HPV-related Outcomes Research Articles

P-425. A Scoping Review of Data Systems for HPV Vaccination and HPV-Related Outcomes in China

Abstract Background Human papillomavirus (HPV) is a major cause of cervical cancer, the sixth most common cancer among women in China. In 2023, China launched a new government plan to facilitate the elimination of cervical, requiring reliable data systems for monitoring and evaluating progress. This study aimed to identify, understand, and summarize data systems that record HPV vaccination, cervical cancer screening, HPV infection, HPV-related cervical and non-cervical diseases, as well as sexual and life behaviors in China. Methods A scoping review of literature from PubMed and the China National Knowledge Infrastructure databases was conducted, covering publications from 2012 to 2023. Two reviewers independently reviewed articles in two rounds, and all disagreements were resolved by a third reviewer. Results From 234 studies, 146 data sources were identified, covering topics including HPV vaccination (n=2), HPV-related cervical and non-cervical diseases (n=121), cervical cancer screening and HPV infection (n=11), HPV-related knowledge, attitude, and belief (n=1), and sexual and life behaviors (n=7). The main source for HPV vaccination data is the National Immunization Program Information Management System, while HPV-related cancer data primarily come from the National Central Cancer Registry of China. Cervical screening and HPV infection data are recorded in clinical or laboratory databases, including KingMed Diagnostics Laboratory and the national “Two Cancer” Screening database. HPV knowledge, attitude and sexual behaviors are mainly collected from surveys of individuals registered in epidemiology registries. Notably, several cities, including Yinzhou, Chengdu, Suzhou, and Lecheng, have recently established population-level data systems linking vaccination, screening to cervical/other HPV outcomes; however, a national system linking HPV vaccination and cervical screening with HPV-related disease outcomes, health beliefs, and risk behaviors is lacking. Conclusion There is a clear need for comprehensive and integrated data systems in China to effectively monitor and evaluate the impact and progress of public health intervention for cervical cancer elimination. Disclosures Wei Wang, PhD, Merck: Stocks/Bonds (Public Company) Ruixuan Wang, MPP, Merck: Co-Op Ya-Ting Chen, PhD, Merck & Co., Inc: Stocks/Bonds (Private Company)

HSV-2 infection and HPV incidence, persistence, and precancerous lesions in a cohort of HPV-vaccinated women living with HIV.

Several co-factors for HPV oncogenesis have been proposed, including co-infection with HSV-2. We assessed the relationship between HSV-2 infection and HPV-related outcomes in quadrivalent HPV-vaccinated (qHPV) women living with HIV (WLWH). In this multi-site study of immunogenicity and efficacy of the qHPV vaccine in WLWH, visits took place at months -3, 0, 2, 6, 12, 18, 24, and annually thereafter. Participants provided clinical data and cervico-vaginal swabs for HPV DNA detection; baseline serum was tested for HSV-2 type-specific antibodies. We used non-parametric statistics to compare HPV-related outcomes by HSV-2 serostatus and use of anti-HSV medication. 151 baseline serum samples underwent HSV-2 testing. At baseline, median age was 39 years, median CD4 count was 500cells/mm3, and 70% had an HIV viral load of <50copies/mL. Baseline HSV-2 seroprevalence was 76.2%. HSV-2 seropositivity was associated with increased age (p = 0.006). Controlling for age and median CD4 count, HSV-2 seropositivity was not associated with HPV incidence, persistence, and precancerous lesions. The use of anti-HSV medications was associated with higher odds of HSIL cytology (OR = 3.35, 95% CI = 1.03,11.26) and a greater number of HPV types detected (OR = 1.18, 95% CI = 1.00,1.39). Results were similar in sensitivity analyses using an index value of 3.5. The presence of HSV lesions during the study was not associated with HPV outcomes. HSV-2 seropositivity was common in this cohort of WLWH in Canada but was not associated with multiple measures of HPV incidence, persistence, and precancerous lesions. However, the use of anti-HSV medications was associated with HSIL cytology and number of HPV types detected.

Vaginal microbiota associated with oncogenic HPV in a cohort of HPV-vaccinated women living with HIV.

