Abstract
ObjectivesWe assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination.MethodsWe conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990–2011 were extracted from the World Health Organization database.FindingsThe review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above.ConclusionThere is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support.
Highlights
The introduction of vaccines has been one of the most effective public health interventions for combating infectious diseases [1,2]
Cervical cancer, which is caused by the human papillomavirus (HPV), is the leading cause of cancer mortality among women in sub-Saharan Africa (SSA) [8,9]
The objective of this study was to provide a systematic review of knowledge and awareness of HPV vaccine, willingness to vaccinate, and acceptability of the vaccine, as well as fulfillment of GAVI Alliance’s eligibility criteria for vaccine assistance in SSA
Summary
The introduction of vaccines has been one of the most effective public health interventions for combating infectious diseases [1,2]. As one of the key strategies in preventing cervical cancer in developed countries, providing HPV vaccines in low and middle income countries is a critical pillar for meeting the global action plan for closing the cancer divide [5]. Outstanding barriers to achieving this goal in low-income countries remain These include high cost of vaccine and vaccine delivery [11], low cervical cancer screening levels [12], poor health system capabilities [11,13], inaccessibility to medical care [14], low awareness and knowledge of HPV and cervical cancer[14,15,16,17,18], and failure of cervical cancer to be recognized as a major health concern [19]
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