Scaling up human papilloma virus vaccination in Pakistan.

Vaccinating Adolescents—New Evidence of Challenges and Opportunities

Attitudes and beliefs about the human papilloma virus vaccine amongst patients with and without cervical dysplasia in a large urban academic hospital (366)

Background: The Latinx population in the United States faces tremendous health disparities, particularly with regards to cervical cancer. Data from the American Cancer Society show that cervical cancer incidence and mortality rates among Latinx women in the US are 40% and 26% higher than in US whites, respectively. These data are surprising considering cervical cancer is highly preventable through use of the Human Papilloma Virus (HPV) vaccination. About 70% of cervical cancer cases are the result of infection with HPV 16 or 18. The 9vHPV vaccine targets HPV 16 and 18 as well as 7 other HPV strains, and it was recently approved for use by the CDC in women through the age of 45. In 2015, only 44% of US Hispanic girls between the ages of 13 and 17 were vaccinated with all three HPV doses. Prior studies have shown that lack of information, cost, and fear are some of the main barriers that prevent Latinx women from receiving the HPV vaccination and vaccinating their children, and that these factors differ across subgroups of Latinx women. Methods: Our goal was to address these health disparities by assessing whether the Latinx population in East Los Angeles also showed low rates of HPV vaccination, and if so, why these women had not received the vaccination. We administered a promotora led survey (in Spanish) to a random sample of 89 Latinx women (aged 25-79) in East Los Angeles to assess rates of HPV vaccination in women and their children, attitudes towards the HPV vaccine, knowledge about the vaccine, and barriers to vaccination. We hypothesized that there would be differences in knowledge about the HPV vaccine, as well as differences in vaccination rates, based on age (>50) and country of origin (Mexico or other) in Latinx women. Results: We found a significant lack of knowledge about the HPV vaccine that persisted across all 89 women. None of the women surveyed had received a single dose of the HPV vaccinations themselves, either because they “did not think it was necessary,” or “did not know why it was important.” About 76% of women surveyed said they did not know what causes most cervical cancer (99% CI [65%-88%]), and of the 23% of women who said they did know what causes cervical cancer, none of the women cited HPV as a cause (99% CI [12%-35%]). Only 55% of women surveyed had heard about the HPV vaccine (99% CI [41%-68%]), and 82% of women did not understand the purpose of the HPV vaccine (99% CI [72%-93%]). However, Chi Square analysis revealed no significant age or country of origin differences in knowledge about the HPV vaccine or vaccination rates. Conclusions: These data show the need for culturally appropriate interventions that are both language specific and literacy level appropriate, in order to increase knowledge about the importance of HPV vaccination among Latinx women of East Los Angeles, particularly how it relates to cervical cancer prevention. Improved access to health education in the community could increase vaccination rates and decrease rates of cervical cancer in this population. Citation Format: Sarita Sooklal, Rosa Barahona, Lourdes Baezconde- Garbanati. Human papillomavirus vaccination rates and knowledge among Latinx women in East Los Angeles [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-274.

