Barriers and Facilitators of Human Papillomavirus (HPV) Vaccination During the Implementation of the School-Based HPV Vaccine Program in Manizales, Colombia

Abstract

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.