Evaluation of a School-Based Cervical Cancer Vaccination Awareness Initiative

Background and context: Cervical cancer is the second most commonly-diagnosed cancer among Nigerian women, even though it is one of the most highly-preventable cancers. Worldwide, this most populated country in Africa ranks 10th in terms of cervical cancer mortality and 7 of every 10 Nigerian women diagnosed with cervical cancer annually die annually. With about 47.72 million women aged 15 years and above who are at risk for cervical cancer and median age of first sexual intercourse being 16 years, there is a huge opportunity to prevent cervical cancer deaths through HPV vaccination. Unfortunately, Nigeria has been unable to access GAVI funding for implementation of country-wide HPV vaccination. Hence, most of the HPV vaccination has been by the private sector, NGOs/CSOs and through out-of pocket payments. In spite of this, uptake of HPV vaccines have been reported to be as low as 8% in some studies. Aim: To determine the barriers to uptake of HPV vaccination among mothers of school-age children and opportunities to increase the uptake from the perspective of mothers. Strategy/Tactics: Use qualitative and quantitative methods to gather relevant information about HPV vaccination uptake from all stakeholders including school heads, teachers, school nurses, mothers/guardians and school associations. Program/Policy process: Through funds provided by the American Cancer Society (ACS) and GlaxoSmithkline, Nigeria, we had a one-day HPV vaccination awareness program targeted at school heads, distributed HPV vaccination consent forms, followed-up with awareness in school PTA meetings, gathered data through questionnaires, FGD and KII after a year to determine project effectiveness. Outcomes: Increased understanding of motivators and demotivating factors of HPV vaccination uptake among mothers of school-aged children, increased understanding of strategies to increase uptake and identification of allies in HPV vaccination advocacy. What was learned: 1. There is a need for consistent, “360 campaign” about HPV vaccination as an effective strategy for prevention of cervical cancer targeted at mothers. 2. Since government at federal and state level is unable to access GAVI funding for HPV vaccination, they do have a role to play in validating the effectiveness and safety of HPV vaccines, as well as the efforts of CSOs and NGOs to encourage parents to consent to HPV vaccination for their children. 3. Working in partnership with school associations could be an effective strategy to increasing HPV vaccination uptake among school-aged children. 4. Female teachers are viable advocates for increasing HPV vaccination uptake in schools, if their knowledge is increased and advocacy tools are provided. 5. There is a possibility that reluctance by the government to incorporate awareness of HPV vaccination into its cervical cancer prevention programs is due to its inability to meet the anticipated demand for free HPV vaccination.

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Human papillomavirus (HPV) vaccination: from clinical studies to immunization programs

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000582 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1317-1326 ◽

Cited By ~ 6

Author(s):

Raúl Murillo ◽

Camila Ordóñez- Reyes

Keyword(s):

Cervical Cancer ◽

Clinical Trials ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Population Based ◽

Immunization Programs ◽

Hpv Vaccines ◽

Middle Income ◽

Middle Income Countries

Cervical cancer incidence and mortality have decreased in high-income countries, but low- and middle-income countries continue to bear a significant burden from the disease. Human papillomavirus (HPV) vaccines are a promising alternative for disease control; however, their introduction is slow in settings with greater need. We conducted a review of HPV vaccine efficacy and effectiveness reported in clinical trials and population-based studies. Efficacy of HPV vaccines is close to 100% when using a three-dose schedule in HPV-negative young women (<25 years old) for protection against persistent infection and HPV vaccine-type associated pre-cancerous lesions. Furthermore, sustained protection for up to 12 years of follow-up has been demonstrated; cross-protection against non-vaccine types is particularly observed for the bivalent vaccine, and preliminary data regarding impact on invasive cancer have emerged. Given its lower efficacy, catch-up vaccination beyond 19 years of age and proposals for vaccinating adult women deserve careful evaluation in accurately designed studies and economic analyses. Despite positive results regarding immunogenicity and post-hoc analysis for cervical intra-epithelial neoplasia in clinical trials, population-based data for prime and booster two-dose schedules are not available. Evaluation of vaccine safety from surveillance systems in immunization programs that have already distributed more than 270 million doses found no association of HPV vaccination with serious side effects. The introduction of HPV vaccination in national immunization programs remains the main challenge in tackling the burden of cervical cancer (up to 2018, only 89 countries have introduced vaccination worldwide, and most of these are high-income countries). Access models and technical capacity require further development to help low- and middle-income countries to increase the pace of vaccine delivery. Alternative approaches such as one-dose schedules and vaccination at younger ages may help reduce the programmatic and economic challenges to adolescent vaccination.

