Search Results (95)

Background: Cervical cancer poses a threat to the health of women globally. Adolescent girls are the primary target population for HPV vaccination, and guardians’ attitude towards the HPV vaccine plays a significant role in determining the vaccination status among adolescent girls. Objectives: This study aimed to explore the factors influencing guardians’ HPV vaccine acceptance for their girls and provide clues for the development of health intervention strategies. Methods: Combining the health belief model as a theoretical framework, a questionnaire-based survey was conducted. A total of 2157 adolescent girls and their guardians were recruited. The multivariable logistic model was applied to explore associated factors. Results: The guardians had a high HPV vaccine acceptance rate (86.7%) for their girls, and they demonstrated a relatively good level of awareness regarding HPV and HPV vaccines. Factors influencing guardians’ HPV vaccine acceptance for girls included guardians’ education background (OR = 0.57, 95%CI = 0.37–0.87), family income (OR = 1.94, 95%CI = 1.14–3.32), risk of HPV infection (OR = 3.15, 95%CI = 1.40–7.10) or importance of the HPV vaccine for their girls (OR = 6.70, 95%CI = 1.61–27.83), vaccination status surrounding them (OR = 2.03, 95%CI = 1.41–2.92), awareness of negative information about HPV vaccines (OR = 0.59, 95%CI = 0.43–0.82), and recommendations from medical staff (OR = 2.32, 95%CI = 1.65–3.25). Also, guardians preferred to get digital information on vaccines via government or CDC platforms, WeChat platforms, and medical knowledge platforms. Conclusions: Though HPV vaccine willingness was high among Chinese guardians, they preferred to vaccinate their daughters at the age of 17–18 years, later than WHO’s recommended optimal age period (9–14 years old), coupled with safety concerns. Future work should be conducted based on these findings to explore digital intervention effects on girls’ vaccination compliance. Full article

Background: South Africa launched a school-based human papillomavirus (HPV) vaccination programme in 2014 and has achieved a national coverage of more than 80%. However, there is subnational variation in coverage, with eThekwini District in the province of KwaZulu-Natal having the lowest coverage at 40%. Knowledge of the factors associated with vaccine acceptance in this district would inform tailored strategies to improve coverage, which could be extrapolated to similar settings. We conducted this cross-sectional study to assess the factors associated with HPV vaccine acceptance in eThekwini District. Methods: We used stratified random sampling to select caregivers of children aged 9–14 years in the district. We interviewed participants in April–May 2023 and employed bivariate and multivariate logistic regression models to assess the factors associated with HPV vaccine acceptance. Results: Of 793 individuals contacted, 713 (89.9%) participated. Most were women (86.1%) and had a mean age of 42.6 ± 11.6 years and secondary or lower education (83.8%). Most participants knew about the HPV vaccination programme (86.0%) and accepted HPV vaccination (93.5%). The latter includes 42.9% who had already vaccinated their daughters and 50.6% who were willing to allow their daughters to be vaccinated. A negligible proportion was either undecided (2.1%) or unwilling (4.4%) to accept HPV vaccination. Awareness of the programme (adjusted odds ratio [aOR] 5.22; 95% confidence interval [95%CI] 2.01–13.56), confidence in vaccine safety (aOR 19.69; 95%CI 5.86–66.15), and endorsement by religious leaders (aOR 5.06; 95%CI 1.56–16.45) were independent predictors of vaccine acceptance. Conclusions: Our findings highlight the critical role of the provision of information and education about the benefits and safety of HPV vaccination. Full article