BackgroundWomen living with HIV (WLWH) experience higher rates of human papillomavirus (HPV) infection and cervical cancer than women without HIV. Changes in the vaginal microbiome have been implicated in HPV-related disease processes such as persistence of high-risk HPV infection but this has not been well defined in a population living with HIV.MethodsFour hundred and 20 girls and WLWH, age ≥9, across 14 clinical sites in Canada were enrolled to receive three doses of quadrivalent HPV vaccine for assessment of vaccine immunogenicity. Blood, cervical cytology, and cervico-vaginal swabs were collected. Cervico-vaginal samples were tested for HPV DNA and underwent microbiota sequencing.ResultsPrincipal component analysis (PCA) and hierarchical clustering generated community state types (CSTs). Relationships between taxa and CSTs with HPV infection were examined using mixed-effects logistic regressions, Poisson regressions, or generalized linear mixed-effects models, as appropriate. Three hundred and fifty-six cervico-vaginal microbiota samples from 172 women were sequenced. Human papillomavirus DNA was detected in 211 (59%) samples; 110 (31%) contained oncogenic HPV. Sixty-five samples (18%) were taken concurrently with incident oncogenic HPV infection and 56 (16%) were collected from women with concurrent persistent oncogenic HPV infection.ConclusionsNo significant associations between taxa, CST, or microbial diversity and HPV-related outcomes were found. However, we observed weak associations between a dysbiotic microbiome and specific species, including Gardnerella, Porphyromonas, and Prevotella species, with incident HPV infection.

Helping Children to Participate in Human Papillomavirus-Related Discussions: Mixed Methods Study of Multimedia Messages.

BackgroundHuman papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children).ObjectiveThis manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health—in particular when such conversations center around the HPV vaccination—and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children’s knowledge and perceptions of HPV prevention.MethodsA mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children’s experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials.ResultsBoth the animated video and a web-based game increased children’s knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements.ConclusionsThis study shows that both materials were effective for improving children’s education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns.

Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.

BackgroundA nonavalent human papillomavirus (HPV) vaccine has been licensed for use in women and men up to age 45 years in the United States. The cost-effectiveness of HPV vaccination for women and men aged 30 to 45 years in the context of cervical cancer screening practice was evaluated to inform national guidelines.Methods and findingsWe utilized 2 independent HPV microsimulation models to evaluate the cost-effectiveness of extending the upper age limit of HPV vaccination in women (from age 26 years) and men (from age 21 years) up to age 30, 35, 40, or 45 years. The models were empirically calibrated to reflect the burden of HPV and related cancers in the US population and used standardized inputs regarding historical and future vaccination uptake, vaccine efficacy, cervical cancer screening, and costs. Disease outcomes included cervical, anal, oropharyngeal, vulvar, vaginal, and penile cancers, as well as genital warts. Both models projected higher costs and greater health benefits as the upper age limit of HPV vaccination increased. Strategies of vaccinating females and males up to ages 30, 35, and 40 years were found to be less cost-effective than vaccinating up to age 45 years, which had an incremental cost-effectiveness ratio (ICER) greater than a commonly accepted upper threshold of $200,000 per quality-adjusted life year (QALY) gained. When including all HPV-related outcomes, the ICER for vaccinating up to age 45 years ranged from $315,700 to $440,600 per QALY gained. Assumptions regarding cervical screening compliance, vaccine costs, and the natural history of noncervical HPV-related cancers had major impacts on the cost-effectiveness of the vaccination strategies. Key limitations of the study were related to uncertainties in the data used to inform the models, including the timing of vaccine impact on noncervical cancers and vaccine efficacy at older ages.ConclusionsOur results from 2 independent models suggest that HPV vaccination for adult women and men aged 30 to 45 years is unlikely to represent good value for money in the US.

Abstract IA05: Sexual orientation, race/ethnicity, and human papillomavirus vaccination disparities among young U.S. women: An intersectional approach