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Global reduction of cervical cancer with human papillomavirus vaccines: insights from the hepatitis B virus vaccine experience

Sexual Health ◽

10.1071/sh09134 ◽

2010 ◽

Vol 7 (3) ◽

pp. 383 ◽

Cited By ~ 8

Author(s):

Margaret E. Heffernan ◽

Suzanne M. Garland ◽

Mark A. Kane

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Hpv Vaccination ◽

Primary Hepatocellular Carcinoma ◽

Health Providers ◽

Hpv Vaccines ◽

B Virus ◽

Global Reduction

Background: Worldwide, prophylactic vaccines against two major human cancers are now commercially available: hepatitis B virus (HBV) vaccines (first licensed in 1982) against primary hepatocellular carcinoma and human papillomavirus (HPV) vaccines (first licensed 2006) against cervical cancer. Initial implementation strategies for HBV vaccination were not successful in preventing disease in the community: it took 15 years for significant global reduction in the burden of this disease. Methods: We compare and contrast HBV vaccine experiences to challenges for successful global HPV vaccination strategies, and make recommendations accordingly. Results: Lessons from HBV immunisation for successful outcomes with HPV immunisation showed that several factors need to be met: (i) the engagement of key stakeholders in all aspects of planning and delivery of HPV vaccine strategies; (ii) understanding the specific characteristics of targeted population groups; (iii) global cooperation and support with WHO recommendations; (iv) Government supported mass immunization programs and cooperation between public and private entities; (v) affordable HPV vaccines for some regions; (vi) culturally appropriate and diverse public education programs in targeted health promotion strategies; (vii) pro-active health providers and parents in encouraging adolescents to undertake HPV vaccination; and (vii) eventual immunisation of infants. Conclusions: The key to success will be affordable, readily deliverable HPV vaccines to young girls as universal campaigns.

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Prophylactic human papillomavirus vaccines: the beginning of the end of cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200409000-00004 ◽

2004 ◽

Vol 14 (5) ◽

pp. 751-761 ◽

Cited By ~ 3

Author(s):

W. A. A. Tjalma ◽

M. Arbyn ◽

J. Paavonen ◽

T. R. Van Waes ◽

J. J. Bogers

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Neutralizing Antibodies ◽

Hpv Vaccination ◽

Phase Iii ◽

Hpv Vaccines ◽

Therapeutic Vaccines ◽

The Status ◽

Prophylactic Vaccines

Persistent infection with one of the oncogenic human papillomavirus (HPV) types is a necessity for the development of cervical cancer. By HPV vaccination, cervical cancer could become a very rare disease. Two types of HPV vaccines can be distinguished: (i) therapeutic vaccines which induce cellular immunity targeted against epithelial cells infected with HPV and (ii) prophylactic vaccines inducing virus-neutralizing antibodies protecting against new but not against established infections. At present, several vaccines have been developed and tested in clinical trials. The vaccines are generally well tolerated and highly immunogenic. The current clinical data indicate that prophylactic vaccines are very effective against new persistent infections and the development of cervical intraepithelial lesions. The protection is type specific. However, the follow-up of the vaccination trials is still short. The effect of HPV vaccines on future cancer incidence will only be known after decades of follow-up. This article will address the status of recently terminated phase II and currently running phase III trials with prophylactic HPV vaccines.

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Study protocol: Yarning about HPV Vaccination: a qualitative study of factors influencing HPV vaccination among Aboriginal and Torres Strait Islander adolescents in Australia

BMJ Open ◽

10.1136/bmjopen-2020-047890 ◽

2021 ◽

Vol 11 (8) ◽

pp. e047890

Author(s):

Lisa J Whop ◽

Tamara L Butler ◽

Julia M L Brotherton ◽

Kate Anderson ◽

Joan Cunningham ◽

...

Keyword(s):

