Projections of human papillomavirus (HPV) vaccination impact in Ethiopia, India, Nigeria and Pakistan: a comparative modelling study

IntroductionCervical cancer is the second most common cancer among women in Ethiopia, India, Nigeria and Pakistan. Our study objective was to assess similarities and differences in vaccine-impact projections through comparative modelling analysis by independently estimating the potential health impact of human papillomavirus (HPV) vaccination.MethodsUsing two widely published models (Harvard and Papillomavirus Rapid Interface for Modelling and Economics (PRIME)) to estimate HPV vaccination impact, we simulated a vaccination scenario of 90% annual coverage among 10 cohorts of 9-year-old girls from 2021 to 2030 in Ethiopia, India, Nigeria and Pakistan. We estimated potential health impact in terms of cervical cancer cases, deaths and disability-adjusted life years averted among vaccinated cohorts from the time of vaccination until 2100. We harmonised the two models by standardising input data to comparatively estimate HPV vaccination impact.ResultsPrior to harmonising model assumptions, the range between PRIME and Harvard models for number of cervical cancer cases averted by HPV vaccination was: 262 000 to 2 70 000 in Ethiopia; 1 640 000 to 1 970 000 in India; 330 000 to 3 36 000 in Nigeria and 111 000 to 1 33 000 in Pakistan. When harmonising model assumptions, alignment on HPV type distribution significantly narrowed differences in vaccine-impact estimates.ConclusionDespite model differences, the Harvard and PRIME models yielded similar vaccine-impact estimates. The main differences in estimates are due to variation in interpretation around data on cervical cancer attribution to HPV-16/18. As countries make progress towards WHO targets for cervical cancer elimination, continued explorations of underlying differences in model inputs, assumptions and results when examining cervical cancer prevention policy will be critical.

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Projections of human papillomavirus (HPV) vaccination impact in Ethiopia, India, Nigeria, and Pakistan: a comparative modelling study

10.1101/2021.06.01.21258170 ◽

2021 ◽

Author(s):

Allison Portnoy ◽

Kaja Abbas ◽

Steven Sweet ◽

Jane Kim ◽

Mark Jit

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccination ◽

Health Impact ◽

World Health ◽

Potential Health ◽

Study Objective ◽

Comparative Modelling ◽

Modelling Analysis ◽

Vaccine Impact

Background: Cervical cancer is the second most common cancer among women in Ethiopia, India, Nigeria, and Pakistan. However, of these four countries, only Ethiopia has introduced human papillomavirus (HPV) vaccination at the national level in 2018 and India in a few states in 2016. Our study objective was to estimate the potential health impact of HPV vaccination among ten cohorts of 9-year-old girls from 2021-2030 in Ethiopia, India, Nigeria, and Pakistan using two independent mathematical models, and assess similarities and differences in vaccine impact projections through comparative modelling analysis. Methods: Using two widely published models (Harvard and PRIME) to estimate HPV vaccination impact, we simulated a vaccination scenario of 90% annual coverage among 9-year-old girls from 2021-2030 in Ethiopia, India, Nigeria, and Pakistan. We estimated the potential health impact in terms of cervical cancer cases, deaths, and disability-adjusted life years (DALYs) averted among vaccinated cohorts from the time of vaccination until 2100. We also conducted a comparative modelling analysis to understand the differences in vaccine impact estimates generated by the two models. Results: Prior to harmonising model assumptions, the range between the PRIME model and the Harvard model for the potential health impact of HPV vaccination in terms of the number of cervical cancer cases averted among girls vaccinated 2021-2030 between the year of vaccination and 2100 was: 262,000 to 270,000 in Ethiopia; 1,640,000 to 1,970,000 in India; 330,000 to 336,000 in Nigeria; and 111,000 to 133,000 in Pakistan. When harmonising model assumptions, alignment on HPV type distribution significantly narrowed the differences in vaccine impact estimates. Conclusions: The main difference in estimates for cases, deaths, and DALYs averted by vaccination between the models are due to variation in interpretation around data on cervical cancer attribution to HPV-16/18; differences in estimates for DALYs averted are additionally due to differences in age-specific remaining life expectancy over time between the two models. As countries make progress towards the World Health Organization targets for cervical cancer elimination, continued explorations of underlying differences in model inputs, assumptions, and results when examining cervical cancer prevention policy will be critical.

