Human Papillomavirus Vaccine Uptake Research Articles

Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study.

Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. This theory-driven, community-based participatory action research-designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools).

Factors Associated with College Students' Human Papillomavirus (HPV) Vaccination and Preferred Strategies for Catch-Up Vaccine Promotion: A Mixed-Methods Study.

Human papillomavirus (HPV) vaccination protects against six types of cancer-cervical, anal, oropharyngeal, penile, vulvar, and vaginal. In the United States (U.S.), HPV vaccination coverage in college students remains low, especially in the Mid-South region, despite the highest risk of HPV infections and disease burden. However, few studies have assessed HPV vaccination among college students here. This study examined factors associated with HPV vaccination among college students in the Mid-South and explored preferred strategies for promoting vaccination. A mixed-methods design comprising a cross-sectional, self-report online survey and dyadic virtual interviews was conducted. Simple random sampling was performed to recruit a total of 417 undergraduate students aged 18-26 from March to May 2021; convenience sampling was performed to recruit three sex-matched dyads of a total of six (four female and two male) undergraduates from survey respondents who had not completed the HPV vaccine series in May 2021. Binary logistic regression analyses showed HPV vaccine knowledge and perceived barriers to vaccination were factors contributing to coverage for both female and male students, while perceived risks of HPV and vaccine hesitancy were factors only among female students. Findings from the qualitative content analysis identified college students' perceived barriers to the vaccination at multiple levels and preferred strategies for vaccination promotion, corroborating the findings from the survey study. The findings provide implications that benefit the development of tailored interventions aimed at facilitating catch-up vaccination among college students in the Mid-South region. There is an urgent need for further research and the implementation of effective strategies that address the identified barriers and improve HPV vaccine uptake in this population.

Nurses’ perceptions, experiences, and practices regarding human papillomavirus vaccination: results from a cross-sectional survey in Montana

BackgroundNationally, much of the focus on improving human papillomavirus (HPV) vaccine uptake has been on effective strategies that physicians use to promote vaccination. However, in large, predominately rural states like Montana, nurses and medical assistants play critical roles in immunization services delivery, and their viewpoints are imperative in designing strategies to increase vaccination rates. We conducted a cross-sectional, descriptive study to determine nurses’ perceptions, experiences, and practices regarding human papillomavirus vaccination in a rural and medically underserved region of the United States.MethodsWe designed, pilot-tested, and disseminated an online survey instrument to nurses and medical assistants working in clinics participating in the Vaccines for Children program in Montana. The online surveys were administered from November 2020 to March 2021. Survey questions focused on clinic vaccination practices, respondents’ perceptions of the HPV vaccine, perceived barriers to vaccine uptake, and general opinions on potential strategies to improve HPV vaccination rates.ResultsWe analyzed data from 227 respondents. Overall, 90% of nurses strongly agreed or agreed that the HPV vaccine is important and had confidence in the vaccine’s safety. More nurses reported experiencing greater parental vaccine refusal or delay for male patients regardless of age. About 53.7% of nurses reported that their clinics had reminder/recall systems to encourage parents to bring their children for vaccination. Nurses identified misinformation from social media, infrequent wellness visits, and vaccine safety concerns as barriers to HPV vaccine uptake.ConclusionsStudy findings identified several promising initiatives to accelerate vaccination in primarily rural states like Montana, including promoting widespread adoption of reminder/recall systems, training nurses in evidence-based techniques to provide strong vaccine recommendations, and leveraging social media to disseminate consistent messages about the HPV vaccine recommendations for both sexes and its role in cancer prevention.

Low Human Papillomavirus Vaccination in a Low-Income Urban Population.

Despite widespread availability of human papillomavirus (HPV) vaccines and recommendations for routine use, awareness and uptake of HPV vaccination are not universal. We assessed self-reported history of HPV vaccination in a sample of low-income men and women recruited from the community using respondent-driven sampling as part of the National HIV Behavioral Surveillance (NHBS) survey in San Francisco. Of the 384 respondents, a minority (12.5%) reported they had received the HPV vaccine. In multivariate analysis, independent associations with HPV vaccination history were female sex (adjusted odds ratio [AOR] = 3.76, 95% confidence interval [CI] = [1.73, 8.17]), younger age (AOR = 0.89 per year, 95% CI = [0.86, 0.92]), and education above high school (AOR = 2.84, 95% CI = [1.37, 5.90]). Missed opportunities for HPV vaccination were evident in 84.4% of respondents having visited a health care provider in the last year, including 40.1% tested for a sexually transmitted infection, and entry into higher education programs (33.4%).