Cervical cancer remains one of the main causes of female mortality, especially in middle- and low-income countries, despite efforts towards the implementation of global vaccination against human papillomavirus (HPV). The aim of this study was to review and compare the most recently published international guidelines providing recommendations on cervical cancer screening strategies among average and high-risk women. Thus, a comparative review of guidelines by the US Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the American Society of Clinical Oncology (ASCO), the World Health Organization (WHO), the Canadian Task Force on Preventive Health Care (CTFPHC), the Cancer Council Australia (CCA), and the European Guidelines (EG) was conducted. There is an overall agreement regarding the suggestions made for women younger than 21 and those older than 65, with all guidelines stating against routine screening, with the exceptions of CTFPHC and CCA that expand the age group to up to 70 and 75 years, respectively. Continuation of screening in older women is also suggested in those with a history of a precancerous lesion and those with inadequate screening. Most guidelines recommend routine screening at 30–65 years, while the WHO advises that screening should be prioritized at 30–49 years. HPV DNA testing is the method of choice recommended by most guidelines, followed by cytology as an alternative, except for CTFPHC, which refers to cytology only, with self-sampling being an acceptable method by most medical societies. Agreements exist regarding recommendations for specific groups, such as women with a history of total hysterectomy for benign reasons, women with a complete vaccination against HPV, individuals from the lesbian, gay, bisexual, transgender, and queer communities and women with multiple sexual partners or early initiation of sexual activity. On the other hand, the age group of 21–29 is addressed differently by the reviewed guidelines, while differentiations also occur in the screening strategies in cases of abnormal screening results, in women with immunodeficiency, those with in utero exposure to diethylstilbestrole and pregnant women. The development of consistent practice protocols for the most appropriate cervical cancer screening programs seems to be of major importance to reduce mortality rates and safely guide everyday clinical practice. Full article

Objectives: The Human papillomavirus (HPV) vaccine is a cornerstone of cancer prevention, yet uptake remains suboptimal in many countries. This study analyzed the factors influencing HPV vaccine acceptance among adults, including a focused analysis of parental behaviors. Methods: Data were collected through a web-based survey using a questionnaire. We performed univariable analysis and three logistic regression analyses to investigate the determinants in the overall sample and among parents. Results: A total of 1821 participants were surveyed. HPV vaccination uptake was low, with only 6.9% of the total sample and 7.6% of young adults (18–35 yo) vaccinated. Among parents, 47.9% had vaccinated children aged 12–17, and 21.1% those aged 18 and over. Higher health literacy was associated with positive attitudes (OR 2.03, 95% CI 1.48–2.79), while receiving information from pediatricians or gynecologists was linked to children’s vaccination status (OR 7.30, 95% CI 2.29–23.31) and parents’ intentions for future HPV vaccination (OR 5.86, 95% CI 1.85–18.50). Adequate knowledge emerged as a strong predictor of positive attitudes (OR 6.50, 95% CI 4.91–8.61) and parents’ intentions (OR 4.89, 95% CI 2.21–10.84). Vaccination status was a key factor influencing parental decisions and overall vaccine acceptance. Conclusions: These findings highlight the critical role of health professionals and the need for targeted communication to address persistent knowledge gaps and promote HPV vaccine confidence within general population. Full article

Cervical cancer causes 350,000 deaths annually, with 90% occurring in low- and middle-income countries (LMICs), despite being largely preventable through vaccination and screening. This review examines innovative approaches to address screening coverage gaps worldwide, analysing both established programmes in high-income countries and implementation strategies for LMICs. Self-sampling technologies demonstrate significant potential to improve the uptake of cervical screening, thereby improving cervical cancer prevention compared to traditional methods, particularly benefiting underserved populations across all healthcare settings. Among self-collection devices, vaginal brushes achieve sensitivity of 94.6% (95% CI: 92.4–96.8) for HPV detection, while novel approaches like the tampon show promising results (sensitivity 82.9–100%, specificity 91.6–96.8%) with high user acceptability. Implementation strategies vary by healthcare context, with high-income countries achieving success through integrated screening programmes and digital solutions, while LMICs demonstrate effective adaptation through community-based distribution (20–35% uptake) and innovative delivery methods. In resource-limited settings, self-sampling increases participation through enhanced patient comfort and cultural acceptability, while reducing costs by 32–48%. Progress toward WHO’s cervical cancer elimination goals require careful consideration of local healthcare infrastructure, cultural contexts and sustainable financing mechanisms. Future research priorities include optimising self-sampling technologies for sustainability and scalability, developing context-specific implementation strategies and validating artificial intelligence applications to enhance screening efficiency across diverse healthcare settings. Full article

