI=0.63, 0.93) were more likely to refuse vaccination. Recruitment by postal invitation versus personal invitation from a healthcare professional resulted in lower vaccine acceptance (OR=0.13, 95% CI=0.02, 0.76). Vaccination coverage of >70% of adolescent girls in national public programs was of borderline significance in predicting human papillomavirus vaccine uptake (OR=3.23, 95% CI=0.95, 10.97). The main reasons for vaccine refusal were vaccine safety concerns (range=30%-59%) and the need for more information on human papillomavirus vaccines (range=1%-72%). No safety issues were experienced by vaccinated women. Acceptance and schedule completion were largely dependent on recruitment method, achieved coverage of national vaccination programs, and personal relationship status. Knowledge of benefits and safety reassurance may be critical to expanding vaccination target ages. Study results suggest that there are no major opinion barriers in adult women to human papillomavirus vaccination, especially when vaccination is offered face to face in healthcare settings. EudraCT Number 2014-003177-42.

Highlights

  • Human papillomavirus−vaccinated cohorts, irrespective of age, will likely reduce their subsequent screening requirements, opening opportunities for global cost reduction and program sustainability

  • The status of the adolescent public vaccination programs and the strategy used in this study to invite women for free human papillomavirus (HPV) vaccination played a major role in vaccine uptake by adult women

  • Within the limitations of the study size in each country, the results suggest that there are no major opinion barriers in the population to HPV vaccination of adult women in several countries in Europe

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Summary

Introduction

Human papillomavirus−vaccinated cohorts, irrespective of age, will likely reduce their subsequent screening requirements, opening opportunities for global cost reduction and program sustainability. Novel methods for cervical cancer detection include clinically validated HPV tests These show a higher sensitivity and negative predictive values than cytology.[4,5] they are processed by automatic or semiautomatic instruments, which increases throughput, eliminates the subjectivity of cytology, and enhances program quality assurance.[6]. Initially indicated for adolescent girls only, HPV vaccines continue to expand their licensing, clinical indications, and dosing regimens These include vaccination of both male and female individuals aged >40 years,[7] vaccination of immunocompromised groups,[8] vaccination at the time of treatment of cervical intraepithelial neoplasia Grades 2 and 3 and adenocarcinoma in situ,[9] vaccination for recurrent respiratory papillomatosis cases,[9] and 2-dose regimens in those aged

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