In 2012, Colombia implemented a school-based HPV vaccination program of a 3-dose series for nine year old girls. Following a mass psychogenic response after vaccination in a Colombian town, vaccination rates dropped from 80% in 2012–2013 to 5% in 2016. The study aimed to identify barriers and facilitators of HPV vaccine uptake among girls eligible for vaccination in the initial years of vaccine implementation from 2012 to 2014, and their parents. We conducted 19 individual qualitative interviews and 18 focus groups with an average of 5 girls, in Manizales, Colombia between 2016 and 2017. In total, 49 girls from six schools and 58 of their parents participated in the study. Participants had some degree of awareness about cervical cancer, especially among those of middle and upper socioeconomic level. However, the vaccine was known as a prevention measure only after pap-smears and condoms. The main facilitator for vaccine uptake for parents was the desire to prevent diseases in general and for girls, it was facilitated by receiving positive information about the vaccine. The main barriers for vaccine uptake or for three doses completion were the event in Carmen de Bolivar, fear of adverse effects and fear of needles. Girls and parents stated that they received little or no information from schools or health care services about the HPV vaccine prior to vaccination. Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program including mass media information about HPV vaccine.

43 Purpose Colombia implemented a school-based human papillomavirus (HPV) vaccination program that consisted of a three-dose series in girls age 9 years in 2012. In 2014, the program included girls up to the last grade of high school, and the second and third doses were scheduled at 6 and 60 months. After a mass psychogenic response after vaccination that occurred from May to October 2014 in Carmen de Bolivar, vaccination rates dropped from 80% in 2012 and 2013 to 18% in 2014. The aim of the current study was to identify barriers and facilitators of HPV vaccine uptake in Colombia. Methods To develop quantitative instruments for a population-based survey, we conducted 19 qualitative interviews and 18 focus groups between September 2016 and February 2017. Participants were girls who were eligible to receive vaccination between 2012 and 2014 and their parents or legal representatives. Results Forty-nine girls who were selected from six schools of low (n = 2), medium (n = 2), and high (n = 2) socioeconomic level and 58 of their parents participated in the study. Eighty-one percent (40 of 49) of girls were age 12 to 15 years at the time of interview. No girls from schools of a low socioeconomic level and only two of 20 of their parents knew the etiology of cervical cancer. Pap smear cytology and condom use were the methods of cervical cancer prevention that were most often mentioned by parents. Only vaccinated girls from schools of a high socioeconomic level considered the HPV vaccine to be a good prevention alternative. Facilitators in adults were the desire to prevent disease in general and HPV. For both girls and their parents, listening to positive information about the vaccine facilitated vaccine uptake. Negative media information about the effects of the vaccine from the 2014 psychogenic event was the main barrier for vaccine uptake or series completion. Fifty-seven percent of girls and 30% of parents mentioned that, at the time of vaccination, information about the HPV vaccine was received mainly through government massive media campaigns, whereas approxiamtely one half of both parents and girls did not receive information from schools or health care services. Conclusion Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program, including mass media information about the HPV vaccine. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Purpose: The first 2 rounds (2012-2013) of the Colombian school-based HPV vaccination program attained 80% coverage of nine-year-old girls. After a psychogenic event in 2014 in a town of the Caribbean region, vaccination fell nationwide to 20% in 2016. We identified factors associated to decreasing coverage of the HPV vaccination program in Manizales, Colombia. Methods: Structured questionnaires based on the HPV health belief model (HBM) were used in a population-based survey (September 2017-February 2019) to privately interview girls from birth cohorts of 2003, 2004 and 2005 and their parents. Vaccination coverage (at least one dose) was defined by the Expanded Program of Immunization Registry, HPV 6/11/16/18 serology and parents and girls self-report. Multivariable adjusted Prevalence Ratios (aPR) and 95% confidence intervals were estimated using complementary log-log regression to identify sociodemographic factors associated to coverage and changes in HBM constructs scores associated to acceptability of the HPV vaccine. Results: 1.287 of 1.299 eligible girls and their parents completed the survey, 99% were school-registered and 97% urban area residents. The vaccine coverage was 93.4% (394/422), 84% (356/424), and 63% (279/441) for the 2003, 2004, and 2005 birth cohorts, respectively. High educational level in parents was associated with decreased HPV vaccine coverage (aPR 0.80, 95%CI 0.66-0.95). The perceived benefits increased (aPR 1.22, 95%CI 1.18-1.27 for parents; aPR 1.25, 95%CI 1.21-1.29 for girls) meanwhile, the perceived barriers (negative recommendation by family/friends, news about vaccine adverse events and health system and school barriers) decreased (aPR 0.73 95%CI 0.69-0.77 for parents; aPR 0.84 95%CI 0.79-0.88 for girls) the acceptability of HPV vaccine. Birth year (2005) and high socioeconomic status were also associated with decrease acceptability. Conclusion: Perceived barriers were associated to decreased acceptability and coverage of vaccination in the first 3 rounds of the national HPV vaccination program in Manizales, Colombia. Citation Format: Karen Cárdenas-Garzón, Maria Cecilia Agudelo, Olga Lucia Tovar-Aguirre, Sandra Franco, Kelly Paola Valverde, Nelson Arias, Difariney Gonzalez, Nilton E. Montoya, Maria Patricia Arbelaez, Isabel Cristina Garces-Palacio, Karly Louie, Simon Beddows, Gloria Sanchez. Factors Related to Human Papillomavirus Vaccine Uptake and Acceptability in Manizales, Colombia, 2017-2019: A Population-Based Study of the 2003, 2004 and 2005 Birth Cohorts. [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 61.