Background: Human papillomavirus (HPV) infection in pediatric populations is an emerging area of interest due to its potential role in early viral transmission and long-term oncogenic risk. The oral cavity may serve as a reservoir for high-risk HPV types; however, its prevalence in children remains under-investigated and unclear. The HOPE (Human papillomavirus Oral infection in PEdiatric population) project aims to assess the prevalence of oral HPV using an innovative salivary sampling method, also exploring the influence of social determinants on parental awareness and attitudes toward HPV vaccination. This paper presents the findings from a cross-sectional pilot study. Methods: This pilot investigation included a total of 70 children (0–14 years) who underwent an oral examination and non-invasive salivary sampling using the novel LolliSponge device. HPV detection was performed using INNO-LiPA^® HPV genotyping. Parents completed a questionnaire assessing socio-demographic factors and HPV-related knowledge. Associations between oral health status, social determinants, and HPV awareness were analyzed. Results: The LolliSponge device demonstrated excellent acceptability among the pilot population. The mean age at recruitment of the children thus far (8 years) appears to correlate with the absence of oral HPV infection. Regarding parental knowledge and attitudes, 51 out of the 70 respondents (72.9%, 95% CI: 62–83%) reported having heard of HPV; however, 94.3% (66/70) were unaware of its transmission routes, and 60% (42/70) did not know that it can cause cancer. Only 4 out of the 70 participants (5.7%) reported that their child had received the HPV vaccine. Lower awareness of the HPV vaccine was significantly associated with a lower educational level (p = 0.001), being married (p = 0.03), and having three or more children (p = 0.039). Awareness of the vaccine’s existence also varied significantly by parental occupation (p = 0.02). Conclusions: The pilot findings of the HOPE project highlight both the potential of innovative strategies for detecting oral HPV infection in children and critical gaps in parental knowledge and vaccine uptake. Preliminary data also reveal an age-related bias in HPV status, suggesting the need for further investigations in a larger cohort of younger children (<5 years). Full article

Background/Objectives: Human papillomavirus (HPV) vaccination is a critical intervention to prevent cervical cancer, especially in settings where screening is limited. In Togo, cervical cancer is the second most common cancer in women. Togo conducted an HPV vaccination campaign for girls aged 9–14 from 27 November to 1 December 2023, followed by introduction of the vaccine into routine immunization. This study aimed to assess regional disparities in vaccination coverage during this campaign. Methods: A cross-sectional study was conducted using data from the nationwide HPV vaccination campaign. The target population included girls aged 9–14, following school and community-based enumeration. The campaign employed school-based, health facility-based, and community-based vaccination strategies. Data were collected via multiple tools, and monitoring was carried out through daily reports and digital tracking. Results: Out of the estimated 654,402 eligible girls, 304,457 (46.5%) were vaccinated. Vaccine coverage varied significantly by region, ranging from 76% in Kara to 15% in Grand Lomé. In-school settings accounted for 91.3% of vaccinations, with the fixed strategy covering 55.4%. In total, 11 districts exceeded 80% vaccine coverage, while 15 districts had <50%. The highest rate of adverse events following immunization was observed in the Maritime region, primarily involving minor symptoms. Conclusion: Although progress was made in HPV vaccination coverage in Togo, regional disparities highlight the need for targeted interventions. Strategies such as expanding vaccine access, enhancing awareness campaigns, and integrating HPV vaccination into routine immunization could improve coverage. Addressing logistical and cultural barriers is also crucial for equitable vaccination, aiming to achieve international benchmarks and reduce HPV-related disease burdens. Further research should explore qualitative factors influencing vaccine acceptance. Full article