Human Papillomavirus and Vaccination

We are writing in response to the article entitled ‘‘Increasing fear of adverse effects decreases intention to vaccinate after the introduction of prophylactic HPV vaccine’’ published in the Archives of Gynecology and Obstetrics [1]. The human papilloma virus (HPV) vaccine has been used in South Korea since 2006 and we have reviewed the implementation and complications associated with this vaccine in this population to understand its use in our country. HPV is a widely prevalent, known risk factor for cervical cancer. In a single-center study of 208 patients, we found that 33.9 % were infected with HPV and the prevalence of highrisk HPV infection was 56.8 % [2]. Although the HPV vaccine protects against cervical cancer and HPV vaccination at a young age appears to be cost effective (as well as partially paid by the government for adolescents in the USA, Austria, and England), its use remains controversial [3]. The HPV vaccine has been used since 2006 in Republic of Korea. At our hospital, the HPV vaccine has been used since 2009. The HPV vaccination prices are not fixed in Republic of Korea; the cost and subsidy associated with the vaccine are based on the welfare and price policies of individual hospitals. From 2009 to 2010, our hospital held five reduced-price vaccination clinics and vaccinated 370 patients who were hospital employees and relatives. In 2012, we offered additional clinics and vaccinated 515 patients. We attribute the increased interest in the vaccine to patient awareness of the benefits due to media coverage and education sponsored by obstetrics and gynecologicrelated medical societies. However, in August 2013, only 17 women were vaccinated during the reduced-price clinics, possibly due to widely reported side effects in the Korean media that increased the fear for the vaccine. In response to this, we evaluated the HPV vaccine using it as a keyword in two of the most popular online domain sites and Google. The online domain sites were chosen by Korean click, which evaluates and analyzes online behavior. We categorized the positive and negative reports regarding HPV vaccination from 100 recent articles on three online sites, finding 91 positive articles and 85 negative articles. On June 15, 2013, a negative media article was posted that supported the elimination of the HPV vaccine recommendation in Japan. It is clear that reports in the media hastened the initial acceptance of the HPV vaccine, and at least two subsequent articles on adverse effects similarly decreased acceptance. We agree the fear of the media’s negative report which decreases the acceptance of HPV vaccination [1]. Data from our single-center study indicate that providing accurate information is important for increasing awareness of the vaccine and we recommend further studies to examine the relationship between media reports and acceptance of the HPV vaccination.

Increasing HPV vaccine interest via standardized multimodal education in an underserved patient population (363)

BackgroundGlobally, cervical cancer is the fourth most common cancer in women with more than 85% of the burden in developing countries. In Uganda, cervical cancer has shown an increase of 1.8% per annum over the last 20 years. The availability of the Human Papillomavirus (HPV) vaccine presents an opportunity to prevent cervical cancer. Understanding how the health system influences uptake of the vaccine is critical to improve it. This study aimed to assess how the health systems is influencing uptake of HPV vaccine so as to inform policy for vaccine implementation and uptake in Mbale district, Eastern Uganda.MethodsWe conducted a cross sectional study of 407 respondents, selected from 56 villages. Six key informant interviews were conducted with District Health Officials involved in implementation of the HPV vaccine. Quantitative data was analyzed using Stata V.13. Prevalence ratios with their confidence intervals were reported. Qualitative data was audio recorded, transcribed verbatim and analyzed using MAXQDA V.12, using the six steps of thematic analysis developed by Braun and Clarke.ResultsFifty six (14%) of 407 adolescents self-reported vaccine uptake. 182 (52.3%) of 348 reported lack of awareness about the HPV vaccine as the major reason for not having received it. Receiving vaccines from outreach clinics (p = 0.02), having many options from which to receive the vaccine (p = 0.02), getting an explanation on possible side-effects (p = 0.024), and receiving the vaccine alongside other services (p = 0.024) were positively associated with uptake.Key informants reported inconsistency in vaccine supply, inadequate training on HPV vaccine, and the lack of a clear target for HPV vaccine coverage as the factors that contribute to low uptake.ConclusionWe recommend training of health workers to provide adequate information on HPV vaccine, raising awareness of the vaccine in markets, schools, and radio talk shows, and communicating the target to health workers.Uptake of the HPV vaccine was lower than the Ministry of Health target of 80%. We recommend training of health workers to clearly provide adequate information on HPV vaccine, increasing awareness about the vaccine to the adolescents and increasing access for girls in and out of school.

