Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries

Abstract

Purpose: The World Health Organization revised its HPV vaccination recommendations to include a two (2-) dose schedule for girls aged ≤15 years. We investigated acceptability of 2-versus 3-dose schedule among adolescent vaccination providers and mothers of adolescent girls in five countries. Methods: Adolescent vaccination providers(N=151) and mothers of adolescent girls aged 9-14 years(N=118) were recruited from Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers’ preference for a 2-versus 3-dose HPV vaccination schedule via quantitative surveys. Mothers’ attitudes toward a 2-dose schedule were assessed through focus group discussions. Results: Most adolescent providers preferred a 2-over 3-dose HPV vaccination schedule (overall:74%), with preference ranging from 45.2% (South Africa) to 90.0% (South Korea). Lower cost, fewer clinic visits, and higher series completion were commonly-cited reasons for 2-dose preference among providers and mothers. Safety and efficacy concerns were commonly-cited barriers to accepting a 2-dose HPV vaccination schedule among providers and mothers. Mothers generally accepted the reduced schedule, however, requested further information from a trusted source. Conclusions: Adolescent vaccination providers and mothers preferred the 2-dose over 3-dose HPV vaccination schedule. Acceptability of a 2-dose HPV vaccination could be improved with additional information to providers and mothers on HPV vaccination safety and efficacy.

Stakeholders’ Understandings of Human Papillomavirus (HPV) Vaccination in Sub-Saharan Africa: A Rapid Qualitative Systematic Review

“…A lack of comprehensive information given to communities at the onset of the introduction of HPV vaccination, almost always initiated and even expedited, the spread of rumors and misinformation in its place [ 26 , 33 , 38 , 40 ]. Such misinformation included distortion of technical facts such as appropriate dose schedule [ 29 , 50 , 51 ], rationale for age of HPV vaccination initiation [ 26 , 49 ] and rumors on the preparedness and training of vaccinators [ 15 , 34 ].…”

Assessing knowledge, attitudes and belief toward HPV vaccination of parents with children aged 9–14 years in rural communities of Northwest Cameroon: a qualitative study

“…Specifically, our findings echo those in the literature in noting that: (1) there exist gaps in vaccine target populations’ awareness and knowledge concerning HPV-related diseases and prevention 15–22 ; (2) fathers and mothers are key decision-makers for children’s vaccination, hence the need to target both in any educational endeavour 23 ; (3) low vaccine cost is key to engaging in vaccination 19 24 ; and (4) receiving information from a trusted source is of central importance to vaccine uptake. 24 25 …”

Adolescent providers’ knowledge of human papillomavirus vaccination age guidelines in five countries

“…12 The main purpose of the study was to assess the acceptability of a two-versus three-dose vaccination schedule among health providers and mothers of adolescent girls, as previously described. 13 Participation was limited to providers who administered or oversaw provision of adolescent vaccines. Participants were recruited from databases of national professional organizations, national health insurance reviews and assessments, study staff contacts, websites, and lists from external consultants, and were contacted via mail, email, or phone.…”

“…Additional descriptive characteristics stratified by country have been reported previously. 12 Median individually reported minimum and maximum recommended ages for HPV vaccination were 11 and 29 years in Argentina (national guideline reports: 11-14), 13 and 48 years in Malaysia (guideline: 13-14), 8 and 14 years in South Africa (guideline: 9-14), 10 and 20 years in South Korea (guideline: [11][12][13][14], and 11 and 12 years in Spain (guideline: 11-14) ( Figure 1, Table 1). In three of five surveyed countries, most providers (97% South Africa, 95% Argentina, 87% Malaysia) included all nationally recommended ages for vaccination in their responses.…”

“…Taking into account these limitations, this study presents a unique compilation of provider data among five diverse locations, adding to prior research of HPV vaccination age recommendations in the U.S. 36 As provider recommendation is among the strongest predictors of successful vaccine uptake among adolescents, 13,14 providers are well positioned to strongly recommend HPV vaccination for girls within the nationally recommended target age range. Programmatic interventions and ministries of health should provide clear policies on age recommendations for HPV vaccination at the national level.…”