Dussault Josée, Gagneux-Brunon Amandine, Le Duc-Banaszuk Anne-Sophie, Bruel Sébastien, Michel Morgane, Gauchet Aurélie, Oudin Doglioni Damien, Sicsic Jonathan, Raude Jocelyn, Barret Anne-Sophie, Thilly Nathalie, Mueller Judith E
Institut Pasteur, Paris, France.
Centre International de Recherche en Infectiologie, Lyon, France.
BMJ Public Health. 2025 Aug 3;3(2):e001007. doi: 10.1136/bmjph-2024-001007. eCollection 2025.
Human papillomavirus (HPV) infections cause several cancers, including nearly all cervical cancer cases. While there are safe and effective vaccines, the adolescent HPV vaccine coverage in France is low (<50%). Thus, we studied the effect of municipality-wide interventions to increase HPV vaccine uptake and intention among middle school students.
This cluster-randomised trial used an incomplete factorial design to arrange three components (in-school education, motivation, mobilisation (EMM); in-school vaccination; and local general practitioner (GP) trainings) into six intervention conditions, which were randomly assigned to 91 participating French municipalities. We assessed HPV vaccine status using online self-reported questionnaires that students (typically aged 13-14) and parents completed at baseline and 5-month follow-up. Using adjusted linear regression, we estimated differences in (1) vaccine uptake and (2) uptake and intention to vaccinate, both by randomisation arm and by intervention component. We explored subgroup effects by at-home multilingualism, gender, age and parental education.
2047 of 2664 (74%) students were unvaccinated against HPV at baseline. The 5-month probability of first-dose vaccine uptake in the control group was 0·09 (95% CI 0.06 to 0.11). Vaccine campaigns alone contributed a 24-percentage-point (0.18, 0.30) increase in uptake compared with the control group. EMM was only effective in increasing vaccine uptake among monolingual francophone students, and we detected no effect from GP training. Vaccine campaigns and EMM both increased the combined outcome of vaccine intention and first-dose uptake, but EMM had the same subgroup effect. Questionnaire data from parents (N=236) were sparser but demonstrated similar overall trends.
Our results demonstrate that in-school HPV vaccine campaigns effectively increase HPV vaccine uptake among adolescents without exacerbating extant disparities in vaccine uptake. EMM can also be a useful tool to increase HPV vaccine intention but must be improved to bridge disparities in its effectiveness. GP training results were inconclusive.
NCT04945655.
人乳头瘤病毒（HPV）感染会引发多种癌症，几乎所有宫颈癌病例都与之相关。虽然有安全有效的疫苗，但法国青少年HPV疫苗接种率较低（<50%）。因此，我们研究了全市范围的干预措施对提高中学生HPV疫苗接种率和接种意愿的影响。
这项整群随机试验采用不完全析因设计，将三个组成部分（校内教育、激励、动员（EMM）；校内接种；以及当地全科医生（GP）培训）安排为六种干预条件，并随机分配给91个参与试验的法国城市。我们使用在线自我报告问卷评估HPV疫苗接种状况，学生（通常年龄在13 - 14岁）和家长在基线和5个月随访时完成问卷。通过调整线性回归，我们估计了（1）疫苗接种率以及（2）接种率和接种意愿方面的差异，分别按随机分组和干预组成部分进行估计。我们通过家庭语言多样性、性别、年龄和父母教育程度来探讨亚组效应。
在基线时，2664名学生中有2047名（74%）未接种HPV疫苗。对照组中首剂疫苗接种的5个月概率为0.09（95%CI 0.06至0.11）。与对照组相比，仅疫苗接种活动就使接种率提高了24个百分点（0.18，0.30）。EMM仅在提高单语法语学生的疫苗接种率方面有效，我们未检测到全科医生培训的效果。疫苗接种活动和EMM都提高了疫苗接种意愿和首剂接种率的综合结果，但EMM具有相同的亚组效应。来自家长（N = 236）的问卷数据较少，但总体趋势相似。
我们的结果表明，校内HPV疫苗接种活动能有效提高青少年的HPV疫苗接种率，且不会加剧现有的疫苗接种差异。EMM也可以是提高HPV疫苗接种意愿的有用工具，但必须加以改进以弥合其有效性方面的差异。全科医生培训的结果尚无定论。
NCT04945655。