Abstract Introduction: Human papillomavirus (HPV) vaccination, which is recommended for U.S. women and girls aged 11–26 years, effectively prevents cervical cancer. Researchers have identified HPV vaccination disparities among groups of women and girls defined in relation to sexual orientation identity or race/ethnicity. However, no study has used an intersectional approach to ascertain HPV vaccine uptake among sexual orientation identity and racial/ethnic subgroups of U.S. women and girls. Methods: Using 2011–2015 National Survey of Family Growth data, we used multivariable logistic regression to estimate differences in the odds of HPV vaccination initiation (i.e., &amp;gt; one dose) across sexual orientation identity and racial/ethnic subgroups of black and white U.S. women aged 15–24 years (N = 2,413), adjusting for demographic factors. We also assessed whether socioeconomic and health care factors helped explain observed disparities. Results: The overall prevalence of HPV vaccination initiation was 47.7%. Compared to white heterosexual women, black lesbians (odds ratio [OR] = 0.16; 95% confidence interval [95% CI]: 0.06, 0.46) had the lowest adjusted odds of HPV vaccination initiation, followed by white lesbians (OR = 0.33; 95% CI: 0.13, 0.82) and black heterosexual women (OR = 0.63; 0.47, 0.85). Including socioeconomic factors in the model only slightly attenuated the HPV vaccination initiation odds ratios for black lesbians (OR = 0.19; 95% CI: 0.06, 0.56), white lesbians (OR = 0.37; 95% CI: 0.15, 0.90), and black heterosexual women (OR = 0.70; 95% CI: 0.52, 0.93) compared to white heterosexual women. Adding health care factors only slightly additionally attenuated the odds ratio comparing black lesbians and white heterosexual women (OR = 0.21; 95% CI: 0.07, 0.67). Conclusions: Our findings identified black lesbians as a particularly underserved subgroup and suggest that sexual orientation identity and race/ethnicity may have a compounding effect on HPV vaccination initiation among black and white U.S. women and girls. Evidence-based interventions that are adapted to the specific needs and experiences of black lesbians and other multiply marginalized groups are needed to promote equity in HPV-related outcomes. Citation Format: Madina Agénor. Sexual orientation, race/ethnicity, and human papillomavirus vaccination disparities among young U.S. women: An intersectional approach [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA05.

Human Papilloma Virus Vaccination After Pediatric Sexual Abuse Evaluations in the Outpatient Child Sexual Abuse Subspecialty Clinic: A Quality Improvement Project.

The nonavalent human papilloma virus (HPV) vaccination prophylactically contributes to the prevention of nine types of HPV-associated oral and genital cancers. HPV vaccination rates remain lower than the national Healthy People 2020 goal of 80%. Victims of pediatric sexual abuse are at a higher risk for acquiring and developing HPV-related outcomes. Current research supports vaccination after sexual abuse as soon as eligible and suggests utilizing multiple types of medical encounters to increase vaccination rates.An institutional-review-board-approved quality improvement project was developed to determine the impact of promoting and providing HPV vaccination during the medical encounter after pediatric sexual abuse in a child protection team (CPT) clinic. Twenty percent of the 111 total clinic patients evaluated in the preintervention period and 21% of the 99 patients evaluated in the postintervention period were HPV vaccine eligible, illustrating a significant opportunity for impact. During the intervention period, 62% of patients who were vaccine eligible and presented for their CPT clinic visit received HPV vaccine. Barriers to vaccination in the outpatient CPT clinic setting included high appointment no-show rates, high social and medical visit complexity, and absence of an appropriate consenting caretaker. Implications for forensic nursing practice are discussed.

USA dental health providers’ role in HPV vaccine communication and HPV-OPC protection: a systematic review

ABSTRACT Background. Improving human papilloma virus (HPV) vaccination coverage in the US will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of dental provider communication about HPV vaccination. Methods. We searched MEDLINE, CINAHL, ScienceDirect, PsycINFO and JSTOR in August 2018 to identify studies of dental provider knowledge, perceived role and communication about HPV, HPV vaccination and HPV-associated oropharyngeal cancer (HPV-OPC). Results. We identified 10 qualitative and quantitative studies. Results of the primarily descriptive studies showed that although there were some deficiencies in knowledge about HPV-related outcomes and its effect on the male population, most providers understand HPV as a sexually transmitted infection and know the HPV vaccine is available, yet many are not discussing the HPV-OPC link or recommending vaccination. Providers were less often to recommend HPV vaccination if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Studies reported mixed results on providers’ perceived role in expanded HPV vaccination and HPV-OPC education, but indicated support for the role of professional organizations in promoting awareness. Conclusion. Interventions are needed to help dental providers perceive their role to deliver effective recommendations within the complex communication environment surrounding HPV vaccination and HPV-OPC education.

Examining HPV Awareness, Sexual Behavior, and Intent to Receive the HPV Vaccine Among Racial/Ethnic Male College Students 18-27 years.