Cervical Cancer ◽

Torres Strait Islander ◽

Hpv Vaccination ◽

Immunisation Programme ◽

Ethics Committee ◽

Research Approach ◽

Indigenous Research ◽

Vaccination Uptake ◽

School Based ◽

Torres Strait

IntroductionAboriginal and Torres Strait Islander women experience a higher burden of cervical cancer than non-Indigenous women in Australia. Cervical cancer is preventable partly through human papillomavirus (HPV) vaccination; in Australia, this is delivered through the national school-based immunisation programme. While HPV vaccination uptake is high among Australian adolescents, there remain gaps in uptake and completion among Aboriginal and Torres Strait Islander adolescents. This study aims to gain a comprehensive understanding of the barriers and facilitators to HPV vaccination uptake and completion among Aboriginal and Torres Strait Islander adolescents in Queensland, Australia.Methods and analysisThe study will be guided by an Indigenist research approach and an ecological model for health promotion. Yarning, a qualitative Indigenous research method, will be conducted in up to 10 schools. Participants will include Year 7 (12/13 years old) Aboriginal and Torres Strait Islander adolescents; parents/caregivers; and local key informants and immunisation programme partners involved in the delivery of school-based HPV immunisation programme. Participants will be recruited through school representatives and investigator networks using purposive and snowball sampling and samples of convenience. Field notes, HPV vaccination clinic observations and sequential diagramming of the HPV vaccination process will be conducted. Thematic analysis of data will be led by Aboriginal and Torres Strait Islander researchers. Synthesised sequential diagrams of the process of HPV vaccination and qualitative themes summarising key findings will be produced.Ethics and disseminationThe Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (1646/20), the Australian National University Human Research Ethics Committee (HREC, 2020/478), the HREC of the Northern Territory Department of Health and Menzies School of Health Research (19-3484) and the Townsville Hospital and Health Service HREC (HREC/QTHS/73789) have approved the study. Dissemination will occur via conferences and peer-reviewed publications. Further dissemination will be determined in partnership with the Aboriginal and Torres Strait Islander Steering Committee, including Youth Representatives and Consultation Network.

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Nurses’ and teachers’ perceived barriers and facilitators to the uptake of the Human Papilloma Virus (HPV) vaccination program in Iquitos, Peru: A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0255218 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255218

Author(s):

Anna Clavé Llavall ◽

Gilles de Wildt ◽

Graciela Meza ◽

Jasmine Tattsbridge ◽

Laura Jones

Keyword(s):

Cervical Cancer ◽

Community Education ◽

Ecological Model ◽

Hpv Vaccination ◽

Barriers And Facilitators ◽

Vaccine Uptake ◽

Vaccination Program ◽

Papilloma Virus ◽

Vaccination Uptake ◽

Depth Interviews

Globally, over 300,000 women die of cervical cancer annually. Given that human papillomavirus vaccines are highly effective in the primary prevention of cervical cancer, it is important to explore the barriers and facilitators to vaccination uptake in areas where the burden of disease remains high. This study, informed by the socio-ecological model, aimed to qualitatively explore vaccination uptake via in-depth interviews with eleven nurses and ten teachers involved in vaccine delivery in Iquitos, Peru. The results highlighted that vaccine uptake was influenced by multiple factors including individuals’ knowledge and attitudes, community beliefs, geography, and policy level variables. Findings suggested that professionals were informed and supportive of the HPV vaccination program but perceived that parents were uninformed about the vaccine. There is a need for community education programs, for a revision of the process of obtaining parental consent, for improved communication between professionals and for involvement of grassroots staff in policy making.

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Awareness of HPV and HPV vaccination in undergraduate students in the North West region of Turkey: Near future outlook

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11405 ◽

2019 ◽

Vol 13 (06) ◽

pp. 516-525

Author(s):

Gulden Aynaci ◽

Zuhal Gusku

Keyword(s):

Cervical Cancer ◽

Young People ◽

University Students ◽

Undergraduate Students ◽

Health Knowledge ◽

Hpv Vaccination ◽

Sexual Life ◽

Hpv Vaccines ◽

Transmitted Infection ◽

Cross Sectional

Introduction: Cervical cancer is the second most common cancer affecting women in the world. Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. The aim of this study was to evaluate the awareness about HPV, risk perception, cervical cancer, and HPV vaccines. Methodology: The sample of this descriptive cross-sectional study consisted of 396 undergraduate university students from Turkey. Sociodemographic characteristics, reproductive health, knowledge about HPV, and HPV vaccination were questioned. Results: The percentage of university students with an active sexual life was 10.6%. The knowledge level of families about HPV, and HPV vaccination were not adequate. The awareness of the fact that HPV was a cause of cervical cancer in women and penile cancer in men tended to increase with the increase in the educational level of parents. Those who knew about HPV vaccines were predominantly females. Conclusions: The results of this study demonstrated that more active education is needed to decrease HPV infections among undergraduate students. Increasing awareness of HPV makes it easier to develop positive behaviors in fighting against it. In order to increase the contribution of young people to educational activities for the community, information about HPV and HPV vaccines should first be included in training programs at universities. To support the development of effective and high-quality public health interventions, young people should be educated so that obstacles to HPV vaccination in various cultural groups can be eliminated. Our findings suggest that awareness about HPV, cervical cancer, and HPV vaccines should be increased.