Correlations of HPV vaccine uptake among eight-grade students in Israel: the importance of ethnicity and level of religious observance

ABSTRACT In Israel, human papilloma virus (HPV) vaccines are included in the national childhood immunization program for eight-grade students, but uptake remains relatively low. This article explores which demographic factors are correlated with HPV vaccination rates. HPV vaccination data for the school year 2017–2018 was assessed among members of Maccabi Healthcare Services, the second largest health service provider in Israel. By matching eighth grade students to their family members’ demographic data via an electronic medical records (EMR) system, we assessed vaccination rates by taking into account sex, socioeconomic status (SES), ethnic categorization, and maternal characteristics. In a total of 45,160 eligible students, 55.3 percent of girls and 48.5 percent of boys were vaccinated for HPV. In a multivariable model, students in Arab communities had a significantly (p < .001) higher odds ratio (2.02; 95 percent CI:1.55–2.64) of being vaccinated, while ultra-orthodox (UO) Jewish students were much less likely to be vaccinated compared to all other students (OR = 0.05; 95 percent CI:0.05–0.06). Ethnicity and level of religious practice are major determinants of HPV vaccine uptake in Israel. This should be taken into account when planning intervention programs in order to improve the uptake of the vaccine.

Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color.

Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.

Abstract 46: Human Papilloma Virus Vaccination and Its Determinants Among Adolescent Girls Aged 14 Years Old in Hai District of Kilimanjaro Region in Northern Tanzania

Abstract Purpose: Human Papilloma Virus (HPV) vaccination is a key primary prevention method against cervical cancer which is given to young girls before onset of sexual activity. In Tanzania, cervical cancer is the most frequent occurring cancer among women and is the leading cause of cancer mortality. The HPV Vaccination program was rolled-out in Tanzania in 2018 for adolescent girls aged 9-14 years old to receive two doses at a six months interval, with the annual vaccine uptake of 46.1%. In 2019, the uptake of the HPV vaccine was 64%, where as the national coverage target is 75%. This study is aimed at assessing the determinants of HPV vaccination among adolescent girls in Hai district, Kilimanjaro region, northern Tanzania. Methods: A cross-sectional study was conducted between July and August 2020 among 14 years old girls in selected secondary schools within Hai district. Close ended questionnaire interviews were conducted to the girls on the study. Data was analysed using SPSS version 20 and odds ratio was used to assess the association between several factors and HPV vaccination. Results: A total of 301 adolescent girls aged 14 years consented to the study. HPV vaccination uptake was 65% (196). More than three fifth (60.7%, 119) reported to have received the two required doses. Knowledge of HPV (OR = 5.68 95% CI (0.72- 44.96); p-value = 0.01) and HPV vaccine (OR = 20.11 95% CI (10.88- 37.99); p-value = 0.01) contributed significantly to HPV vaccine uptake among the adolescent girls in the study. More than one-third (34.9%, 105) of the participants were not vaccinated, main reasons adduced for not being vaccinated include lack of proper information about HPV vaccine (60.0%), fear of side effects (14%) and parental refusal (11%). Conclusion: HPV vaccination is globally accepted as a pivotal primary prevention means against cervical cancer. Emphasizing dissemination of clear and comprehensible information to the society, especially to the adolescent girls, about HPV, cervical cancer and HPV vaccine will significantly increase HPV vaccination among the adolescent girls. Utilizing health care workers and policy makers in providing such education will facilitate its successful implementation. Citation Format: Jojet Josephat. Human Papilloma Virus Vaccination and Its Determinants Among Adolescent Girls Aged 14 Years Old in Hai District of Kilimanjaro Region in Northern Tanzania [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 46.

Incomplete HPV vaccination among individuals aged 27-45 years in the United States: A mixed effect analysis of individual and contextual factors.