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Potential health impact and cost-effectiveness of bivalent human papillomavirus (HPV) vaccination in Afghanistan

Vaccine ◽

10.1016/j.vaccine.2019.12.013 ◽

2020 ◽

Vol 38 (6) ◽

pp. 1352-1362 ◽

Cited By ~ 1

Author(s):

Palwasha Anwari ◽

Frédéric Debellut ◽

Elisabeth Vodicka ◽

Andrew Clark ◽

Farhad Farewar ◽

...

Keyword(s):

Human Papillomavirus ◽

Cost Effectiveness ◽

Hpv Vaccination ◽

Health Impact ◽

Potential Health

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Public health impact and cost effectiveness of routine and catch-up vaccination of girls and women with a nine-valent HPV vaccine in Japan: a model-based study

BMC Infectious Diseases ◽

10.1186/s12879-020-05632-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Palmer Cody ◽

Keisuke Tobe ◽

Machiko Abe ◽

Elamin H. Elbasha

Keyword(s):

Cervical Cancer ◽

Cost Effectiveness ◽

Hpv Vaccination ◽

Cost Effective ◽

Health Impact ◽

Vaccination Program ◽

Sensitivity Analyses ◽

Screening Programs ◽

Life Years ◽

Catch Up

Abstract Background Combined with cancer screening programs, vaccination against human papillomavirus (HPV) can significantly reduce the high health and economic burden of HPV-related disease in Japan. The objective of this study was to assess the health impact and cost effectiveness of routine and catch-up vaccination of girls and women aged 11–26 years with a 4-valent (4vHPV) or 9-valent HPV (9vHPV) vaccine in Japan compared with no vaccination. Methods We used a mathematical model adapted to the population and healthcare settings in Japan. We compared no vaccination and routine vaccination of 12–16-year old girls with 1) 4vHPV vaccine, 2) 9vHPV vaccine, and 3) 9vHPV vaccine in addition to a temporary catch-up vaccination of 17–26 years old girls and women with 9vHPV. We estimated the expected number of disease cases and deaths, discounted (at 2% per year) future costs (in 2020 ¥) and discounted quality-adjusted life years (QALY), and incremental cost effectiveness ratios (ICER) of each strategy over a time horizon of 100 years. To test the robustness of the conclusions, we conducted scenario and sensitivity analyses. Results Over 100 years, compared with no vaccination, 9vHPV vaccination was projected to reduce the incidence of 9vHPV-related cervical cancer by 86% (from 15.24 new cases per 100,000 women in 2021 to 2.02 in 2121). A greater number of cervical cancer cases (484,248) and cancer-related deaths (50,102) were avoided through the described catch-up vaccination program. Routine HPV vaccination with 4vHPV or 9vHPV vaccine prevented 5,521,000 cases of anogenital warts among women and men. Around 23,520 and 21,400 diagnosed non-cervical cancers are prevented by catch-up vaccination among women and men, respectively. Compared with no vaccination, the ICER of 4vHPV vaccination was ¥975,364/QALY. Compared to 4vHPV, 9vHPV + Catch-up had an ICER of ¥1,534,493/QALY. Conclusions A vaccination program with a 9-valent vaccine targeting 12 to 16 year-old girls together with a temporary catchup program will avert significant numbers of cases of HPV-related diseases among both men and women. Furthermore, such a program was the most cost effective among the vaccination strategies we considered, with an ICER well below a threshold of ¥5000,000/QALY.