BackgroundEnsuring vaccine access is a prerequisite for promoting human papilloma virus (HPV) vaccination. Although HPV vaccination efforts in China have primarily focused on young females, little research has examined the difficulties they face in accessing the HPV vaccine and its impact on vaccine uptake and intention. This study analyzed the overall perception of access difficulties to HPV vaccines, as well as three specific vaccine access difficulties, and examined their influencing factors among female university students in China. We also examined the associations between overall and specific vaccine access difficulties and HPV vaccination intention and uptake.MethodsA cross-sectional study was conducted among female university students from eight universities or colleges in Zhejiang Province, China, from December 2020 to January 2021. Logistic regressions were used to identify factors associated with both overall and specific perceptions of vaccine access difficulties. A multivariable logistic regression model and a multiple linear regression model were used to explore factors influencing HPV vaccine uptake and vaccine intention by controlling for potential confounding factors, respectively.ResultsA total of 3176 female university students were included in this study. The proportion of female students perceiving overall difficulty in obtaining HPV vaccine, as well as difficulties in accessing the desired type of HPV vaccine, HPV vaccination centers, and HPV vaccination information, were 60.6%, 57.7%, 60.7%, and 54.0%, respectively. Perceived overall difficulty in obtaining HPV vaccine, as well as difficulties in accessing the desired type of HPV vaccine, HPV vaccination centers, and HPV vaccination information were associated with HPV vaccine uptake and intention.ConclusionsChinese female university students generally perceived various difficulties in accessing HPV vaccine. It is crucial to improve access to HPV vaccine, optimize the layout and service quality of HPV vaccination centers, and enhance the dissemination and transparency of HPV vaccine information. More efforts are needed to provide a strong guarantee for HPV vaccination uptake among female university students.

Objective: Human papilloma virus (HPV) infection is the most common sexually transmitted viral infection worldwide. It is the cause of cervical cancer, and also causes many malignant, and benign diseases. Although it has an effectual vaccine, vaccination rates are still at an undesired level. In this cross-sectional study, it was aimed to investigate the knowledge and attitudes of pediatricians about HPV vaccine. Method: A questionnaire consisting of 18 questions about HPV disease and vaccine was applied to pediatricians working in our hospital via face-to-face interviews. Demographic characteristics, duration of their working in the field of pediatrics, and some questions and suggestions about HPV disease and vaccine were included in the questionnaire. Results: Ninety-eight (66.6%) out of 147 pediatricians participated in the questionnaire survey..The median age of the participants was 30.5 years (min-max: 25-66), and they were consisted mostly (70.4%).of female pediatricians. In terms of distribution of their academic positions, 54 (55.1%) of them were working as pediatric residents. Only 15.3% of the participants had received HPV vaccine. When questions about the vaccine were analyzed, 94.9% of the participants knew that the HPV vaccine was not included in the national vaccination schedule, 64.3% knew the recommended vaccination age, and 84.7% knew that application gender of the vaccine. Some ( 60.2%) participants recommended HPV vaccine to their patients. When pediatricians were asked why they did not recommend the vaccine, according to their responses, the most important factor was the fact that had not sufficient knowledge about the vaccine (14.3%) and had not encountered a patient within the indication (14.3%).The vaccine recommendation rates of the vaccinated physicians were statistically significantly higher than unvaccinated physicians (p=0.028).There was no statistically significant difference between medical experience and recommendation for HPV vaccine beforehand and knowing the names of HPV vaccines (p=0.316, p=0.414, respectively). Conclusion: Although the overall attitude towards HPV vaccination was generally positive in our study, additional training should be provided to both pediatricians and healthcare professionals in order to achieve higher HPV vaccination coverage rates in Turkey.

