Abstract
Cervical cancer rates in Sub-Saharan Africa (SSA) are amongst the highest worldwide. All three of the Human Papillomavirus (HPV) vaccines (9-valent, quadrivalent and bivalent HPV vaccine) provide primary protection against the most common cancer-causing strains of HPV (types 16 and 18) that are known to cause 70% of cervical cancers. Over the last five years, there has been an increase in Sub-Saharan African countries that have introduced the HPV vaccine. The majority of research has been conducted on supply-side barriers and facilitators to HPV vaccination uptake in SSA, yet little research has been conducted on demand-side or end-user perspectives of, and decisions around, HPV vaccination. In order to complement existing research, and inform current and future HPV vaccination implementation approaches, this qualitative systematic review explored Stakeholders’ understandings of HPV vaccination in SSA. This review searched the following databases: Embase (via Scopus), Scopus, MEDLINE (via PubMed), PubMed, EBSCOhost, Academic Search Premier, Africa-Wide Information, CINAHL, PsycARTICLES, PsycINFO, SocINDEX, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) and found a total of 259 articles. Thirty-one studies were found eligible for inclusion and were analyzed thematically using Braun and Clarke’s methods for conducting a thematic analysis. The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Three major themes emerged from this analysis; knowledge of HPV vaccination and cervical cancer is intertwined with misinformation; fear has shaped contradictory perceptions about HPV vaccination and gender dynamics are relevant in how stakeholders understand HPV vaccination in SSA.
Highlights
Human papillomavirus (HPV) is a central causative agent of cervical cancer, the second most common cancer among women in Africa, where approximately 372.2 million women aged 15 years and older are at risk of developing cervical cancer [1]
Stakeholders’ understandings and perceptions of cervical cancer, Human Papillomavirus (HPV) and HPV vaccination are shaped by a mix of knowledge and misinformation, both of which are influenced by social processes and relationships and both of which act as both barriers and facilitators to HPV vaccination
Stakeholders who create a demand for the HPV vaccine are arguably the most vital to its uptake and continued necessity, especially when the momentum of HPV vaccination in Sub-Saharan Africa (SSA) has only recently been initiated
Summary
Human papillomavirus (HPV) is a central causative agent of cervical cancer, the second most common cancer among women in Africa, where approximately 372.2 million women aged 15 years and older are at risk of developing cervical cancer [1]. There are more than 100 types of HPV, at least 14 of which are high-risk strains that can cause cancers of the vulva, vagina, penis, anus, oropharynx and most commonly the cervix [2,3,4]. Such strains are commonly sexually transmitted an are highly transmissible through skin-to-skin genital contact, anal, oral and vaginal sex, with estimations that two thirds of those who have had sexual contact with HPV-infected persons will become infected themselves [2,5], making it the most common viral infection of the reproductive tract and the most common sexually transmitted disease in the world [2,5,6]. Implementation of an HPV vaccination program in Eldoret, Kenya: results from a qualitative assessment by key stakeholders Eldoret, Kenya
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