Human papillomavirus (HPV) awareness and vaccination among males in the general population is low. Men in general, but particularly racial/ethnic men, are disproportionately affected by HPV. The purpose of this article is to examine college males’ (a) HPV awareness, (b) sexual behaviors, and (c) intention to receive the HPV vaccination. A non-probability sample of all students who self-reported their race/ethnicity and were attending a university in Southeastern United States were contacted by the university registrar’s office and recruited to participate in the 15-minute survey. Males, ages 18–27 years (N = 190), were identified for this study. χ2, t-tests, and binomial logistic regression analyses assessed the relationship between knowing about HPV and HPV vaccine and the intent to receive the HPV vaccination. Findings indicated that 67.4% of the sample identified as Hispanic or Black. Among all men, 73.2% reported previous sexual experience and 49.5% were currently sexually active. There were 79.5% who had previous knowledge about HPV and 55.8% had knowledge about the HPV vaccine; 71.1% of the sample did not intend to receive the vaccine. Hispanic and Black men were less likely to identify as virgins, more likely to be sexually active, and more likely to have sexual experiences at an earlier age compared to White, Asian, and other men. Men with previous HPV vaccine knowledge (28.4%) were more likely to intend to receive the vaccine compared to men who did not have previous knowledge about the vaccine (14.9%). Providing males with information about HPV, its transmission, and possible HPV-related outcomes may increase HPV vaccine uptake.

Human Papillomavirus Vaccination Initiation Among Sexual Orientation Identity and Racial/Ethnic Subgroups of Black and White U.S. Women and Girls: An Intersectional Analysis.

Human papillomavirus (HPV) vaccination, which is recommended for U.S. women and girls aged 11-26 years, effectively prevents cervical cancer. Researchers have identified HPV vaccination disparities among groups of women and girls defined in relation to sexual orientation identity or race/ethnicity. However, no study has used an intersectional approach to ascertain HPV vaccine uptake among sexual orientation identity and racial/ethnic subgroups of U.S. women and girls. Using 2011-2015 National Survey of Family Growth data, we used multivariable logistic regression to estimate differences in the odds of HPV vaccination initiation (i.e., ≥ one dose) across sexual orientation identity and racial/ethnic subgroups of black and white U.S. women aged 15-24 years (N = 2,413), adjusting for demographic factors. We also assessed whether socioeconomic and health care factors helped explain observed disparities. The overall prevalence of HPV vaccination initiation was 47.7%. Compared to white heterosexual women, black lesbians (odds ratio [OR] = 0.16; 95% confidence interval [95% CI]: 0.06-0.46) had the lowest adjusted odds of HPV vaccination initiation, followed by white lesbians (OR = 0.33; 95% CI: 0.13-0.82) and black heterosexual women (OR = 0.63; 0.47-0.85). Including socioeconomic factors in the model only slightly attenuated the HPV vaccination initiation odds ratios for black lesbians (OR = 0.19; 95% CI: 0.06-0.56), white lesbians (OR = 0.37; 95% CI: 0.15-0.90), and black heterosexual women (OR = 0.70; 95% CI: 0.52-0.93) compared to white heterosexual women. Adding health care factors only slightly additionally attenuated the odds ratio comparing black lesbians and white heterosexual women (OR = 0.21; 95% CI: 0.07-0.67). Our findings identified black lesbians as a particularly underserved subgroup and suggest that sexual orientation identity and race/ethnicity may have a compounding effect on HPV vaccination initiation among black and white U.S. women and girls. Evidence-based interventions that are adapted to the specific needs and experiences of black lesbians and other multiply marginalized groups are needed to promote equity in HPV-related outcomes.

Human papillomavirus vaccine effectiveness by number of doses: Systematic review of data from national immunization programs

BackgroundHuman papillomavirus (HPV) vaccines were first licensed as a three-dose series; a two-dose series is now recommended in some age groups and there is interest in possible one-dose vaccination. MethodsWe conducted a systematic literature review of HPV vaccine effectiveness by number of doses, including assessment of biases and impact of varying buffer periods (time between vaccination and outcome counting). ResultsOf 3787 articles identified, 26 full articles were assessed and 14 included in our review. All studies were conducted within the context of recommended three-dose schedules of bivalent (3) or quadrivalent HPV vaccine (11). Two evaluated effectiveness for prevention of HPV prevalence, six anogenital warts, and six abnormal cervical cytology or histology. Many studies found differences between three-, two- and one-dose vaccine recipients, indicating possible differences in HPV exposure prior to vaccination or in risk behavior. Adjusted or stratified analyses were conducted to control for potential confounding. All studies found significant vaccine effectiveness with three doses, 11 with two doses at various intervals, and six with one dose. Most studies showed a relationship (not always statistically significant) between effectiveness and number of doses, with greater decreases in HPV-related outcomes with three, followed by two and one dose(s). Few studies conducted formal comparisons of three vs fewer doses. Three of four studies that examined buffer periods found higher effectiveness and a smaller difference by number of doses with longer periods. ConclusionMost post-licensure studies report highest effectiveness with three doses; some found no statistically significant difference between two and three doses. Additionally, almost half found some effectiveness with one dose. Several biases impact estimates, with most biasing two- and one-dose results away from showing effectiveness. Future effectiveness studies, examining persons vaccinated prior to sexual activity and using methods to reduce potential sources of bias, can help inform vaccination policy.