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. Cervical cancer (CC) is the most common HPV-associated cancer, and Korean Americans (KAs) experience one of the highest CC incidence and mortality rates among Asian Americans. Awareness and knowledge of HPV and HPV vaccine are essential in preventing HPV-associated cancers; however, studies emphasize low HPV awareness and knowledge among KAs. Although HPV causes cancers in both men and women, there exist misconceptions that the HPV vaccine is only for women and not for men. Furthermore, research on HPV vaccination among KAs has been conducted mostly among women. The health belief model (HBM) is a value-expectancy theory that is used to explain and predict individual changes in health behaviors and has been used in multiple studies that aimed to understand HPV vaccination behavior. Purpose: The purpose of this study is to develop an HBM guided text messaging program to increase HPV awareness, knowledge, and HPV vaccination among Korean young adults in the U.S. Methods: A total of 10 Korean young adults between the ages of 18 and 26 completed the mixed methods study. The survey examined HPV, HPV vaccine, and cervical cancer awareness and knowledge, beliefs, and vaccination intention. The qualitative interview with cognitive response testing (CRT) of the text messages, which were preconstructed based on previous literature and six constructs of HBM, allowed participants to provide feedback on the comprehension and emotional response to the messages, and any other recommendations to improve the content and delivery of the messages. Results: All participants (N=10) indicated to have never received the HPV vaccine and most participants had no intention to receive the HPV vaccine within one year. Although most of the participants were aware of HPV and HPV vaccine, overall knowledge of HPV, HPV vaccine, and cervical cancer were low. The interviews revealed that reasons for vaccine hesitancy and non-vaccination included cost, inconvenience, and low perceived susceptibility. Especially, there was low perception of the importance of HPV vaccination for males. Overall, findings from the CRT showed that there was a clear understanding of the preconstructed text messages. There was a consensus on the duration and timing of the messages and participants provided recommendations on the content, tone, and structure of the messages. Using the HBM, participants’ feedback on HPV awareness, knowledge, and vaccination intention, the text messaging library was revised and includes a total of 9 text messages over the four days. Conclusions: This study provides important insights into the development of an educational text messaging program among Korean young adults in the U.S. Current study will build a foundation for an educational mobile health program to help increase awareness and knowledge of HPV and HPV-associated cancers, as well as HPV vaccination intention, and impact HPV-associated cancer rates among KAs through vaccination in the long term. Citation Format: Min Jeong Jeon, Daisy Le. Development of an educational text messaging program to improve human papillomavirus awareness, knowledge, and vaccination intention among Korean young adults in the U.S. [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C101.

Human papillomavirus (HPV) is the most common sexually transmitted viral infection. HPV can cause cervical cancer and other cancers of the genitals, neck and throat. Two HPV vaccines are available, Cervarix and Gardasil, which are the first vaccines directed at the prevention of cervical cancer. The purpose of the study was to assess the knowledge of human papilloma virus and HPV vaccine among rural women in Vhembe district in Limpopo Province. A quantitative descriptive approach was adopted. The quantitative design enabled the discovery of more information by means of direct questioning of a sample of women 30years and older. A convenience sampling was used to select 1546 respondents. Data was analysed using the Statistical Package for Social Sciences. The findings revealed that (97.8%) of women lacked knowledge about Human Papilloma Virus and HPV vaccine and were also not aware of the transmission methods of HPV virus. Furthermore (94.3%) were not aware who was eligible for HPV vaccine and the age range for vaccination and (92.1%) displayed negative attitudes to the use of vaccines if given a pamphlet to let their daughters be immunized. The awareness on human papilloma virus and HPV vaccine among women in Vhembe district is limited. There is a need to educate and promote awareness on cervical cancer screening methods among women to reduce the burden of morbidity and mortality.

Background: Anal cancer disproportionally impacts gay, bisexual, and other male sexual minorities (GBM). Human Papillomavirus (HPV) vaccination is a safe and effective method to prevent anal cancer; however, coverage of HPV vaccination among adult GBM is low. Key barriers to vaccination are lack of awareness and knowledge of anal cancer, low motivation to get vaccinated, and lack of access and availability. For many young GBM, regular interactions with the healthcare system center around HIV prevention. Thus, we propose that federally qualified health centers (FQHCs) can increase uptake and reach of HPV vaccination by integrating and promoting HPV vaccination in ongoing HIV preventive care (e.g., Pre-exposure Prophylaxis [PrEP]). The objectives of this project were to (1) assess the acceptability of integrating HPV vaccination with PrEP management and (2) determine needs for informed decision making. Methods: We conducted a web-based cross-sectional survey of unvaccinated GBM (18-45) who received PrEP care at a FQHC in Philadelphia. Data collection took place in 2021 and 2022. The main outcome was intent to initiate HPV vaccination within 12 months (5-point scale). Other measures included beliefs about HPV vaccination in PrEP care, perceived information needs, and preferred information delivery modes. Descriptive and bivariate statistics were used to analyze the data. Results: The sample (N=59) was ethnoracially diverse (50.0% non-White) and in the catchup (23.7%; 18-26 yrs.) or shared clinical decision making (76.3%; 27-45) age ranges. Most were gay identified (71.2%) cisgender men (74.6%). Just 23.7% were aware they were eligible for HPV vaccination and even fewer knew that vaccination could prevent anal cancer (11.9%). Overall vaccine intentions were high (M=3.7; SD=1.0). Intentions were 26.1% higher (M=4.4; SD=1.0) if HPV vaccination was offered during PrEP appointments. Most (88.7%) agreed that offering HPV vaccination during PrEP visits would increase the likelihood that they would get vaccinated; however, 64.4% strongly/somewhat agreed that they needed more information about HPV vaccination prior to making an informed decision. Perceived information need was inversely associated with vaccine intentions (r=-0.31, p=0.02). Most participants (>50%) indicated they wanted to know more about their risk for anal cancer and effectiveness of HPV vaccination. The majority (71.2%) preferred to get medically accurate information on anal cancer prevention from a website that they could go to on their own time. Other delivery modes were iPads at their doctor’s office (28.8%), printed information given to them by their doctor (28.8%), and text messages from a healthcare provider (25.4%). Conclusion: Offering and promoting HPV vaccination as part of PrEP management visits was highly acceptable among PrEP patients. Interventions should focus on raising awareness about anal cancer and promoting informed decision making for anal cancer prevention. Citation Format: Christopher W. Wheldon, Sarah Bass, Bradley Collins. Integrating HPV (human papillomavirus) vaccination into HIV prevention: Acceptability and information needs among PrEP (pre-exposure prophylaxis) patients at a federally qualified health center [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B052.