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Community groups to increase Human papillomavirus (HPV) vaccination through Participatory Learning and Action, Reducing barriers and increasing community Mobilisation in Zambia (CHARMZ) project.

10.21203/rs.3.rs-56035/v1 ◽

2020 ◽

Author(s):

Katarina Hoernke

Keyword(s):

Cervical Cancer ◽

Hpv Vaccination ◽

Community Mobilisation ◽

Structured Interviews ◽

Community Based ◽

Community Groups ◽

Participatory Learning ◽

Vaccination Uptake ◽

Key Stakeholders ◽

Participatory Learning And Action

Abstract Background Zambia has a high incidence of cervical cancer. Uptake of the human papillomavirus (HPV) vaccine has been low since it first became available in Zambia in 2013. Community mobilisation and engagement with civil society has been identified as a key component of HPV vaccination programs in low and middle-income countries. Of the evidence available on community-based interventions in the context of HPV, participatory approaches which work closely with local stakeholders to identify and overcome barriers to HPV vaccination uptake have shown promising results. This is a proposal for a community-based cluster randomised controlled trial to increase HPV vaccination uptake in Zambia through a participatory learning and action (PLA) cycle approach in community groups. PLA is an approach in which participants identify and prioritise problems, and subsequently develop, implement and evaluate solutions to improve the health needs of their community. Key stakeholders to be engaged in this project include government members, policymakers, healthcare, donors and relevant non-governmental organisations (NGO), religious leaders, and civil society members. Formative research will be carried out with key stakeholders through semi-structured interviews and focus group discussions. The community group intervention will be facilitated by local healthcare workers from the cervical cancer prevention program in Zambia (CCPPZ).Results Success will be indicated by an increase in HPV vaccination uptake. The primary outcome will be HPV vaccination rates measured quantitatively. Data will be gathered once at the start of the study, once midway through the PLA phase and once during the post-intervention phase. Questionnaires and semi-structured interviews will allow for measurement of secondary outcomes both quantitatively and qualitatively, including perceived (i) HPV vaccination and cervical cancer knowledge, (ii) acceptability, accessibility and equitability of the HPV vaccination, as well as (iii) attitudes of female group members towards other cervical cancer screening and treatment services.Conclusions There is a need to address the high cervical cancer disease burden in Zambia. This would be the first intervention aiming to increase HPV vaccination uptake in Zambia through a low-cost, sustainable and scalable community-based participatory learning and action cycle approach.

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Burden of Human Papillomavirus (HPV)-Related Cancers Attributable to HPVs 6/11/16/18/31/33/45/52 and 58

JNCI Cancer Spectrum ◽

10.1093/jncics/pky045 ◽

2018 ◽

Vol 2 (4) ◽

Cited By ~ 27

Author(s):

Silvia de Sanjosé ◽

Beatriz Serrano ◽

Sara Tous ◽

Maria Alejo ◽

Belén Lloveras ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Hpv Vaccines ◽

Middle Income ◽

Vaccination Programs ◽

Hpv Dna ◽

Hpv E6 ◽

Potential Impact

Abstract Background Many countries, mainly high- and upper-middle income, have implemented human papillomavirus (HPV) vaccination programs, with 47 million women receiving the full course of vaccine (three doses) in 2014. To evaluate the potential impact of HPV vaccines in the reduction of HPV-related disease, we aimed to estimate the HPV type distribution and burden of anogenital and head and neck cancers attributable to HPV types (HPVs 16/18/31/33/45/52/58/6/11) included in currently licensed HPV vaccines. Methods In all, 18 247 formalin-fixed paraffin-embedded specimens were retrieved from 50 countries. HPV DNA detection and typing were performed with the SPF-10 PCR/DEIA/LiPA25 system. With the exception of cervical cancer, HPV DNA-positive samples were additionally subjected to HPV E6*I mRNA detection and/or p16INK4a immunohistochemistry. For cervical cancer, estimates were based on HPV DNA, whereas for other sites, estimates were based on HPV DNA, E6*I mRNA, and p16INK4a biomarkers. Results The addition of HPVs 31/33/45/52/58 to HPVs 16/18/6/11 in the nonavalent HPV vaccine could prevent almost 90% of cervical cancer cases worldwide. For other sites, the nonavalent HPV vaccine could prevent 22.8% of vulvar, 24.5% of penile, 60.7% of vaginal, 79.0% of anal cancers, 21.3% of oropharyngeal, 4.0% of oral cavity, and 2.7% of laryngeal cancer cases. Conclusions Our estimations suggest a potential impact of the nonavalent HPV vaccine in reducing around 90% of cervical cancer cases and a global reduction of 50% of all the cases at HPV-related cancer sites.

