Talabi Odunayo, Gilbert Hannah, Fawzi Mary C Smith, Anorlu Rose, Randall Thomas
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Infectious Disease Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
BMJ Public Health. 2023 Jul 19;1(1):e000003. doi: 10.1136/bmjph-2023-000003. eCollection 2023 Nov.
More than 80% of cervical cancer cases diagnosed globally are in low-income and middle-income countries. In sub-Saharan Africa, where treatment facilities are widely unavailable, it is a leading cause of cancer deaths in women. Human papillomavirus (HPV) vaccination, which is known to prevent almost 90% of cases of cervical cancer, has low uptake in this region, and little is known about the behaviour of those who have been offered the HPV vaccine. This knowledge is critical to guide policy-makers in sub-Saharan Africa on how best to roll out the vaccine and ensure successful and sustainable HPV vaccination programmes.
To better understand uptake of the HPV vaccine among schoolgirls in Nigeria, we designed a mixed-methods convergent study, with a case-control quantitative arm that recruited caregivers of adolescent schoolgirls as cases (those who accepted vaccination) and controls (those who did not accept vaccination). For the qualitative study, we conducted 10 focus group discussions with of caregivers and 6 in-depth interviews with school administrators, vaccination sponsors and policy-makers.
Those with high awareness of HPV vaccination had three times the odds of uptake (adjusted OR (aOR) 2.6, 95% CI 1.54 to 4.31, p=0.002). Giving HPV vaccines in school was also associated with uptake (aOR 3.1, 95% CI 1.54 to 6.43, p=0.002). Being offered free HPV vaccination was significant in the bivariate analysis (aOR 1.67, 95% CI 1.03 to 2.70, p=0.039) but was marginally significant in the multivariate analysis (aOR 0.63, 95% CI 0.37 to 1.06, p=0.086). Qualitative themes supported these findings, demonstrating that effective awareness and convenience of vaccination could encourage uptake. Key barriers to uptake included lack of affordability and limited availability of vaccines.
Effective awareness, administering HPV vaccines in school and subsidising HPV vaccination costs can improve uptake.
全球超过80%的宫颈癌确诊病例发生在低收入和中等收入国家。在撒哈拉以南非洲地区，治疗设施普遍匮乏，宫颈癌是导致女性癌症死亡的主要原因。人乳头瘤病毒（HPV）疫苗接种可预防近90%的宫颈癌病例，但该地区的疫苗接种率较低，而且对于那些已获得HPV疫苗接种机会的人的行为知之甚少。这些信息对于指导撒哈拉以南非洲地区的政策制定者如何以最佳方式推广该疫苗并确保HPV疫苗接种计划取得成功和可持续性至关重要。
为了更好地了解尼日利亚女学生对HPV疫苗的接种情况，我们设计了一项混合方法的趋同研究，其中定量研究采用病例对照法，招募青春期女学生的照顾者作为病例组（接受疫苗接种者）和对照组（未接受疫苗接种者）。对于定性研究，我们与照顾者进行了10次焦点小组讨论，并对学校管理人员、疫苗接种赞助商和政策制定者进行了6次深入访谈。
对HPV疫苗接种有较高认知度的人接种疫苗的几率是其他人的三倍（调整后的比值比（aOR）为2.6，95%置信区间为1.54至4.31，p = 0.002）。在学校接种HPV疫苗也与接种率相关（aOR为3.1，95%置信区间为1.54至6.43，p = 0.002）。在双变量分析中，提供免费HPV疫苗接种具有显著意义（aOR为1.67，95%置信区间为1.03至2.70，p = 0.039），但在多变量分析中仅具有边缘显著性（aOR为0.63，95%置信区间为0.37至1.06，p = 0.086）。定性研究主题支持了这些发现，表明有效的认知度和接种便利性可促进疫苗接种。疫苗接种的主要障碍包括费用负担不起和疫苗供应有限。
有效的认知度、在学校接种HPV疫苗以及补贴HPV疫苗接种费用可提高接种率。