Background/Objectives: Over the past 50 years, developing new vaccines has been pivotal in responding to emerging and re-emerging diseases globally. However, despite substantial partner support, introducing new vaccines in sub-Saharan Africa remains challenging. This systematic review documents the barriers to new vaccine introduction in sub-Saharan Africa by distinguishing between vaccines integrated into routine immunization programs and those introduced primarily for outbreak response. Methods: A comprehensive electronic search was conducted across five databases for articles published in English or French on the challenges of new vaccine introduction in sub-Saharan Africa. Three reviewers screened articles independently based on the titles and abstracts, with full-text assessments conducted for inclusion. Data were analyzed thematically and synthesized narratively. Results: A total of 796 articles were retrieved from the five databases. Following the screening, 33 articles were finally retained and included in the review. These articles concerned the introduction of eight new vaccines (malaria vaccine, COVID-19 vaccine, HPV vaccine, Ebola vaccine, cholera vaccine, hepatitis B vaccine, rotavirus vaccine, and typhoid vaccine). The analyses revealed coordination and financing challenges for six vaccines in seventeen countries, acceptability challenges for five vaccines in ten countries, logistical challenges for two vaccines in six countries, and quality service delivery challenges for three vaccines in thirteen countries. Conclusions: Addressing the challenges of introducing new vaccines in sub-Saharan Africa requires targeted, evidence-based strategies. Prioritizing political commitment, innovative funding, public education, workforce development, and infrastructure improvements will strengthen immunization systems and enable timely vaccine delivery. Collaborative efforts and a focus on local context can advance equitable health outcomes, safeguard public health, and support global immunization goals. Full article

The aim of this study was to assess the association between the use of and trust in sources of information, knowledge about human papillomavirus (HPV) and vaccines against it, perceived lack of information, and the decision to receive the HPV vaccine in undergraduate students in Belgrade. The sample of this cross-sectional study included students aged 18 to 27 who received the second dose of the HPV vaccine or used other services of the general medicine department at the Institute for Students’ Health of Belgrade during the period June–July 2024. The research instrument was a questionnaire consisting of socio-demographic data, information environment (sources of information, trust in sources of information, as well as questions related to perceived lack of information), knowledge about HPV and HPV vaccines, and vaccination status. Participants filled out an online questionnaire created on the RedCap platform of the Faculty of Medicine, University of Belgrade, which they accessed via a QR code. Hierarchical logistic regression was used to assess the association between vaccine status and socio-demographic characteristics, use and trust in information sources, knowledge, and perceived lack of information. Of the 603 participants who filled out the questionnaire completely, 78.6% were vaccinated against HPV. Key factors associated with vaccine uptake were female gender (OR = 2.33, p < 0.05), use of scientific literature (OR = 1.40, p < 0.05) and family as a source of information (OR = 1.37, p < 0.01), less frequent use of regional TV channels (OR = 0.76, p < 0.05), higher level of knowledge (OR = 1.43, p < 0.01), and lower perceived lack of information (OR = 0.50, p < 0.01). These variables explained 41% of variability in vaccine uptake in the multivariate hierarchical logistic regression model. Exposure to and trust in sources of information were significantly associated with knowledge about HPV and HPV vaccination, as well as with the perceived lack of information regarding HPV vaccination, and were the most significant determinants of the decision to accept HPV vaccine in the student population. Full article

Background/Aims: The global promotion of HPV vaccines has underscored the importance of vaccination for both males and females in reducing disease transmission and associated complications. Despite robust evidence supporting male HPV vaccination, China has yet to approve it. Public discussions on male HPV vaccination, influenced by policy delays, gender norms, and commercialization, reveal diverse attitudes and significant challenges in achieving equitable health outcomes. This study investigates public perceptions and attitudes toward male HPV vaccination in China by analyzing cognitive frames and the social, cultural, and economic factors shaping these discussions. Methods: This study employs a cross-sectional design to analyze 4997 Sina Weibo posts using the Analysis of Topic Model Networks (ANTMN), identifying five frames: Disease Risk and Prevention, Virus Transmission, Gender Roles and Perceptions, Vaccine Promotion and Acceptance, and Market Dynamics and Consumption. Results: The findings reveal a significant gap between policy implementation and public awareness of male HPV vaccination in China. Despite growing recognition of its benefits, entrenched gender norms and biases hinder equitable health outcomes. Social media, as a pivotal platform for health communication, plays a dual role in facilitating public discourse while also amplifying misinformation. Policy delays and concerns over vaccine commercialization heighten public hesitancy, emphasizing the need for inclusive policies and targeted education. Conclusions: This study highlights the necessity for systemic efforts to address gender biases, enhance public education on male HPV vaccination, and rebuild trust in vaccination programs. A multifaceted approach is required to bridge these gaps, integrating policy reforms, inclusive health communication strategies, and equitable vaccine access. These measures aim to promote awareness and increase vaccination uptake among males in China, ultimately contributing to more comprehensive and equitable public health outcomes. Full article

