Knowledge differences between male and female university students about human papillomavirus (HPV) and cervical cancer: Implications for health strategies and vaccination

Knowledge about HPV and cervical cancer (CC) depends on several factors such as gender and education, which brings implications for health strategies and vaccination. A survey was conducted in Portugal with a representative sample of 1706 university students. Only 55.4% (n = 945) had already heard of HPV, although 88.3% (n = 834) from that know that is a risk factor for CC. 89% students (n = 841) wants to be vaccinated against it, but only 13.8% stated as main reason to be vaccinated “prevention of the disease”. Mean scores of knowledge were calculated. Statistical differences were found, regarding “CC knowledge”, in gender (p < 0.001) and between health sciences schools and non-health sciences schools (p < 0.001). Differences regarding the study area in “knowledge and beliefs of HPV” (p < 0.001) and in “relation between HPV and CC” (p < 0.001) were found. Therefore, these differences may help to develop effective strategies that lead to decline CC incidence and mortality.     

Singaporean men's knowledge of cervical cancer and human papillomavirus (HPV) and their attitudes towards HPV vaccination

Little is known of men's knowledge of cervical cancer and its links with human papillomavirus (HPV), or of their attitudes and beliefs about HPV vaccination. This is despite men's sexual behaviour contributing to HPV transmission and their potential role in deciding whether their children are vaccinated against HPV. To address this, a comprehensive survey was conducted in Singapore where plans are underway for an HPV vaccination program. A representative sample of 930 Singaporean men was found to have moderate knowledge of cervical cancer but poor knowledge and awareness of HPV. Although these men showed strong support for HPV vaccination, overall findings highlight the importance of including men in education campaigns that aim to decrease the incidence of cervical and other HPV-related cancers and to increase the uptake of HPV vaccination.     

Parents' health beliefs and HPV vaccination of their adolescent daughters

Though many studies have documented correlates of HPV vaccine acceptability, our study is one of the first to examine correlates of vaccine initiation. The current study aimed to identify modifiable correlates of HPV vaccine initiation among adolescent girls in high risk communities and whether correlates varied by race and urban/rural status. In 2007, we conducted a cross-sectional survey of 889 parents of adolescent girls aged 10–18 living in areas of North Carolina, USA with high cervical cancer rates. We analyzed data using logistic regression. Health Belief Model constructs were associated with HPV vaccine initiation in multivariate analyses, including doctor's recommendation to get HPV vaccine, perceived barriers to obtaining HPV vaccine, and perceived potential vaccine harms. While exploratory stratified analyses suggested that many of the same parent beliefs were important correlates of HPV vaccine initiation regardless of racial group or urban/rural status, a few differences did exist. These potentially modifiable beliefs offer well-defined targets for future interventions designed to increase HPV vaccine coverage. However, the beliefs' relative importance may differ between racial groups and regions.     

Knowledge,attitudes and acceptance toward Human papillomavirus (HPV) vaccination: Perspectives of Muslim women and men

ObjectivesHuman papillomavirus (HPV) infection is the leading risk factor for the development of anogenital cancers. Most Arab countries lack both HPV education and national HPV vaccination programs. The objective of this study was to assess knowledge, attitudes, and acceptance toward HPV vaccination in men and women from Oman, a country in the Middle Eastern North Africa region.MethodsThis cross-sectional quantitative study used convenience sampling to recruit male and female participants, aged 18 years and above from all 11 governorates of Oman to complete a validated self-administered questionnaire online in the Arabic language. The questionnaire comprised five sections, with a total of 32 questions. The questionnaire, including Arabic and English versions, was content validated and piloted.ResultsA total of 1403 participants, including 952 parents and 369 healthcare providers, completed the survey. The results showed a lack of knowledge regarding HPV infection and vaccines, including among healthcare providers. Less than a quarter of the participants had heard of HPV infection, with digital sources of information being the most common. Factors such as being a woman or a healthcare provider or completing higher levels of education were independently and significantly positively association with HPV awareness (p < 0.001). The majority of the participants lacked vaccine safety knowledge, had concerns about the vaccine's side effects, and sought reassurance of its protection against HPV infection (62%, 71.5%, and 84.6%, respectively). Nevertheless, nearly two-thirds of the participants agreed to take the HPV vaccine, with support for both boys and girls being vaccinated. There was almost universal agreement among the participants regarding the need for parental and adolescent HPV educational programs.ConclusionOmani women and men showed a high level of acceptance and favorable attitude toward HPV vaccination. The study findings support future efforts to implement school and public-level HPV education and a national HPV vaccination program in Oman.     