Association of Chlamydia trachomatis Infection With Redetection of Human Papillomavirus After Apparent Clearance

Persistent infection with oncogenic human papillomavirus (HPV) is associated with an increased risk of cervical malignancy. Redetection of type-specific HPV after a period of nondetection may be caused by reactivation of a low-level persistent infection. Little is known about factors associated with type-specific HPV redetection. For a longitudinal cohort of adolescent women with frequent behavioral and sexually transmitted infection (STI) information (every 3 months), Cox proportional hazard models were used to assess the influence of sexual behaviors and STIs on the redetection of oncogenic or high-risk HPV infections. A total of 210 type-specific high-risk HPV detection episode periods were identified in this longitudinal cohort; 71 (33.8%) were characterized by a period of nondetection followed by redetection. Chlamydia trachomatis (hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.44-6.86) was associated with redetection; redetection was >2 times more likely with each additional self-reported sex partner in the past 3 months (HR, 2.26; 95% CI, 1.35-3.78). This study demonstrates the role of C. trachomatis and number of recent sexual partners in type-specific HPV redetection. Given that persistent oncogenic HPV infections are associated with cancer-related outcomes, understanding the potential role of such factors in the pathogenesis of HPV-related outcomes is important.

Knowledge of human papillomavirus and anal cancer among men who have sex with men attending a New York City sexually transmitted diseases clinic

Men who have sex with men (MSM) are at risk for human papillomavirus (HPV) infection and anal cancer (AC) yet little is known regarding MSM knowledge and risk perception for these outcomes. We surveyed 116 MSM attending a sexually transmitted disease clinic and found that over a quarter (27%) did not know HPV is transmitted via anal sex and most (77%) were unaware of the link with AC. Many MSM (60%) perceived risk for HPV; far fewer (35%) perceived risk for AC. In adjusted logistic regression analyses, having friends or acquaintances with HPV or genital warts was associated with knowledge of anal HPV transmission (odds ratio [OR] = 4.3; 95% confidence interval [CI] = 1.4, 13.4) and AC risk-perception (OR = 6.2; 95% CI = 2.3, 16.7); reporting a regular source of care was associated with awareness of a link between HPV and AC (OR = 3.1; 95% CI = 1.1, 9.1); and MSM and women versus MSM, had less perceived risk for HPV (OR = 0.05; CI = 0.01, 0.29). Nearly all expressed hypothetical acceptance of HPV vaccine. In our sample, many MSM were unaware of a link between MSM sexual practices and HPV-related outcomes.

Transoral robotic surgery and human papillomavirus status: Oncologic results

Patients with oropharyngeal squamous cell carcinoma (OPSCC) have been shown to have distinct outcome profiles based on their human papillomavirus (HPV) status. The purpose of this study was to assess HPV-related outcomes after transoral robotic surgery (TORS) with adjuvant therapy as indicated. This study consisted of a retrospective review of 50 patients with OPSCC within a prospective single-arm cohort study. Outcome measures included HPV status, margin status, relapse pattern, and survival. Thirty-seven patients were HPV-positive (74.0%) with 34 patients (91.9%) being serotype-16. Negative margins were achieved in 92.3% (HPV-negative) and 94.6% (HPV-positive). In the HPV-negative group, there were no local recurrences and 1 patient had both regional and distant recurrence (7.7%). In the HPV-positive group, there were no local or regional recurrences and 2 patients (5.4%) had distant recurrences. There were no statistically significant differences in survival between the 2 cohorts (overall survival, disease-specific survival, disease-free survival). TORS as a primary surgical modality, followed by adjuvant therapy as indicated, offers disease control in both HPV-negative and HPV-positive groups. We believe that multi-institutional studies are warranted to further evaluate this novel approach for patients who are HPV negative and HPV positive.