10546 Background: In the United States, the Human papillomavirus (HPV) vaccine is approved for use up to age 45. Incomplete HPV vaccination rates among those over age 26, however, remain high. The aim of this study was to examine the independent effects of individual- and neighborhood-level factors on incomplete HPV vaccine series in the United States (US) among those aged 27-45 years. Methods: This retrospective cohort study used administrative data from Optum’s Clinformatics DataMart Database to identify individuals aged 27-45 years who received 1 or more doses of HPV vaccine between July 2019 and June 2022. Multilevel multivariable logistic regression models were applied to the data on 7,662 individuals aged 27-45 years who were fully vaccinated against HPV or not, nested within 3839 neighborhoods across the US. Results: More than half of the participants in this study (52.93%) were not completely vaccinated against HPV. About 64% of the eligible participants aged 27-30 years did not complete their HPV vaccine series. After adjusting for all other covariates in the final model, being older than 30 years old decreased the odds of incomplete HPV vaccine series. Participants living in neighborhoods of South region of the US had enhanced odds of incomplete HPV vaccine series compared to those residing in Northeast region (aOR 1.21; 95% CrI 1.03–1.42). There was significant clustering of incomplete HPV vaccine series at the neighborhood level. Conclusions: This study revealed that individual- and neighborhood-level factors significantly influence HPV vaccination incompleteness in the US. Interventions to improve HPV vaccination uptake and completion should take into consideration both individual- and contextual-level characteristics during design, planning and implementation of policies and programs to improve HPV vaccination coverage and completion in the US and other similar countries. Acknowledgement Dr. Adekanmbi is supported by a research career development award (K12HD052023: Building Interdisciplinary Research Careers in Women’s Health Program-BIRCWH; Berenson, PI) from the National Institutes of Health/Office of the Director (OD), National Institute of Allergy and Infectious Diseases (NIAID), and Eunice Kennedy Shriver National Institute of Child Health &amp; Human Development (NICHD). Dr. Guo is currently supported by an award (K07CA222343) from the National Institutes of Health, National Cancer Institute (NIH/NCI). Dr. Berenson is supported by an award (PP200048) from the Cancer Prevention and Research Institute of Texas (CPRIT). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or CPRIT. Conflict of Interest: All authors report no conflicts of interest.

Abstract 4210: Over 10 years since HPV vaccine approval, awareness of the causal link between HPV and HPV-associated cancers remains low in the US

Abstract Background: Over 90% of Human papillomavirus (HPV)-associated cancers could be prevented with the HPV vaccination; yet vaccine uptake remains suboptimal. Awareness that HPV causes several cancers has been shown to improve HPV vaccination uptake. While several efforts to increase HPV-associated diseases awareness as a way to improve vaccine uptake have been made, it is unclear if these efforts have resulted in increased HPV-associated cancers awareness over the years. We examined the awareness of the link between HPV and HPV-associated cancers between 2014 and 2020 in the US. Methods: We used the Health Information National Trends Survey (HINTS) data from 2014 (HINTS 4 cycle 4) to 2020 (HINTS 5 cycle 4). HINTS is a nationally representative survey of adults aged ≥18 in the civilian non-institutionalized US population. HPV-associated cancer awareness was assessed with the question “Do you think HPV can cause i) anal ii) cervical iii) oral and iv) penile cancers”. Responses were “yes”, “no” and “not sure”. Weighted prevalence estimates and corresponding 95% CIs were calculated for all four HPV-associated cancer awareness questions at each timepoint. Results: There were five timepoints included in the study: HINTS 4 cycle 4 (2014, n=2239), HINTS 5 cycle 1 (2017, n=2034), HINTS 5 cycle 2 (2018, n=2050), HINTS 5 cycle 3 (2019, n=2270), and HINTS 5 cycle 4 (2020, n=2340). Awareness of the link between HPV and cervical cancer was high (77.6% in 2014) but decreased by 7.4% between 2014 and 2020 (Table). However, awareness of the link between HPV and anal, oral, and penile cancers was low (around 30% for each cancer type) and remained stable between 2014 and 2020 (Table). Conclusions: Awareness of the link between HPV and HPV-associated cancers has remained steady for anal, oral and penile cancers or declined slightly for cervical cancer over time. There is a need for implementing novel and target interventions to increase awareness and counteract HPV vaccine disinformation. Awareness of the link between HPV and HPV-associated cancers Weighted percent (95% CI) H4C4 (2014) H5C1 (2017) H5C2 (2018) H5C3 (2019) H5C4 (2020) HPV cause anal cancer 27.9 (24.7, 31.1) 29.1 (25.7, 32.5) 24.4 (21.3, 27.5) 28.8 (25.5, 32.0) 27.4 (24.3, 30.6) HPV cause oral cancer 31.2 (28.0, 34.4) 30.7 (27.6, 33.9) 27.0 (23.8, 30.1) 31.1 (27.8, 34.4) 29.5 (26.3, 32.8) HPV cause penile cancer 30.3 (27.1, 33.6) 31.2 (28.1, 34.2) 29.2 (25.9, 32.5) 32.0 (28.7, 35.4) 28.4 (25.1, 31.6) HPV cause cervical cancer 77.6 (74.9, 80.3) 81.5 (78.9, 84.2) 75.0 (72.0, 78.1) 73.9 (70.4, 77.3) 70.2 (67.0, 73.5) Citation Format: Eric Adjei Boakye, Mrudula Nair, Joel Fokom Domgue, Dina K. Abouelella, Heena Y. Khan, Nosayaba Osazuwa-Peters. Over 10 years since HPV vaccine approval, awareness of the causal link between HPV and HPV-associated cancers remains low in the US [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4210.