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KNOWLEDGE, ATTITUDE AND PRACTICE OF MOTHERS HAVING THEIR DAUGHTERS AGED 1 TO 26 YEARS OLD TOWARDS HPV VACCINATION AGAINST CERVICAL CANCER IN AN BINH WARD, NINH KIEU DISTRIC, CAN THO CITY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.4_5.19 ◽

2014 ◽

pp. 133-139

Author(s):

Duc Tam Lam ◽

Vu Quoc Huy Nguyen

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccination ◽

Common Disease ◽

Cross Sectional ◽

Face To Face ◽

Correct Knowledge ◽

Attitude And Practice ◽

Can Tho City ◽

Knowledge Attitude And Practice

Backgroud: Cervical cancer is a common disease after breast cancer. That is caused by Human papillomavirus (HPV) and now, we have HPV vaccin to prevent the disease with objectives: to determine rate of correct knowledge, attitudes and practice towards HPV vaccination against cervical cancer of mothers who have daughters aged 1 to 26 years old in An Binh ward, Ninh Kieu district, Can Tho city and to determine the relationship between correct knowledge and correct attitudes and correct behaviors towards vaccination against cervical cancer of these mothers. Materials and method: Cross-sectional, community survey on 410 mothers who are interviewed face to face by using a questionnaire. Results: The rate of correct knowledge, attitude and practice towards HPV vaccination against cervical cancer is 4.4%; 89.5%; 12.2%; respectively. There’s a correlation between correct knowledge and correct behaviors towards vaccination against cervical cancer among mothers (p<0.05), but no correlation between correct knowledge and correct attitudes. Conclusion: the rate of mothers who have correct knowledge and behaviors is relatively low but whose correct attitude is high. Therefore, may be they want to know more information about vaccination against cervical cancer so that it should have appropriate information-education-counseling and health care campaign to community. Keywords: Knowledge, Attitude, practice, vaccine, Human papillomavirus, cervical

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Nurses’ and midwives’ knowledge, attitudes, and acceptance regarding human papillomavirus vaccination in Ghana: a cross-sectional study

BMC Nursing ◽

10.1186/s12912-020-00530-x ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Nancy Innocentia Ebu ◽

Gifty Esinam Abotsi-Foli ◽

Doreen Faakonam Gakpo

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccination ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Cancer Risk Factors ◽

Cervical Cancer Risk ◽

Nurses And Midwives

Abstract Background Nurses and midwives play important roles in educating the public on cervical cancer prevention strategies. Aim This study sought to assess nurses’ and midwives’ knowledge of, attitudes towards, and acceptance of human papillomavirus (HPV) vaccination in relation to their background characteristics. Methods A descriptive cross-sectional study using questionnaires was conducted with a convenience sample of 318 female nurses and midwives, ages 20 to 59, at the Korle-Bu Teaching Hospital in Ghana. The data were summarised using frequencies, percentages, chi-square tests, and Fisher’s exact tests. Results The results indicated that 41.5% (n = 132) of the participants had high levels of knowledge about cervical cancer risk factors, and 17.6% (n = 56) of the respondents had received at least one dose of the HPV vaccine. Reasons for receiving the HPV vaccination included advice from a colleague (12.9%, n = 41) and perceived threat of cervical cancer (11.7%, n = 37). Of the 262 respondents who had not been vaccinated, 24.45% (n = 78) strongly agreed and 28.0% (n = 89) agreed with the statement that there was limited information on HPV vaccination. Also, there were statistically significant associations between age (X2 = 23.746, p = 0.001), marital status (X2 = 14.758, p = 0.005), completed level of education (X2 = 21.692, p = 0.001), and duration of working at the hospital (X2 = 8.424, p = 0.038) and acceptance of HPV vaccination. Conclusions This study demonstrated gaps in knowledge about cervical cancer risk factors and attitudes towards HPV vaccination, indicating the need for targeted measures to improve knowledge and attitudes. Also, measures to increase acceptance of HPV vaccination among nurses and midwives should consider their sociodemographic characteristics.

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Stakeholders’ Understandings of Human Papillomavirus (HPV) Vaccination in Sub-Saharan Africa: A Rapid Qualitative Systematic Review

Vaccines ◽

10.3390/vaccines9050496 ◽

2021 ◽

Vol 9 (5) ◽

pp. 496

Author(s):

Caroline Deignan ◽

Alison Swartz ◽

Sara Cooper ◽

Christopher J. Colvin

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Sub Saharan Africa ◽

African Countries ◽

Qualitative Systematic Review ◽

Sub Saharan ◽

And Gender

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.