HPV vaccination coverage of teen girls: The influence of health care providers

Katagwa, Vian N.; Opio, Ronald O.; Niwasasira, Dickson N.; Onyege, Alex; Naisanga, Molly; Bongomin, Felix A.; Kitara, David L. Author Information

Background: Despite having guidelines recommending vaccination against the human papillomavirus (HPV) and widespread coverage for the vaccine, HPV vaccination rates among U.S. Hispanic and island Puerto Rican (PR) girls are low. In 2012, only 16% of PR girls aged 11–18 and 42% of U.S. Hispanic girls aged 13-17 were vaccinated with all three HPV vaccine doses; far fewer than the Healthy People 2020 goal of 80%. Parents are crucial to the success of HPV vaccine uptake efforts. Few studies focusing on parents have examined possible differences in HPV knowledge and vaccine acceptability within ethnic groups. The purpose of the study is to assess potential differences in HPV knowledge, vaccine awareness, and acceptability between U.S. Hispanic and island PR women. Methods: We utilized data from the Health Information National Trends Survey (HINTS) 2007 and HINTS Puerto Rico 2009. For the current study, we restricted our analyses to female respondents in both surveys for a total sample of 792 women (n = 375; U.S. Hispanic HINTS 2007 and n = 417; Puerto Rican HINTS-PR 2009). Using the Wald chi-square test, we assessed if there were significant differences in HPV knowledge, vaccine awareness, and acceptability between U.S. Hispanics and island PR women. Results: Island PR women had significantly higher HPV vaccine awareness (66.9% vs. 61.0%; Wald X2 F(1, 97) = 16.03, p < .001) and were more accepting of the HPV vaccine for a real or hypothetical daughter (74.8% vs. 56.1%; Wald X2 F(2, 96) = 7.18, p < .001) compared to U.S. Hispanic women. Both groups were highly knowledgeable that HPV causes cancer (89.2% in both samples) and HPV is a sexually transmitted infection (78.1% [U.S. Hispanics] and 84.7% [PR]). Less than 10% of both groups recognized that HPV can go away on its own without treatment. Conclusions: Our study found that island PR women were more aware of and accepting of the HPV vaccine when compared to U.S. Hispanic women. Future research should further explore these in-group differences to determine what in the PR socio-cultural context or environment may have led to higher HPV vaccine awareness and acceptability. Findings may also assist in developing culturally appropriate health education programs and media to promote HPV vaccination among both groups. Citation Format: Daisy Y. Morales-Campos, Robin C. Vanderpool. Examining differences in HPV knowledge, vaccine awareness, and acceptability between U.S. Hispanic and island Puerto Rican women. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B88.