Knowledge, Sexual Behaviors on Human Papillomavirus Infections and Associated Factors: Survey Among Female Adolescents and Adults in the Republic of Congo

<i>Background</i>. Human papillomavirus (HPV) infection is sexually transmitted and responsible for anogenital warts and malignancies but its early diagnosis is hampered by the people’s lack of knowledge about the disease and prevention methods, especially in resource-limited countries. <i>Objective</i>. The study was designed to determine knowledge; attitudes and practices toward HPV infection in an urban women community, and evaluate the factors that are associated with HPV-related disease’s lack of knowledge. <i>Method</i>. Between February 2021 and August 2022, a cross sectional and prospective study was conducted in Pointe-Noire (PNR) and Brazzaville (BZV) region within the Republic of Congo. Anonymous questionnaire was used to explore demographics, knowledge, attitudes, and behaviors. Data analysis were performed using StataSE11 software (version 11 SE). <i>Results</i>. Overall 250 (96.2%) of 260 people surveyed agreed to participate and of these, 70.4% were recruited in Brazzaville and, the mean age was 20.9 (min-max: 15-35) years. A low proportion (21.6%) of women reported knowing what HPV is and of these, only 40.7% had adequate knowledge of HPV. 17.2% reported a knowledge of cervical cancer, 12.0% an adequate preventive measures and all of them were adults. The mean age of first sexual intercourse was 16.8 (IQ_25-75%: 16-18) years and statistically earlier in the adolescents (p=0.0001). The mean number of sexual partners was 2.6 (IQ_25-75%: 1-3). 56.8% of participants use condoms regularly and 10.4% occasionally and, less than one-third used oral contraception. Only 3 participants received HPV vaccine. HPV infection were found in 38.0% of participants, and significantly lower among adults than adolescents (10% <i>vs</i> 45.7%; OR=5.43, 95%CI: 1.97-14.97, p=0.001) and, than young adults (42.9%; OR=1.04, 95%CI: 3.24-33.06, p<0.0001). Participants with more than two sexual partners are twice for acquiring HPV infection (aOR=2.36, 95%CI: 1.33-4.21, p=0.003). Study area (aOR = 0.17, <i>p</i> = 0.0001), age > 18 years (aOR = 2.54, <i>p</i> = 0.03) and age at first intercourse (17 – 21 years) (aOR = 0.40, <i>p</i> = 0.04) were determinants of HPV knowledge. Study area (aOR = 0.03, <i>p</i> = 0.0001), age > 18 years (aOR = 6.18, <i>p</i> = 0.009), concubinage (aOR = 0.14, <i>p</i> = 0.001) and 3-4 sexual partners (aOR = 5.18, <i>p</i> = 0.004) were determinants of cervical cancer knowledge. <i>Conclusion</i>. These results highlight the important of developing and implementing appropriate outreach strategies to improve patient awareness and knowledge of HPV-related diseases and to promote HPV vaccination uptake targeting adolescents and young adults in the Republic of Congo.

Barriers and facilitators to HPV and meningococcal vaccination among men who have sex with men: a qualitative study

BackgroundMen who have sex with men (MSM) have suboptimal uptake of human papillomavirus (HPV) and meningococcal vaccines. This study examines barriers and facilitators to HPV and meningococcal vaccination among MSM in a large, racially/ethnically diverse, and medically underserved U.S. region.MethodsIn 2020, we conducted five focus groups with MSM living in the Inland Empire, California. Participants discussed (1) their knowledge about and attitudes toward HPV, meningococcal disease, and related vaccines; and (2) factors that would encourage or discourage vaccine uptake. Data were systematically analyzed to identify salient barriers and facilitators to vaccination.ResultsParticipants (N = 25) had a median age of 29. Most were Hispanic (68%), self-identified as gay (84%), and had college degrees (64%). Key barriers to vaccination included: (1) limited awareness and knowledge about HPV and meningococcal disease, (2) reliance on mainstream healthcare providers for vaccine information, (3) stigma and reluctance to disclose sexual orientation, (4) uncertainty about health insurance coverage and vaccine costs, and (5) distance and time required to access vaccines. Key facilitators to vaccination were: (1) vaccine confidence, (2) perceived severity of HPV and meningococcal disease, (3) bundling vaccination into routine healthcare, and (4) pharmacies as vaccination sites.ConclusionsFindings highlight opportunities for HPV and meningococcal vaccine promotion, including targeted education and awareness campaigns for MSM, LGBT inclusivity training for healthcare providers, and structural interventions to improve vaccine accessibility.