Background: School-based immunization programs are crucial for equitable vaccine coverage, yet their success depends on parental consent processes. This study investigates patterns of vaccine decision-making within Australia’s school-based immunization program, specifically focusing on human papillomavirus (HPV) and diphtheria-tetanus-pertussis (dTpa) vaccines offered free to adolescents aged 12–13. Methods: This qualitative study was conducted in the South Eastern Sydney Local Health District (2022–2023). Semi-structured interviews were held with school staff (n = 11) across government, Catholic, and independent schools, parents whose children were not vaccinated at school (n = 11) and a focus group with public health unit staff (n = 5). Data were analyzed to identify key barriers and patterns in vaccine decision-making. Results: Analysis revealed three distinct groups of parents whose children were not vaccinated through the school program: (1) those favoring general practitioners for vaccination, driven by trust in medical providers and a preference for personalized care; (2) those intending to consent but facing logistical barriers, including communication breakdowns and online consent challenges; and (3) vaccine-hesitant parents, particularly regarding HPV vaccination, influenced by safety concerns and misinformation. These findings demonstrate that non-participation in school vaccination programs should not be automatically equated with vaccine hesitancy. Conclusions: Tailored interventions are necessary for addressing vaccine non-participation. Recommendations include strengthening collaboration with general practitioners, streamlining consent processes and providing targeted education to counter misinformation. This study provides valuable insights into social determinants of vaccine acceptance and offers actionable strategies for improving vaccine uptake in school-based programs. Full article

Background: HPV vaccination is the key measure to prevent cervical cancer, but uptake in China lags behind global targets. Understanding Chinese guardians’ preferences is key to improving vaccine acceptance and coverage. Methods: A nationwide online discrete choice experiment survey was conducted among 4933 Chinese guardians across seven provinces in 2022 to quantify preferences and willingness to pay. Attributes included effectiveness, safety, duration, valency, location, and out-of-pocket cost. Results: Out of the 4933 guardians who participated in the study, 4179 (84.72%) were mothers. More than 60% of the guardians belonged to the age group of 35–44 years. Additionally, over half of the respondents (53.15%) had daughters between the ages of 9 and 14 years. Respondents were open to accepting the HPV vaccine with 95% efficacy and exceptional safety. Guardians expressed a preference for longer protection duration (specifically 15 years (βa = 0.340, 95% CI: 0.31, 0.37)) and higher vaccine valency. As for willingness to pay, the respondents placed the highest value on vaccine efficacy, being willing to shell out more than USD 1100 for 95% protection as compared to 50%. Furthermore, very good safety commanded a premium of over USD 800 when compared to average safety. When it comes to willingness to uptake, a vaccine with 95% efficacy led to a more than 35% increase in acceptance as compared to one with 50% efficacy. Similarly, exceptional safety resulted in an increased willingness to uptake of over 25% when compared to average safety. Conclusions: The DCE highlighted effectiveness, safety, and durability as critical drivers of HPV vaccine acceptance, but substantial barriers persist regarding adolescent female coverage in China. Full article

Adolescents are the target group for HPV vaccination. Studies that examine factors influencing acceptability among adolescents and interventions aimed at improving knowledge, attitudes, perceptions, intentions, and, most importantly, vaccination rates are less common than those addressing parents or healthcare professionals. The specialized literature was searched for studies evaluating the impact of various interventions on adolescents. In the final analysis, 41 studies were included (35 original studies and 6 reviews). Educational interventions increased adolescents’ knowledge scores in the selected studies. Peer education proved highly effective in rapidly and significantly improving knowledge about HPV. Additionally, multicomponent interventions generated awareness and knowledge that persisted for months after the interventions. HPV vaccine uptake increased following educational interventions in 11 out of the 14 studies that evaluated this outcome; studies presenting multicomponent interventions also proved effective in improving vaccination rates. Higher HPV vaccine series completion was reported following a reminder system strategy. Interventions directed at adolescents, combined with strategies involving parents and healthcare professionals, can play an important role in improving HPV vaccination rates. Educated adolescents must be involved in decisions about their own health and can be a valuable source of information for their peers and parents. Full article