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

IntroductionHuman papillomavirus (HPV) vaccination has not been introduced in many countries in South-Central Asia, including Afghanistan, despite the sub-region having the highest incidence rate of cervical cancer in Asia. This study estimates the potential health impact and cost-effectiveness of HPV vaccination in Afghanistan to inform national decision-making.MethodAn Excel-based static cohort model was used to estimate the lifetime costs and health outcomes of vaccinating a single cohort of 9-year-old girls in the year 2018 with the bivalent HPV vaccine, compared to no vaccination. We also explored a scenario with a catch-up campaign for girls aged 10–14 years. Input parameters were based on local sources, published literature, or assumptions when no data was available. The primary outcome measure was the discounted cost per disability-adjusted life-year (DALY) averted, evaluated from both government and societal perspectives.ResultsVaccinating a single cohort of 9-year-old girls against HPV in Afghanistan could avert 1718 cervical cancer cases, 125 hospitalizations, and 1612 deaths over the lifetime of the cohort. The incremental cost-effectiveness ratio was US$426 per DALY averted from the government perspective and US$400 per DALY averted from the societal perspective. The estimated annual cost of the HPV vaccination program (US$3,343,311) represents approximately 3.53% of the country′s total immunization budget for 2018 or 0.13% of total health expenditures.ConclusionIn Afghanistan, HPV vaccine introduction targeting a single cohort is potentially cost-effective (0.7 times the GDP per capita of $586) from both the government and societal perspective with additional health benefits generated by a catch-up campaign, depending on the government′s willingness to pay for the projected health outcomes.     

The cost-effectiveness of human papillomavirus vaccination in the Philippines

Cervical cancer is the second most common cancer among women in the Philippines. Human papillomavirus (HPV) vaccination provides protection from the most common cancer-causing HPV types. This analysis used a proportionate outcomes model to estimate the potential cost-effectiveness of four different HPV vaccine products—Cervarix?, Cecolin®, GARDASIL®, and GARDASIL®9—for routine HPV vaccination of 10 cohorts of 9-year-old girls from the government and societal perspectives. Model parameters included cervical cancer burden, healthcare and program costs, vaccine efficacy with and without potential cross-protection, and vaccination coverage. Univariate and probabilistic sensitivity analyses evaluated the impact of uncertainty on model results. Compared to no vaccination, HPV programs with Cecolin®, Cervarix?, and GARDASIL® are projected to be cost-effective at US$1,210, US$1,300, and US$2,043 per DALY averted, respectively, from the government perspective, and at US$173, US$263, and US$1,006 per DALY averted, respectively, from the societal perspective when cross-protection was considered. When direct comparisons were made across vaccines, GARDASIL® was dominated by Cervarix? and Cecolin®. In a scenario where cross-protection was not considered, results were similar except that Cervarix? and GARDASIL® were both dominated by Cecolin®. GARDASIL®9 was not cost-effective under any of the modeled scenarios.     