Knowledge, attitude, and uptake of human papillomavirus vaccine among adolescent schoolgirls in Ethiopia: a systematic review and meta-analysis

BackgroundCervical cancer is an international public health issue. Nearly all cases of cervical cancer are caused by the human papillomavirus. The HPV vaccine prevents more than 75% of cervical cancer. The extent to which adolescent girls' knowledge and uptake of the HPV vaccine have to be investigated in order to build effective promotion strategies and increase the uptake of the vaccine. The evidence that is currently available in this area is controversial and inconclusive. Hence, this study has estimated the pooled proportion of good knowledge, positive attitude, and uptake of the HPV vaccine and its associated factors among adolescent schoolgirls in Ethiopia.MethodsPubMed, Google Scholar, AJOL, ScienceDirect, and DOAJ were used to search relevant studies. A total of 10 studies were included. The data were extracted by two reviewers using Microsoft Excel and exported to STATA Version 17 for analysis. A random effects model was applied during the analysis. Heterogeneity and publication bias across the studies were evaluated using I2 statistics and Egger’s test, respectively. The PROSPERO registration number for the review is CRD42023414030.ResultA total of eight studies comprising 3936 study participants for knowledge and attitude and five studies with 2,481 study participants for uptake of HPV were used to estimate the pooled proportions of good knowledge, a positive attitude, and uptake of the HPV vaccine, respectively. The pooled proportions of good knowledge, positive attitude, and uptake of the HPV vaccine were 55.12%, 45.34%, and 42.05%, respectively. Being an urban resident (OR = 4.17, 95% CI = 1.81, 9.58), having good knowledge (OR = 6.70, 95% CI = 3.43, 13.07), and a positive attitude (OR = 2.04, 95% CI = 1.51, 2.74), were significantly associated with the uptake of the vaccine.ConclusionThe pooled proportions of good knowledge, a positive attitude, and uptake of the HPV vaccine were low in Ethiopia. Being an urban resident and having good knowledge and a positive attitude towards the HPV vaccine were significantly associated with the uptake of the HPV vaccine. We recommend increasing adolescent knowledge, positive attitudes, and uptake of HPV vaccination through school-based seminars, health education, and community mobilization.

Exploring the Barriers and Facilitators Influencing Human Papillomavirus Vaccination Decisions Among South Asian and Chinese Mothers: a Qualitative Study.

Human papillomavirus (HPV) vaccines are safe and effective in preventing HPV infection and HPV-related cancers. However, the HPV vaccine uptake rate is lower among the ethnic minority population than in the majority population. This qualitative study explored the barriers and facilitators influencing South Asian minority and Chinese mothers' decisions to vaccinate their daughters against HPV in Hong Kong. South Asian and Chinese mothers with at least one daughter aged 9 to 17years were recruited to this study. Twenty-two semi-structured focus group interviews were conducted, and the transcripts were analysed via content analysis. Two barriers and three facilitating factors were common among South Asian and Chinese mothers: inadequate knowledge of cervical cancer, HPV or the HPV vaccine and high perceived barriers to HPV vaccination due to vaccine cost, the receipt of reliable information from schools or the government, high perceived benefits of HPV vaccination to health, and the presence of vaccination programme arranged by school or government. Despite these commonalities, South Asian mothers experienced more barriers to making the decision to vaccinate than Chinese mothers. Particularly, obtaining family support was an important factor for South Asian mothers. The vaccination decision was considered a joint decision between the mother and father, and the father's agreement was of particular importance to Pakistani mothers. This study identified the factors that hindered and facilitated South Asian and Chinese mothers' decisions to vaccinate their daughters against HPV. The comparison between groups improves our understanding of the distinct needs of South Asian in Hong Kong.

