Health system factors influencing uptake of Human Papilloma Virus (HPV) vaccine among adolescent girls 9-15 years in Mbale District, Uganda

Abstract

Background: Globally, cervical cancer is the fourth most common cancer in women with more than 85% of the burden in developing countries. In Uganda, cervical cancer has shown an increase of 1.8% per annum over the last 20 years. The availability of the Human Papillomavirus (HPV) vaccine presents an opportunity to prevent cervical cancer. Understanding how the health system influences uptake of the vaccine is critical to improve it. This study aimed to assess how the health systems is influencing uptake of HPV vaccine so as to inform policy for vaccine implementation and uptake in Mbale district, Eastern Uganda. Methods: We conducted a cross sectional study of 407 respondents, selected from 56 villages. Six key informant interviews were conducted with District Health Officials involved in implementation of the HPV vaccine. Quantitative data was analyzed using Stata V.13. Prevalence ratios with their confidence intervals were reported. Qualitative data was audio recorded, transcribed verbatim and analyzed using MAXQDA V.12, using the six steps of thematic analysis developed by Braun and Clarke. Results: Fifty six (14%) of 407 adolescents self-reported vaccine uptake. 182 (52.3%) of 348 reported lack of awareness about the HPV vaccine as the major reason for not having received it. Receiving vaccines from outreach clinics (p = 0.02), having many options from which to receive the vaccine (p = 0.02), getting an explanation on possible side-effects (p = 0.024), and receiving the vaccine alongside other services (p = 0.024) were positively associated with uptake. Key informants reported inconsistency in vaccine supply, inadequate training on HPV vaccine, and the lack of a clear target for HPV vaccine coverage as the factors that contribute to low uptake. Conclusion: We recommend training of health workers to provide adequate information on HPV vaccine, raising awareness of the vaccine in markets, schools, and radio talk shows, and communicating the target to health workers. Uptake of the HPV vaccine was lower than the Ministry of Health target of 80%. We recommend training of health workers to clearly provide adequate information on HPV vaccine, increasing awareness about the vaccine to the adolescents and increasing access for girls in and out of school.

Why don’t adolescent girls in a rural Uganda district initiate or complete routine 2-dose HPV vaccine series: Perspectives of adolescent girls, their caregivers, healthcare workers, community health workers and teachers

“…However, there seems to be variations in adequacy of cold-chain capacity and infrastructure between districts. Nabirye et al, found a fully functioning cold chain infrastructure in Eastern Uganda, which was attributed to the revamp supported by development partners in preparation for the introduction of other new childhood vaccines [ 13 ].…”

“…As a consequence, disrespectful behavior frightened some of the girls to the point of leaving the health facilities without being vaccinated. Disrespectful behavior of some health professionals has been reported as a major reason for drop out from a childhood immunization program in Ethiopia [ 48 ] and a key barrier to HPV vaccination in Eastern Uganda [ 13 ]. Our findings highlight the importance of working towards respectful provision of national vaccination services in general in order to improve completion of vaccine doses.…”

“…Similarly, a recent population-based cross-sectional study conducted among 460 girls aged 12–17 years found that almost half (49.6%) of the respondents did not initiate the vaccine series at all and only 18% completed the vaccine series [ 12 ]. Another population-based cross-sectional survey conducted among 407 girls aged 9–15 years found that 51% of the respondents were not vaccinated at all and only 14% had completed the vaccine series [ 13 ]. The findings from these population-based surveys imply that a significant proportion of adolescents do not get the full benefits of the HPV vaccine.…”

Knowledge, Attitude and Practice of Main Stakeholders towards Human Papilloma Virus Infection and Vaccination in Mombasa and Tana-River Counties in Kenya: A Qualitative Study

“…This corresponds to a study on cervical cancer screening and acceptability of HPV vaccine among women in Kilimanjaro [49]. Although great support has been established since HPV vaccines have been available since 2006/2007 to promote and educate women globally and especially in LMICs [50], the WHO's recommendation on the HPV vaccine is that in order to achieve the much needed high levels of HPV acceptability, there is urgent need to conduct campaigns to create awareness and provide more accessibility [6,34,51].…”

“…However, vaccine uptake remains suboptimal globally. This has been associated with low levels of vaccine awareness [32][33][34]. There are many factors that lead to poor compliance to the HPV vaccination program which in turn highly contribute to the failure of vaccine uptake.…”