澳门妇女和医师对HPV疫苗的认知态度调查及其推广应用分析

目的了解澳门特别行政区女性和执业医师在人乳头瘤病毒(human papillomavirus,HPV)疫苗纳入免费防疫接种计划之前对其认知、接受度,及疫苗的使用情况,分析影响接种的主要因素,评估HPV疫苗在澳门发展情况,为宫颈癌预防工作提供适当的模式。方法 2008年8~12月采用问卷抽样调查方式对澳门特别行政区1 716名女性及108名执业医师进行问卷调查,利用SPSS 13.5软件进行统计分析。结果受调查妇女中,47.1%的女性曾听过HPV,76.7%的女性听过宫颈癌疫苗,认为HPV感染与宫颈癌有关联性的仅为35.4%。另外,38.4%的女性及其中43.4%的母亲愿意自己或女儿接种疫苗。据多因素logistic回归分析得出年龄、个人收入、职业、个人防护、担心患宫颈癌、担心疫苗来源、认为自己年龄太大或太小是影响接受疫苗的主要因素。澳门医师对HPV及HPV疫苗都有中高度认知。约60%受调查医师对HPV疫苗有信心,而评价疫苗的不足主要是价格太贵。结论澳门宣传有关HPV及HPV疫苗的知识是有效的,HPV疫苗在澳门使用人数逐渐增加。为增加澳门居民对疫苗的接受程度,达到预防宫颈癌的目的,政府仍需采用多种宣传方式加强宣传力度。     

深圳地区女性流动人群HPV预防性疫苗接种意愿调查及影响因素分析

目的 了解深圳地区女性流动人群对HPV及其疫苗的认知情况及疫苗接种意愿和相关影响因素。方法 于2015年1-6月在深圳市10个行政区各社康中心对21～60岁女性流动人群进行问卷调查,采用非条件logistic回归模型分析HPV疫苗接种意愿的影响因素。结果 本次调查的969名女性流动人群平均年龄为（35.34±8.21）岁,仅有283人（29.2%）听说过人乳头瘤病毒,但548人（56.6%）愿意接种HPV预防性疫苗。不愿意接种的主要原因有:“担心疫苗的安全性”（34.7%）、“疫苗还没有大面积推广”（17.8%）、“疫苗的价格问题”（11.4%）、“对疫苗的效果不信任”（9.7%）、“认为没有患子宫颈癌的危险”（9.7%）及“已经有性生活,接种与否没有什么不同”（8.3%）。多因素logistic回归分析显示,中部地区（OR = 1.537,95%CI:1.034～2.286）和东部地区（OR = 2.252,95%CI:1.641～3.091）、汉族（OR = 1.698,95%CI:1.018～2.832）、高中及以上学历（OR = 2.150,95%CI:1.345～3.437)、近6个月性伴数为2个及以上（OR = 2.019,95%CI:1.105～3.689)的妇女对HPV疫苗接种意愿更高。结论 深圳地区女性流动人群HPV及其疫苗知晓率较低,接种意愿相对较高。地区、民族、受教育程度、性伴数量是影响女性流动人群HPV疫苗接种意愿的相关因素。     

Preparing for HPV vaccination in South Africa: key challenges and opinions

This article reports on qualitative research investigating key challenges and barriers towards human papillomavirus (HPV) vaccine introduction in the Western Cape Province, South Africa. A total of 50 in-depth interviews and 6 focus groups were conducted at policy, health service and community levels of enquiry. Respondents expressed overall support for the HPV vaccine, underscored by difficulties associated with the current cervical screening programmes and the burgeoning HIV/AIDS epidemic in South Africa. Overall poor community knowledge of cervical cancer and the causal relationship between HPV and cervical cancer suggests the need for continued education around the importance of regular cervical screening. The optimal target populations for HPV vaccination was influenced by the perceived median age of sexual activity in South African girls (9-15 years), with an underlying concern that high levels of sexual abuse had significantly decreased the age of sexual exposure suggesting vaccination should commence as early as 9 years. Vaccination through schools with the involvement of other stakeholders such as sexual and reproductive health and the advanced programme on immunization (EPI) were suggested. Opposition to the HPV vaccine was not anticipated if the vaccine was marketed as preventing cervical cancer rather than a sexually transmitted infection. The findings assist in identifying potential barriers and facilitating factors towards HPV vaccines and will inform the development of policy and programs to support HPV vaccination introduction in South Africa and other African countries.     