Complex intervention to promote human papillomavirus (HPV) vaccine uptake in school settings: A cluster-randomized trial

Using a cluster-randomized trial design, we aimed to evaluate a complex intervention to increase uptake of human papillomavirus (HPV) vaccination in schools. The study was undertaken in high schools in Western Australia and South Australia between 2013 and 2015 with adolescents aged 12–13 years. Interventions included education, shared decision-making, and logistical strategies. The main outcome was school vaccine uptake. Secondary outcomes included consent forms returned and mean time to vaccinate 50 students. We hypothesised that a complex intervention would increase 3-dose HPV vaccine uptake. We recruited 40 schools (21 intervention, 19 control) with 6, 967 adolescents. There was no difference between intervention and control (3-dose mean 75.7% and 78.9%, respectively). Following adjustment for baseline covariates, absolute differences in coverage in favour of the intervention group were: dose 1, 0.8% (95% CI, −1.4,3.0); dose 2, 0.2% (95% CI, −2.7, 3.1); dose 3, 0.5% (95% CI, −2.6, 3.7). The percentage of returned consent forms in intervention schools (91.4%) was higher than in control schools (difference: 6%, 95% CI, 1.4, 10.7). There was a shorter mean time to vaccinate 50 students at dose 3. The difference for dose 3 was 110 min (95% CI, 42, 177); for dose 2, 90 min (95% CI, −15, 196); and dose 1, 28 min (95% CI, −71, 127). Logs revealed the inconsistent implementation of logistical strategies. The intervention had no impact on uptake. Inadequate resourcing for logistical strategies and advisory board reluctance toward strategies with potential financial implications impacted the implementation of logistical components. Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12614000404628, 14.04.2014.The study protocol was published in 2015 before data collection was finalised (Skinner et al., 2015). The HPV.edu study groupWe would like to acknowledge the contributions to this study by members of the HPV.edu Study Group, including: Professor Annette Braunack-Mayer: Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia; Dr. Joanne Collins: Women's and Children's Health Network and School of Medicine and Robinson Research Institute, University of Adelaide, SA, Australia; Associate Professor Spring Cooper: School of Public Health, City University of New York (CUNY), New York, NY, USA; Heidi Hutton: Telethon Kids Institute, University of Western Australia, WA, Australia; Jane Jones: Telethon Kids Institute, University of Western Australia, WA, Australia; Dr. Adriana Parrella: Women's and Children's Health Network and School of Medicine and Robinson Research Institute, University of Adelaide, SA, Australia; and South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Associate Professor David G. Regan: The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, NSW, Australia; Professor Peter Richmond: Perth Children's Hospital, Child and Adolescent Health Service, Western Australia, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, WA, Australia, and School of Medicine, University of Western Australia, Perth, WA, Australia; Dr. Tanya Stoney: Telethon Kids Institute, University of Western Australia, WA, Australia. Contact for the HPV.edu study group: Cristyn.Davies@sydney.edu.au or Rachel.Skinner@sydney.edu.au.

Leveraging health infrastructure to optimize HPV vaccination for adolescents in Zambia: Protocol for an implementation study.

Cervical cancer is the leading cause of cancer death in Zambia, where HIV prevalence is also high (11.3%). HIV heightens the risk of developing and dying from cervical cancer. The human papillomavirus (HPV) vaccine can prevent 90% of cervical cancers, and in Zambia is recommended for adolescent girls ages 14-15 years, including those with HIV. Currently they mainly deliver HPV vaccination via school-based campaigns, which may exclude the most vulnerable adolescents-those out-of-school or who irregularly attend. Adolescents living with HIV (ALHIV) are more likely to have these vulnerabilities. Further, school-based campaigns are not tailored to the WHO-recommended HPV vaccination schedule for ALHIV (3 versus 2 doses). Integrating HPV vaccination into routine care in adolescent HIV clinics may ensure that ALHIV have access to vaccine at the WHO-recommended schedule. Such integration requires a multilevel approach, stakeholder engagement, and diversified implementation strategies, given known challenges of providing the HPV vaccine in LMICs, including Zambia. Our study aims to integrate HPV vaccination into routine care in adolescent HIV clinics. To achieve success, we will co-design a package of implementation strategies using a previously successful implementation research approach developed for cervical cancer prevention in LMICs: the Integrative Systems Praxis for Implementation Research (INSPIRE). INSPIRE is a novel, comprehensive approach to develop, implement, and evaluate implementation science efforts. Following key elements of INSPIRE, our specific aims are to: 1) Identify the unique multilevel contextual factors (barriers and facilitators) across HIV settings (rural, urban, peri-urban) that influence HPV vaccine uptake; 2) Use Implementation Mapping to translate stakeholder feedback and findings from Aim 1 into a package of implementation strategies to integrate HPV vaccine into HIV clinics; 3) Conduct a Hybrid Type 3 effectiveness-implementation trial to evaluate the package of multilevel implementation strategies for integrating HPV vaccine into HIV clinics. Our research team has strong support, technical expertise, and resources (e.g., vaccines) from the Zambian Ministry of Health; and political will for scale-up. This stakeholder-based implementation model has the potential to be transported to HIV clinics across Zambia and serve as a model to address cancer prevention priorities for those with HIV in other LMICs. To be registered prior to Aim 3, when implementation strategies finalized.