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Effect of a cervical cancer survivor story on willingness and behavioral change for Human Papillomavirus Vaccination: Randomized Controlled Trial (Preprint)

10.2196/preprints.34715 ◽

2021 ◽

Author(s):

Yukio Suzuki ◽

Akiko Sukegawa ◽

Yutaka Ueda ◽

Masayuki Sekine ◽

Takayuki Enomoto ◽

...

Keyword(s):

Cervical Cancer ◽

Randomized Controlled Trial ◽

Human Papillomavirus ◽

Cancer Survivor ◽

Controlled Trial ◽

Hpv Vaccination ◽

Intervention Group ◽

Control Group ◽

Randomized Controlled ◽

Cervical Cancer Survivor

BACKGROUND Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools showed only limited effects on increasing the willingness of parents to vaccinate their daughters. OBJECTIVE The aim of this trial was to assess the effect of a cervical cancer survivor story on the willingness of parents to get HPV vaccination for their daughters. METHODS In this double-blinded, randomized controlled trial implemented online, we enrolled 2175 participants aged 30–59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film of cervical cancer survivor story or nothing, stratified by sex (male vs. female) and willingness to HPV vaccination prior to randomization (Yes vs. No). The primary endpoint was the rate of parents who agreed to HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed to HPV vaccination for their daughters and the HPV vaccination rate at 3 months. RESULTS Among 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) patients were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short movie (odds ratio [OR] 1.55, 95% CI 1.27-1.91). In a sub-analysis, the willingness to vaccinate daughters for HPV was 10.9% higher in males in the intervention group (OR 1.75, 95% CI 1.36-2.25); however, such a difference was not observed among females (OR 1.25, 95% CI 0.86-1.81). Male participants were more likely to have willingness for HPV vaccination compared to female participants. In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention; 77 (7.9%) in the intervention group and 72 (8.7%) in the control group. CONCLUSIONS A cervical cancer survivor story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents did not increase vaccination rates in children eligible for HPV vaccination. CLINICALTRIAL UMIN Clinical Trials Registry UMIN000039273; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043714.

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Prevalence of human papillomavirus by geographical regions, sexual orientation and HIV status in China: a systematic review and meta-analysis

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053412 ◽

2018 ◽

Vol 94 (6) ◽

pp. 434-442 ◽

Cited By ~ 13

Author(s):

Xiaomeng Ma ◽

Qian Wang ◽

Jason J Ong ◽

Christopher K Fairley ◽

Shu Su ◽

...

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Human Papillomavirus ◽

Meta Analysis ◽

Hpv Vaccination ◽

Hpv Infection ◽

Central China ◽

Hiv Positive ◽

Heterosexual Men ◽

Hpv Prevalence

ObjectiveHuman papillomavirus (HPV) infection causes multiple cancers in both women and men. In China, both HPV vaccination and cervical cancer screening coverages are low. We aim to investigate the temporal and geographical trends of HPV DNA prevalence in heterosexual men, women, men who have sex with men (MSM) and people living with HIV (PLHIV) in China.MethodsWe conducted a systematic review, collecting publications in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Data from January 2000 to May 2017. A total of 247 studies were selected for this meta-analysis to estimate pooled HPV prevalence, incidence of cervical cancer and risk of infection for subgroups. Meta-regression was applied to identify contributing factors to prevalence heterogeneities.ResultsThe national HPV prevalence was 15.6% (95% CI (14.4% to 16.9%)) in women with normal cervical cytology, and Central China had the highest prevalence (20.5% (15.2% to 25.8%)). HPV prevalence in heterosexual men (14.5% (11.3% to 17.7%)) was comparable with that of women (OR=1.09 (0.98 to 1.17)), but HPV prevalence in MSM (59.9% (52.2% to 67.6%)) was significantly higher than that in heterosexual men (OR=8.81 (8.01 to 9.69)). HIV-positive women (45.0% (38.4% to 51.6%)) and HIV-positive MSM (87.5% (82.3% to 90.9%)) had 4.67 (3.61 to 6.03) and 6.46 (5.20 to 8.02) times higher risk of HPV infection than their HIV negative counterparts.ConclusionHPV infection is prevalent in China, particularly in Central China, in comparison with the global level and neighbouring countries. Targeted HPV vaccination for women, MSM and PLHIV and scale-up of cervical screening for women are priorities in curbing the HPV epidemic in China.

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