Human papillomavirus (HPV) vaccine implementation in low and middle-income countries (LMICs): Health system experiences and prospects

Prophylactic vaccines for human papillomavirus (HPV) are being introduced in many countries for the prevention of cervical cancer, the second most important cause of cancer-related death in women globally. This is likely to have a significant impact on the future burden of cervical cancer, particularly where screening is non-existent or limited in scale. Previous research on the challenges of vaccinating girls with the HPV vaccine has focused on evidence from developed countries. We conducted a systematic search of the literature in order to describe the barriers and challenges to implementation of HPV vaccine in low- and middle-income countries. We identified literature published post-2006 to September 2012 from five major databases. We validated the findings of the literature review with evidence from qualitative key informant interviews. Three key barriers to HPV vaccine implementation were identified: sociocultural, health systems and political. A linked theme, the sustainability of HPV vaccines programmes in low- and middle-income countries, cuts across these three barriers. Delivering HPV vaccine successfully will require multiple barriers to be addressed. Earlier research in developed countries emphasised sociocultural issues as the most significant barriers for vaccine roll-out. Our evidence suggests that the range of challenges for poorer countries is significantly greater, not least the challenge of reaching girls for three doses in settings where school attendance is low and/or irregular. Financial and political barriers to HPV vaccine roll-out continue to be significant for many poorer countries. Several demonstration and pilot projects have achieved high rates of acceptability and coverage and lessons learned should be documented and shared.     

Modeling HPV vaccination scale-up among urban young men who have sex with men in the context of HIV

IntroductionYoung men who have sex with men (YMSM) are at high risk to contract human papillomavirus (HPV). While an effective vaccination exists, its use among YMSM is markedly lower compared to non-MSM and women. This study compares scaling up HPV vaccination in conjunction with other prevention strategies.MethodsAn agent-based model of urban YMSM (≤26 years of age) reflective of the demography of Philadelphia, PA, simulated for up to ten years of follow-up to examine anal and oral transmission of the HPV genotypes covered in the nonavalent (9v) vaccine: 6, 11, 16, 18, 31, 33, 45, 52, 58. Starting HPV prevalences ranged from a high of 18% (type 6) to a low of 6% (type 31); overall 65% of individuals carried any HPV genotype. Simulated levels of vaccination were ranged from 0% to 13% (present-day level), 25%, 50%, 80% (Healthy People 2020 target), and 100% in conjunction with condom use and HIV seroadaptive practices. The primary outcome was the relative reduction in HPV infection.ResultsCompared to present-day vaccination levels (13%), scaling-up vaccination led to expected declines in 10-year post-simulation HPV prevalence. Anal HPV (any 9v types) declined by 9%, 27%, 46%, and 58% at vaccination levels of 25%, 50%, 80%, and 100%, respectively. Similarly, oral HPV (any 9v types) declined by 11%, 33%, 57%, and 71% across the same levels of vaccine uptake. Comparing the prevention strategies, condoms blocked the greatest number of anal transmissions when vaccination was at or below present-day levels. For oral transmission, vaccination was superior to condom use at all levels of coverage.ConclusionsPublic health HPV preventions strategies should continue to emphasize the complementary roles of condoms and vaccination, especially for preventing oral infection. Improving vaccination coverage will ultimately have the greatest impact on reducing HPV infection among YMSM.     

Outsmart HPV: Acceptability and short-term effects of a web-based HPV vaccination intervention for young adult gay and bisexual men

BackgroundEffective interventions to promote human papillomavirus (HPV) vaccination are needed, particularly among populations at increased risk of HPV-related disease. We developed and pilot tested a web-based intervention, Outsmart HPV, to promote HPV vaccination among young gay and bisexual men (YGBM).MethodsIn 2016, we recruited a national sample (n = 150) of YGBM ages 18–25 in the United States who had not received any doses of HPV vaccine. Participants were randomized to receive either standard HPV vaccination information (control) or population-targeted, individually-tailored content (Outsmart HPV intervention). We assessed between group differences in HPV vaccination attitudes and beliefs immediately following the intervention using multiple linear regression.ResultsThere were no differences in HPV vaccination attitudes, beliefs and intentions between groups at baseline. Compared to participants in the control group, intervention participants reported: greater perception that men who have sex with men are at higher risk for anal cancer relative to other men (b = 0.34); greater HPV vaccination self-efficacy (b = 0.15); and fewer perceived harms of HPV vaccine (b = −0.34) on posttest surveys (all p < .05). Overall, intervention participants reported high levels of acceptability and satisfaction with the Outsmart HPV intervention (all > 4.4 on a 5-point scale).ConclusionsFindings from this study provide preliminary support for a brief, tailored web-based intervention in improving HPV vaccination attitudes and beliefs among YGBM. An important next step is to determine the effects of Outsmart HPV on HPV vaccine uptake.Clinical trials registrationClinicalTrials.gov identifier NCT02835755.     