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Internet Survey of Awareness and Behavior Related to HPV Vaccination in Japan

Vaccines ◽

10.3390/vaccines9020087 ◽

2021 ◽

Vol 9 (2) ◽

pp. 87

Author(s):

Risa Kudo ◽

Masayuki Sekine ◽

Manako Yamaguchi ◽

Megumi Hara ◽

Sharon J. B. Hanley ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Sexual Activity ◽

Large Scale ◽

Hpv Vaccination ◽

Social Background ◽

Internet Survey ◽

Hpv Vaccines ◽

Poor Knowledge ◽

High Risk Sexual Behavior

Recommendations for HPV vaccines were suspended in 2013 due to unfounded safety fears in Japan. We aimed to clarify the differences between vaccinated and unvaccinated females in their awareness, knowledge, and behaviors toward cervical cancer, HPV vaccination and sex. Questionnaires were administered online to women aged 16 to 20. We conducted investigations for the following: awareness, knowledge, and actions for cervical cancer, HPV vaccination, and sexual activity, as well as items related to participants’ social background. The survey in 828 girls revealed three points. The first is that more than half of the surveyed Japanese girls had poor knowledge about cervical cancer screening, HPV, or HPV vaccines. The second is that those in the unvaccinated group had a particularly poor knowledge of the subject and tended to have higher sexual activity. The final is that only 0.5% of the girls experienced changes in awareness about sexual activity after vaccination. In conclusion, this is the first large-scale survey analyzing the association between HPV vaccination and sexual activity in Japanese girls. Not only do unvaccinated girls not benefit from vaccines, but they also tend to engage in high-risk sexual behavior, and thus it is even more important to provide information on the effectiveness of vaccines and the usefulness of cancer screening.

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Impact of Web-Based Health Education on HPV Vaccination Uptake Among College Girl Students in Western and Northern China: A Follow-Up Study

10.21203/rs.3.rs-785616/v1 ◽

2021 ◽

Author(s):

Xi Zhang ◽

Hui Chen ◽

Jing Zhou ◽

Jing Li ◽

Qian Huang ◽

...

Keyword(s):

College Students ◽

Health Education ◽

Hpv Vaccination ◽

Northern China ◽

Female College Students ◽

Control Group ◽

Hpv Vaccines ◽

Web Based ◽

Female College ◽

Vaccination Uptake

Abstract Objective: To investigate the knowledge of human papillomavirus (HPV) and HPV vaccines, HPV vaccination uptake, and vaccination willingness among female college students, and to explore the effect of a web-based educational intervention, immediately and at one month later, on HPV knowledge, vaccine acceptability and uptake among female college students in Western and Northern China. Methods: A web-based interventional follow-up study was conducted at two universities in Western and Northern China between February and April 2020. Female freshmen were required to complete an online questionnaire, and then eligible students were randomized into intervention and control group. Students in the intervention group received 7-days of web-based health education regarding HPV and HPV vaccines, while the control group received educational materials unrelated to HPV prevention. All students were asked to complete post-intervention questionnaire to assess their awareness, uptake, and willingness regarding HPV vaccination at a 7 days and 30 days interval, respectively. Differences between intervention and control groups were compared using the Chi-square test. Multivariable logistic regression was used to analyze the influencing factors of vaccination intentions. Results: A total of 967 participants were included in this study. Prior to the intervention, 63.8%, 66.3%, and 60.8% of students had heard of HPV, HPV-related diseases, and HPV vaccines, respectively. However, only 2.2% of students had reported to have been vaccinated, and 33.0% were willing to be vaccinated against HPV. After 7-days education, students in the intervention group had higher awareness and willingness of HPV vaccines than those in the control group. Major reasons that college female students do not accept HPV vaccines were the high cost (57.7%) and concerns about the adverse events (56.0%). School location, education background of parents, history of counseling about HPV vaccines, history of sexual behavior, and having heard of HPV vaccines are influencing factors on willingness to be vaccinated. Conclusion: The female college students’ HPV vaccination uptake is insufficient, and they have minimal detailed knowledge about HPV and its vaccines. Web-based health education on HPV vaccines is an easy, feasible, and effective way to improve the awareness and acceptance of HPV vaccination among female college students, but it has limited effect on improving HPV vaccination uptake.

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