Application of the theoretical domains framework to identify factors influencing catch-up HPV vaccinations among male college students in the United States: A review of evidence and recommendations.

Genital human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection among young adults ages 15-25years in the United States (US). Although HPV vaccines are recommended for individuals ages through 26years, vaccine completion rates remain substantially low. Accordingly, our study utilized a comprehensive - Theoretical Domains Framework (TDF) of behavior change to systematically identify facilitators and barriers to catch-up HPV vaccinations. Five databases - Medline, Embase, CINAHL, ERIC, and PsycINFO were searched from January 2009 to July 2019 for empirical studies using quantitative and qualitative methods to assess HPV vaccine uptake among males ages 18-26years within US college and university settings. The TDF analytic process included a content analysis using the mixed deductive-inductive approach to extract, analyze and categorize data into TDF domains/themes and sub-themes. Overall, 17 studies were selected for data extraction. We identified eleven key TDF domains that influenced HPV vaccination behavior among college male students: 'knowledge' (82% of included studies), 'environmental context and resources' (53%), 'beliefs about consequences' (53%), 'unrealistic optimism' (50%) and 'pessimism' (6%), 'emotion' (50%), 'social influences' (50%), 'beliefs about capabilities' (41%), 'intention' (24%), 'reinforcement' (18%), 'social professional role and identity'(12%), and 'behavioral regulation' (12%). Barriers influencing HPV vaccine uptake included lack of knowledge and awareness regarding HPV infections, HPV vaccine safety, effectiveness, side effects, and costs; absence of health providers' recommendations; lack of healthcare and health insurance; low levels of perceived susceptibility and severity for HPV infections; HPV vaccine misinformation; as well as social stigma and peer influences regarding HPV vaccinations. Enablers for HPV vaccine uptake included high levels of perceived benefits for HPV vaccines. Our study theoretically identified factors influencing HPV vaccinations. This could inform the efficient planning, support, and implementation of interventions that facilitate catch-up HPV vaccination practices among high-risk males within college/university settings.

Patterns of HPV vaccine hesitancy among catch-up generations in Japan: A descriptive study.

Cervical cancer is a preventable disease caused by human papillomavirus (HPV). The HPV vaccine uptake in Japan has been slow since the Ministry of Health, Labour and Welfare suspended the recommendation for proactive HPV vaccination in 2013. In April 2022, Japan initiated catch-up vaccinations for women who missed the opportunity to receive the HPV vaccine. However, as of September 2022, very few women had received catch-up vaccination, raising concerns about vaccine hesitancy in the target population. It is necessary to understand the thinking and motivation of the target population to develop effective strategies to improve vaccination rates. Therefore, using cluster analysis, this study aimed to clarify the pattern of HPV vaccine hesitancy among the catch-up generations in Japan. This descriptive study was based on an Internet survey completed by 3,790 women in Japan aged over 18years who were eligible for catch-up vaccination and had not yet received an HPV vaccine. Participants were asked about their intention and thinking about the HPV vaccine and descriptive norms on vaccination intention. Cluster analysis using k-means clustering was performed to clarify these patterns. Cluster analysis revealed three hesitancy patterns: acceptance, neutral and refusal. The acceptance group, with high intention, comprised 28.2% of the participants, and students and a high-income level mainly dominated this group. The refusal group, with negative thinking and low intention, accounted for 20.1% and was more prevalent among workers and the unemployed. The neutral group, with neutral thinking and intention, accounted for 51.6%. The perceived effect of descriptive norms on vaccination intention was large in the acceptance group but small in the refusal group. HPV vaccine awareness promotion strategies must be based on the characteristics of each group and the different distributions of sociodemographic factors.

Identification of subgroups in the Danish population for targeted human papillomavirus vaccination efforts.

