Abstract
BackgroundIn England, two national programmes of HPV vaccination for girls have been instituted, a routine programme for 12- and 13-year-olds and a catch-up programme for 17- and 18-year-olds. Uptake rates across the country have been far from uniform, and this research sought to identify factors explaining the variation in uptake by locality.MethodsAn association between uptake, deprivation and ethnic background had been established in pilot research. The present analysis was conducted at an aggregate, Primary Care Trust (PCT), level for the first year of the programmes. Published measures of HPV vaccination uptake, material deprivation, ethnic composition of PCT populations, primary care quality, and uptake of cervical screening and of other childhood immunisations were collated. Strong evidence of collinearity amongst the explanatory variables required a factor analysis to be undertaken. This provided four independent factors, used thereafter in regression models to explain uptake by PCT.ResultsThe factor analysis revealed that ethnic composition was associated with attitudes towards cervical screening and other childhood vaccinations, whilst material deprivation and quality of primary care were orthogonal. Ethnic composition, early childhood vaccination, cervical screening and primary care quality were found to be influential in predicting uptake in both the routine and the catch-up cohorts, although with a lower degree of confidence in the case of the last two independent variables. Lower primary care quality was significant in explaining a greater fall in vaccination uptake between the first two doses in the catch-up cohort. Greater deprivation was a significant explanatory factor for both uptake and the fall in uptake between doses for the catch-up cohort but not for uptake in the routine cohort.ConclusionThese results for uptake of the first year of the national programme using aggregate data corroborate findings from intentions surveys and pilot studies. Deprivation, the ethnic composition of the population, the effectiveness of primary care and the acceptability of childhood vaccinations are salient factors in explaining local HPV vaccine uptake in England.
Highlights
In England, two national programmes of human papillomavirus (HPV) vaccination for girls have been instituted, a routine programme for 12- and 13-year-olds and a catch-up programme for 17- and 18-year-olds
In England, the Joint Committee on Vaccination and Immunisation [2] evaluated the available scientific evidence [3] and recommended that an HPV vaccination protocol be added to the national childhood immunisation schedule, ostensibly as a cervical cancer preventative
This paper reports a search for factors explaining differences in HPV vaccine uptake by Primary Care Trust (PCT)
Summary
In England, two national programmes of HPV vaccination for girls have been instituted, a routine programme for 12- and 13-year-olds and a catch-up programme for 17- and 18-year-olds. In England, the Joint Committee on Vaccination and Immunisation [2] evaluated the available scientific evidence [3] and recommended that an HPV vaccination protocol be added to the national childhood immunisation schedule, ostensibly as a cervical cancer preventative. This paper reports a search for factors explaining differences in HPV vaccine uptake by PCT. Pilot research in two PCTs in north-west England, conducted prior to the implementation of the main programme, revealed lower uptake in more deprived areas and amongst ethnic minority girls. In the USA, a study of girls insured through a large managed care organisation identified higher household income, a family experience of sexually-transmitted disease, receipt of other vaccines and mothers’ attendance for cervical cancer screening as positive predictors of HPV vaccination [11,12]
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