Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 201-2206 East Mall, Vancouver, BC V6T1Z3, Canada.
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Health Policy Plan. 2020 Oct 1;35(8):1021-1028. doi: 10.1093/heapol/czaa083.
Increasing human papilloma virus (HPV) vaccination coverage is one of the key approaches to preventing cervical cancer globally. However, some argue that HPV vaccine recipients may engage in risky compensatory sexual behaviours because of perceived protection afforded by the vaccine. Therefore, we investigated the impact of a wide-scale HPV vaccination programme on sexual behaviours among adolescent women in Rwanda-the first African country to implement a national HPV vaccination. We identified a cohort of women who were eligible for the HPV vaccination and those who were not eligible from the most recent Rwanda Demographic and Health Survey. We used a quasi-experimental regression discontinuity design, exploiting the quasi-random change in HPV vaccination eligibility in 2011, to compare sexual behaviours among vaccinated and unvaccinated adolescent women. We studied the impact of the vaccination on reported sexual intercourse, average number of sexual partners and teenage pregnancy across the vaccination eligibility threshold. Our analysis included 3052 adolescent women (mean age: 18.6 years), of whom 58% were eligible for HPV vaccination. Nearly one in five adolescents reported having had sexual intercourse (18.5%). The average reported lifetime number of sexual partners was 1.41. The proportion of teenage pregnancy was 5.3%. We found no evidence that HPV vaccination was associated with any significant changes across the eligibility threshold in reported sexual behaviours we studied: no significant increase in the proportion of having sexual intercourse [odds ratio (OR): 0.80, 95% confidence interval (CI): 0.57-1.12; P = 0.19], in lifetime number of sexual partners (rate ratio 0.99, 95% CI: 0.83-1.17, P = 0.91) and in the proportion of teen pregnancies (OR 1.05, 95% CI: 0.50 to 2.20, P = 0.89) at the eligibility threshold. The Rwandan national HPV vaccination programme did not increase sexual behaviours among adolescent women, assuaging concerns of engaging in risky compensatory sexual behaviours some have feared.
提高人乳头瘤病毒（HPV）疫苗接种率是全球预防宫颈癌的关键方法之一。然而，有人认为，由于疫苗提供的保护作用，HPV 疫苗接种者可能会采取危险的补偿性性行为。因此，我们调查了在卢旺达实施全国 HPV 疫苗接种计划对青少年女性性行为的影响——卢旺达是第一个实施全国 HPV 疫苗接种的非洲国家。我们从最近的卢旺达人口与健康调查中确定了一批有资格接种 HPV 疫苗的女性和没有资格接种 HPV 疫苗的女性。我们使用了准实验回归不连续性设计，利用 2011 年 HPV 疫苗接种资格的准随机变化，比较了接种和未接种 HPV 疫苗的青少年女性的性行为。我们研究了接种疫苗对越过接种资格门槛的报告性交、平均性伴侣数量和青少年怀孕的影响。我们的分析包括 3052 名青少年女性（平均年龄：18.6 岁），其中 58%有资格接种 HPV 疫苗。近五分之一的青少年报告有过性行为（18.5%）。报告的终生性伴侣平均数量为 1.41。青少年怀孕的比例为 5.3%。我们没有发现 HPV 疫苗接种与我们研究的报告性行为越过资格门槛有任何显著变化有关的证据：有性行为的比例没有显著增加[优势比（OR）：0.80，95%置信区间（CI）：0.57-1.12；P=0.19]，终生性伴侣数量（比率比 0.99，95%CI：0.83-1.17，P=0.91）和青少年怀孕的比例（OR 1.05，95%CI：0.50 至 2.20，P=0.89）在资格门槛处。卢旺达全国 HPV 疫苗接种计划并没有增加青少年女性的性行为，减轻了一些人担心的参与危险补偿性性行为的担忧。
