Factors associated with HPV vaccine uptake in teenage girls: A systematic review

doi:10.1016/j.vaccine.2012.03.063

Vaccine

Volume 30, Issue 24, 21 May 2012, Pages 3546-3556

https://doi.org/10.1016/j.vaccine.2012.03.063 Get rights and content

Abstract

Background

Since 2006 Human papillomavirus (HPV) vaccination has become available to adolescent girls and women in an increasing number of countries, to protect against the virus causing cervical cancer. The vaccine series is offered in three doses over 6 months, and this study aimed to identify factors associated with initiation and/or completion of the 3 dose series in (pre-) adolescent girls. Previous studies have considered intention to vaccinate rather than actual vaccination uptake.

Methods

A systematic search of Medline, Medline in process, Embase and CINAHL, from 2006 to March 2011 for articles related to HPV-vaccine uptake among adolescent girls and factors potentially associated with uptake yielded 25 studies.

Results

The majority of studies were surveys or retrospective reviews of data, only 5 studies reported data on program completion. Most were conducted in the United States (20/25). Higher vaccine uptake was associated with having health insurance, of older age, receipt of childhood vaccines, a higher vaccine related knowledge, more healthcare utilization, having a healthcare provider as a source of information and positive vaccine attitudes. In US settings, African American girls were less likely to have either initiated or completed the three dose vaccination series.

Conclusions

HPV vaccination programs should focus on narrowing disparities in vaccine receipt in ethnic and racial groups and on providing correct information by a reliable source, e.g. healthcare providers. School-based vaccination programs have a high vaccine uptake. More studies are required to determine actual vaccine course completion and factors related to high uptake and completion, and information from a broader range of developed and developing settings is needed.

Highlights

► Systematic review of factors associated with HPV vaccine uptake not intention. ► 25 included studies of variable quality, most at moderate risk of bias. ► Uptake associated with health insurance, older age, better knowledge, positive attitudes. ► In US, African American girls less likely to initiated or complete 3 dose series. ► More studies needed about series completion and factors linked to high uptake rates.

Section snippets

Background

Human papillomavirus (HPV) is a sexually transmitted infection that is a necessary (but insufficient) cause of 99% of all cervical cancer cases [1]. Two HPV vaccines are available, Cervarix^® and Gardasil^® [2], [3], which are the first vaccines directed at the prevention of (cervical) cancer [4]. Cervarix^®, a bivalent HPV vaccine, targets types 16 and 18, responsible for nearly 70% of all cervical cancer cases, while Gardasil^®, a quadrivalent vaccine, also targets types 6 and 11, which cause

Search strategies

Medline, Medline in process, Embase and CINAHL were searched by two researchers from 2006 to the 7th of March 2011. The search terms were papillomavirus infections, human papillomavirus or HPV AND vaccines or papillomavirus vaccines AND adolescent, child or girl* AND accept*, aware*, attitude*, belief*, behave*, decision, decide, intent*, know*, perceived*, percept*, risk*, sever*, uptake*, effectiveness, coverage, vaccination, mass vaccination, decision making or perception. The reference

Results

The search resulted in 66 potentially eligible abstracts which were assessed against the inclusion criteria by obtaining the full-text article. We identified 33 relevant articles representing 25 unique studies, after multiple publications from the same study were identified (Fig. 1).

Discussion

To our knowledge this is the first systematic review of factors influencing actual HPV vaccine uptake, since previous systematic reviews have primarily focused on vaccine acceptability and intention to vaccinate, not actual uptake [11], [12], [46]. This review confirms the findings of these previous reviews identifying a range of important predictors to vaccination including: the vaccinated girl's race or ethnicity, age, health insurance status, previous vaccination history, and knowledge about

Conclusions

The aims of this systematic review were to evaluate factors associated with the success of HPV vaccination programs for (pre-)adolescent girls in increasing vaccine coverage in this population. Important factors influencing initiation and completion of the HPV vaccination series included race/ethnicity, girls’ age, parental and adolescent knowledge about HPV and vaccination and healthcare utilization. However, the quality of the included studies limits the conclusions we can make about the

Acknowledgments

Annette Braunack-Mayer, Helen Marshall and Maureen Watson are investigators on an Australian Research Council Linkage Grant Project (LP100200007) known as Health Bridges, which is investigating intersectoral collaboration and the school-based HPV immunization program, and Rebecca Tooher is the project manager on this grant. We would like to acknowledge the helpful comments provided by the other Health Bridges investigators: Maree O’Keefe, Rachel Skinner, Kirsten McKaffrey, Teresa Burgess, and

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Factors associated with HPV vaccine uptake in teenage girls: A systematic review

Abstract

Background

Methods

Results

Conclusions

Highlights

Section snippets

Background

Search strategies

Results

Discussion

Conclusions

Acknowledgments

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