Strategies to vaccinate against cancer of the cervix: feasibility of a school-based HPV vaccination program in Peru

Operational research using a mixed method, cross-sectional, case-study approach assessed the feasibility and health system impact of large-scale implementation of human papillomavirus (HPV) vaccination into routine vaccine delivery by the Ministry of Health in Peru. The strategy was school-based vaccination of fifth grade girls in 527 primary schools in Piura region. Our evaluation showed that school-based HPV vaccination is feasible without major changes in existing health systems. This was reflected in the opinions of health personnel, the lack of impact on other vaccine coverage, and the high HPV vaccine coverage documented in routine records and by an independent community-based survey.     

Epidemiological impact of the human papillomavirus vaccination program on genital warts in Portugal: A retrospective,chart review study

BackgroundThe quadrivalent human papillomavirus (HPV) vaccine was introduced in the Portuguese National Immunization Program in October 2008, targeting 13-year-old girls. This study aimed at evaluating the impact of HPV vaccination on the epidemiology of genital warts (GWs) in Portugal.MethodsObservational, retrospective chart review study conducted at two free-of-charge walk-in sexually transmitted diseases (STD) clinics in Lisbon region. The medical records of all patients attending a first STD consultation at the study centers between May 2006 and December 2017 (observation period) were reviewed. The number of patients diagnosed with GWs and/or chlamydial infection at each year was documented and used to determine yearly prevalence of both conditions throughout the observation period. We broke down the observation period into pre-vaccination (May 2006 to December 2008) and vaccination (January 2009 to December 2017) periods.ResultsMost patients were male (69.5%) and aged ≥ 25 years (78.1%). The majority of male patients were men who have sex with women (62.0%). Marked decreases in the prevalence of GWs between the last year of the pre-vaccination period (2008) and the last year of the observation period (2017) were found for female patients aged ≤ 19 and 20–24 years (86.8% and 77.4%, respectively). Lower decreases were observed for male patients of the same age groups (38.5% and 19.3%, respectively). GWs prevalence increased among patients ≥ 25 years (9.7% and 14.7% among female and male patients, respectively). Overall prevalence of chlamydial infection increased by 75.9% between 2008 and 2017.ConclusionsThis study contributes to the body of evidence showing that public HPV vaccination programs are effective in reducing the prevalence of GWs among vaccine-eligible patients. HPV vaccination program may significantly reduce the burden associated with GWs in Portugal.     

Development and pre/post testing of a decision aid supporting Chinese parental and young women’s HPV vaccination decision-making

ABSTRACT

We developed and tested the acceptability and utility of a novel HPV vaccination decision aid (DA) among Chinese young women aged 18–26 years and parents of adolescent girls aged 9–17 years. From March to May 2016, a total of 101 parents plus 109 young women completed baseline surveys assessing their HPV vaccination knowledge, decision self-efficacy, decision conflict, and HPV vaccination intention. Two weeks after receiving the DA, 84 (83.2%) parents and 92 (84.4%) young women completed re-assessments. Chi-square tests or t-tests were performed to compare the before-and-after differences. Cohen’s d was calculated to indicate the effect size. After reading the DA, both participating young women’s and parents’ knowledge of HPV vaccination (Cohen’s d = 0.62 among young women and d = 0.59 among parents) and decision self-efficacy (d = 0.38 among young women and d = 0.59 among parents) significantly increased. Both young women’s and parents’ decision conflict (d = ?0 · 98 and ?1.06) significantly decreased. The proportion of young women intending to receive HPV vaccination and parents deciding to vaccinate daughters against HPV significantly increased (p < 0 · 0001). The DA showed good acceptability and utility facilitating HPV vaccination decision-making for most Chinese young women and parents of adolescent girls. Further randomized controlled trials of this tool are essential.     