Background: In 2020, the WHO proposed the global strategic goal of accelerating the elimination of cervical cancer (CC). One of the key strategies is that, by 2030, 90% of girls will complete HPV vaccination by age 15. In 2017, HPV vaccines were first marketed in China. Objectives: This study aimed to explore the changes in parents’ knowledge about CC, HPV, HPV vaccines, and acceptance of HPV vaccination 5 years after the introduction of HPV vaccines into China. Associated factors and reasons for refusal by parents were also explored. Methods: A school-based follow-up study was conducted among parents in China from May 2018 to May 2023. Comparison using Chi-square tests was performed to measure the changes. Univariate and multivariate analyses were used to explore factors associated with HPV vaccination among teenage girls. Results: The overall cognitive level in terms of CC- and HPV-related knowledge among parents increased, and they expressed more willingness to vaccinate their daughter (35.4% in 2018 vs. 56.6% in 2023). The HPV vaccination rate among teenage girls remained at a low level (4.4% in 2018, 9.8% in 2023). The main obstacles reported by parents were limited knowledge (42.0%), scarcity of the HPV vaccine (29.2%), waiting until their daughter was older (27.5%), safety concerns (14.7%), high cost (9.0%), and effectiveness concerns (4.6%). Parents who are elderly, local residents, have received HPV vaccines themselves, have had experience of vaccinating their children with influenza vaccines, and have a higher knowledge level of CC, HPV and HPV vaccines are more likely to vaccinate their children with HPV vaccines. Conclusions: Although we observed an increment in parents’ knowledge level in terms of CC, HPV, HPV vaccines, and HPV vaccine uptake over the past 5 years, the HPV vaccine coverage among girls still falls short of the WHO’s 2030 target. Comprehensive intervention strategies, including tailored health education among adolescents and their parents, doctor recommendations, and providing financial subsidies or free HPV vaccines are needed in China. Full article

Cervical cancer is highly preventable through vaccination, early detection, and treatment, yet is the fourth most common cancer globally. HPV testing is superior to cytology for the detection of cervical pre-cancer, and jurisdictions around the world are implementing HPV primary screening, which offers the opportunity for self-screening, an important self-care intervention. Digital health solutions are also increasingly important components of self-care. In this study, we assessed the acceptability and completion of self-screening for cervical cancer offered through a digital platform within a low screening uptake region of British Columbia. The primary objective of this study was to evaluate the acceptability of self-screening for cervical cancer offered through a digital platform as measured by return rates of self-screening kits. Patients due or overdue for cervix screening were invited to participate. Eligible participants registered online to receive a self-screening kit, which included a device for vaginal self-screening, instructions, and a return envelope, sent to their home. After self-screening using the vaginal device, HPV testing was conducted. HPV-negative participants were returned to routine screening, and HPV-positive participants were recommended for cytology or colposcopy. Attendance rates at follow-up were evaluated. Participants were invited to complete an acceptability survey. From April 2019 to December 2023, 283 participants were sent kits, with 207 kits returned for a completion rate of 73%. Of valid samples (n = 202), 15 were HPV positive, and 93% attended follow-up care. Most respondents found the CervixCheck website easy to use, informative, and secure and were satisfied with receiving their results online. CervixCheck had a high completion rate among participants who were sent a self-screening kit. High compliance with recommended follow-up and high acceptability of self-screening for cervical cancer was observed. Most participants indicated they would self-screen again in the future. Innovative approaches to cervical screening, including self-screening and the use of digital health interventions, are ways to enhance equity and improve uptake of cervical screening. Full article