Nakibuuka Violet, Muddu Martin, Kraehenbuhl Jean Pierre, Birungi Caroline, Semitala Fred C, Tusubira Andrew K
Makerere University Joint AIDS Program (MJAP), Kampala, Uganda.
Makerere University School of Medicine, Kampala, Uganda.
PLoS One. 2024 Aug 8;19(8):e0300155. doi: 10.1371/journal.pone.0300155. eCollection 2024.
Human Papilloma Virus (HPV) vaccination can prevent more than 90% of cancers caused by HPV. Although this vaccination is recommended and provided at no cost to all adolescent girls aged 9 to19 years in Uganda, its uptake remains low. We sought to determine the uptake of, and factors associated with HPV vaccination among adolescent girls living with HIV in Uganda.
We conducted an explanatory sequential mixed methods study, among adolescent girls living with HIV, attending HIV care at the Mulago ISS HIV clinic in Kampala, Uganda. We administered a structured questionnaire to elicit data on HPV vaccination and its covariates to a systematic random sample of 264 adolescent girls with HIV. A participant who had received all the three recommended HPV vaccine doses was classified as fully vaccinated. We then conducted four focus group discussions among adolescent girls living with HIV (n = 32), eight in-depth interviews among their parents and five Key informant interviews among their healthcare providers. We conducted descriptive statistics and logistic regression analyses for the quantitative data before thematic analysis for the qualitative data.
Of 264 adolescent girls, 31% (83/264) had at least one HPV vaccine dose; 22% (59/264) two doses, while 8.0% (21/264) were fully vaccinated (received three doses). While most participants received their first and second doses (48% (40/83)) and 57.6% (34/59), respectively) from school, the largest number of participants (47.1% (12/21)) received their third dose at community outreaches. Participants who received counseling from community members were three times more likely to get fully vaccinated compared to those who did not receive counseling (aOR 3.28, Cl:1.07-10.08, P = 0.038). From the qualitative follow-up, three major themes were identified: (1): Limited information about HPV vaccination, which gave room for misconceptions and doubts about the vaccine; (2) Parental influence on adolescent decisions was strong despite parents having limited knowledge about HPV vaccination and (3) Inadequacy of HPV vaccination services at the hospital and in the schools.
Full HPV vaccination was low among adolescent girls living with HIV. Counseling of the adolescents by community members, alongside HPV vaccination community outreaches, provided a platform for vaccination. There should be strategies to provide adequate information about HPV vaccine to health workers, parents, and the adolescents. In addition to schools, community-based initiatives, including outreaches and lay-health workers can be utilized to improve HPV vaccine uptake among girls with HIV.
人乳头瘤病毒（HPV）疫苗接种可预防90%以上由HPV引起的癌症。尽管乌干达建议为所有9至19岁的青春期女孩免费提供这种疫苗，但其接种率仍然很低。我们试图确定乌干达感染艾滋病毒的青春期女孩中HPV疫苗的接种情况及其相关因素。
我们在乌干达坎帕拉穆拉戈国际空间站艾滋病毒诊所接受艾滋病毒治疗的感染艾滋病毒的青春期女孩中进行了一项解释性序列混合方法研究。我们向264名感染艾滋病毒的青春期女孩的系统随机样本发放了一份结构化问卷，以获取有关HPV疫苗接种及其协变量的数据。接受了所有三剂推荐HPV疫苗的参与者被归类为完全接种。然后，我们在感染艾滋病毒的青春期女孩（n = 32）中进行了四次焦点小组讨论，在她们的父母中进行了八次深入访谈，并在她们的医疗服务提供者中进行了五次关键信息访谈。我们对定量数据进行了描述性统计和逻辑回归分析，然后对定性数据进行了主题分析。
在264名青春期女孩中，31%（83/264）至少接种了一剂HPV疫苗；22%（59/264）接种了两剂，而8.0%（21/264）完全接种（接种了三剂）。虽然大多数参与者分别从学校接种了第一剂和第二剂（分别为48%（40/83）和57.6%（34/59）），但接种第三剂的参与者中，最大比例（47.1%（12/21））是在社区外展活动中接种的。与未接受咨询的参与者相比，接受社区成员咨询的参与者完全接种的可能性高出三倍（调整后比值比3.28，置信区间：1.07 - 10.08，P = 0.038）。从定性随访中，确定了三个主要主题：（1）关于HPV疫苗接种的信息有限，这为对疫苗的误解和疑虑留出了空间；（2）尽管父母对HPV疫苗接种的了解有限，但父母对青少年决策的影响很大；（3）医院和学校的HPV疫苗接种服务不足。
感染艾滋病毒的青春期女孩中HPV疫苗的完全接种率较低。社区成员对青少年的咨询以及HPV疫苗接种社区外展活动提供了一个接种平台。应该制定策略，向卫生工作者、父母和青少年提供关于HPV疫苗的充分信息。除了学校之外，还可以利用包括外展活动和非专业卫生工作者在内的社区倡议，来提高感染艾滋病毒女孩的HPV疫苗接种率。