辽阳地区HPV感染亚型分布及HPV疫苗接种意向调查

目的分析辽阳地区HPV感染亚型分布及HPV疫苗接种意向。方法以2017年11月至2019年12月在辽阳市中心医院妇产科体检进行HPV筛查的辽阳地区女性3612例作为研究对象,分析人群的HPV感染情况,比较不同年龄的HPV感染、多重HPV感染之间的差异,研究HPV疫苗接种意愿的影响因素。结果HPV感染阳性患者576例,感染率为15.95%。不同年龄的HPV感染情况之间的差异有统计学意义(χ2=9.261,P=0.000)。在低危型感染中,主要以HPV55、HPV61、HPV81为主,高危型感染中,主要以HPV16、HPV51、HPV66、HPV53为主。多因素分析中,年龄较低、家庭月收入较少、大学生在读以及所学专业或从事专业为非医药人群的HPV疫苗的意向显著降低。结论辽阳地区的高危型HPV主要为HPV16、HPV51、HPV66、HPV53,建议重点对年龄较小、家庭月收入较少、大学生在读以及所学专业或从事专业为非医药人群进行干预,以降低宫颈癌发病。     

Introduction of a National HPV vaccination program into Bhutan

BackgroundCervical cancer is the most common cancer in Bhutanese women. To help prevent the disease, the Ministry of Health (MoH) developed a national human papillomavirus (HPV) vaccine program.MethodsMoH considerations included disease incidence, the limited reach of cervical screening, poor outcomes associated with late diagnosis of the disease, and Bhutan's ability to conduct the program. For national introduction, it was decided to implement routine immunization for 12 year-old girls with the quadrivalent HPV6/11/16/18 (QHPV) vaccine and a one-time catch-up campaign for 13–18 year-old girls in the first year of the program (2010). Health workers would administer the vaccine in schools, with out-of-school girls to receive the vaccine at health facilities. From 2011, HPV vaccination would enter into the routine immunization schedule using health-center delivery.ResultsDuring the initial campaign in 2010, over 130,000 doses of QHPV were administered and QHPV 3-dose vaccination coverage was estimated to be around 99% among 12 year-olds and 89% among 13–18 year-olds. QHPV vaccine was well tolerated and no severe adverse events were reported. In the three following years, QHPV vaccine was administered routinely to 12 year-olds primarily through health centers instead of schools, during which time the population-level 3-dose coverage decreased to 67–69%, an estimate which was confirmed by individual-level survey data in 2012 (73%). In 2014, when HPV delivery was switched back to schools, 3-dose coverage rose again above 90%.DiscussionThe rapid implementation and high coverage of the national HPV vaccine program in Bhutan were largely attributable to the strength of political commitment, primary healthcare and support from the education system. School-based delivery appeared clearly superior to health centers in achieving high-coverage among 12 year-olds.ConclusionsBhutan's lessons for other low/middle-income countries include the superiority of school-based vaccination and the feasibility of a broad catch-up campaign in the first year.     

浙江某地大学生性病/艾滋病防治知识、信念和行为

目的了解大学生性病／艾滋病有关知识、态度、行为以及对当前学校性教育的需求与评价，为制定适合当前大学生的干预策略和方案提供依据。方法对浙江省某市2所综合性大学所有在校全日制一～四年级学生22940人开展自答式问卷调查：结果大学生性安全知识仍较缺乏，43．9％～49．4％的大学生接触过各种黄色性媒体，8．1％的大学生认为自己可能会感染艾滋病，13．1％有婚前性行为，94.1％的大学生认为有必要在大学中开展性教育。结论教育不能只停留在性生理和性病／艾滋病知识教育的水平，更重要的是帮助学生建立正确的性态度和性行为，