In the Danish childhood vaccination program, the human papillomavirus (HPV) vaccination coverage is lower than for other vaccines. To tailor a targeted HPV vaccination effort, we aimed to identify girls in Denmark with lower first dose HPV vaccination coverage than girls in general. A population-based retrospective cohort study was performed of girls born in 2001-2004, residing in Denmark in September 2019 (N=128,351). Data from the Danish Vaccination Register was linked to sociodemographic data from the Danish Civil Registration System and Statistics Denmark. Cox's proportional hazard regression models were used to compare vaccination uptake rates between subgroups of girls. HPV vaccination coverage at 14years of age varied widely by municipality (53.4-80.6%). Girls living with neither of their parents had a lower chance of being vaccinated compared to girls living with both their parents (HR 0.43; 95% CI 0.41-0.46), likewise for girls attending special need education compared with girls attending public schools (HR 0.50; 95% CI 0.42-0.59). The vaccination uptake among immigrants was lower compared to Danish-born girls (HR 0.51; 95% CI 0.49-0.54), especially among immigrant girls whose parents had not passed any Danish exams. Finally, girls who were DTaP-IPV revaccinated had a 50% greater chance of being HPV vaccinated compared to girls who were not (HR 1.61; 95% CI 1.58-1.64). To increase the HPV vaccination uptake, we recommend vaccination efforts targeting girls living without any of their parents, girls attending special need education, immigrants, and girls who are not DTaP-IPV revaccinated. When targeting immigrants, the effort should focus on disseminating sufficient and understandable information about the Danish childhood vaccination program to the parents.

Knowledge and Attitudes Toward Inpatient Postpartum HPV Vaccination Among Pregnant Women [ID: 1376898

INTRODUCTION: Inpatient postpartum human papillomavirus (HPV) vaccination is a novel strategy to increase HPV vaccine uptake; however, data on pregnant women's perspectives are lacking. We sought to assess knowledge and attitudes toward inpatient postpartum HPV vaccination among pregnant women. METHODS: An electronic survey assessing HPV vaccination knowledge, status, and attitudes toward postpartum HPV vaccination was distributed among pregnant women aged 15–45 years engaged in prenatal care at a large health system in Baltimore, Maryland. Reasons for their attitudes toward postpartum HPV vaccination were measured on a 5-point Likert scale. Responses were analyzed using descriptive statistics and χ2 tests. RESULTS: Mean age was 31.3+6.2 years among 309 pregnant participants. Self-identified race and ethnicity included 47.5% White, 29% Black/African American, 11.2% Asian, and 16.2% Hispanic/Latina. 88.7% had heard of the HPV vaccine, 50.5% had received at least one dose, and 35.0% had completed the series. HPV vaccination status did not differ by socioeconomic characteristics (P&gt;.05). Of the 153 HPV vaccine-naive women, 40.0% desired to receive it after delivery, with the top reasons being “I think it is safe” and “I think the protection can benefit me.” 24.2% were not interested (“I don't think it will benefit me” and “I'm worried about the side effects”), and 36.0% were unsure (“No healthcare provider has recommended it to me so far” or “I usually don't say yes to all vaccines”). CONCLUSION: The majority of pregnant HPV vaccine-naive women were willing to receive an HPV vaccine dose postpartum. HPV vaccine education during prenatal care may further increase uptake.

Correlates of Parental Consent to Human Papillomavirus Vaccine Uptake by Their Adolescent Daughters in ZAMBIA: Application of the Health Belief Model.

Parental consent for adolescent human papillomavirus (HPV) vaccine uptake is important; however, refusal is prevalent. Therefore, this study aimed to understand factors associated with parental consent for their adolescent daughter's HPV vaccination. A cross-sectional study was conducted in Lusaka, Zambia, between September and October 2021. We recruited parents from different social settings. The means and standard deviations or median and interquartile ranges were used as appropriate to summarise continuous variables. Simple and multiple logistic regression models were fitted with robust estimation of standard errors. The odds ratios are presented with 95% CI. Mediation analysis was conducted using a generalised structural equation model. The study enrolled 400 parents, mean age 45.7 years [95% CI, 44.3-47.1]. Two hundred and fifteen (53.8%) parents reported consenting to their daughters' HPV vaccination, and their daughters received it. None of the health belief model (HBM) construct scores showed an independent association with parental consent. Higher, compared to lower wealth index (AOR; 2.32, 95% CI: 1.29-4.16), knowing someone with genital warts (AOR = 2.23, 95 CI: 1.04-4.76), cervical cancer screening uptake (AOR = 1.93, 95% CI: 1.03-3.62) were associated with increased odds of parental consent. This study highlights factors influencing parental consent for their daughters' HPV vaccination. Ongoing sensitisation programs are important to improve their decision-making.