Determinants in the Uptake of the Human Papillomavirus Vaccine: A Systematic Review Based on European Studies

Abstract

BackgroundCervical cancer is the fourth most common cancer affecting women worldwide. Since 2006, two human papillomavirus vaccines (HPVV) have been licensed to protect women against the virus that causes cervical cancer. However, worldwide coverage remains unequal. Studies from the USA found strong evidence for differences in HPVV uptake by ethnicity and healthcare coverage. As the profile of ethnic groups and the healthcare system in the USA differ from countries in Europe where HPVV is free in most of the countries, we conducted a systematic review in order to analyze the determinants of HPVV uptake in Europe.MethodsWe performed a systematic Pubmed, Scopus, and Science Direct search to find articles published from HPVV availability in European countries until April 2014. No age restriction was applied. We included all studies assessing factors associated with HPVV uptake. Uptake refers to either initiation and/or completion of the three dose vaccination program.ResultsOut of the 23 eligible studies, 14 were retrospective reviews of data, six were cross-sectional surveys, and three were prospective cohort studies. Higher HPVV uptake was associated with ethnic majority populations, higher socio-economic status, regular cervical screening participation by the mother, and having received previous childhood vaccinations.ConclusionSince the vaccine is offered for free in most of the European countries, the findings suggest that ethno-cultural and educational factors play an important role when it comes to HPVV uptake. Girls who were undervaccinated had also a lower uptake of standard childhood vaccines and mothers who were less likely to attend cervical cancer screening. This may indicate that only few parents have specific concerns with HPVV, and that preventive health care should seek ways to target these vulnerable groups.

National roll-out of latent tuberculosis testing and treatment for new migrants in England: a retrospective evaluation in a high-incidence area

“…In the literature small-scale, setting-specific studies on LTBI screening have been described and systematic reviews on LTBI treatment uptake and completion have shown varied associations with migrant or refugee populations [ 21 , 22 ]. We are not aware of any other study which has examined additional demographics such as country of birth in detail, however other disease screening initiatives such as HPV vaccination [ 23 ] and HIV testing [ 24 ] have demonstrated similar differences among ethnic minorities.…”

Association between mothers’ screening uptake and daughters’ HPV vaccination: a quasi-experimental study on the effect of an active invitation campaign

“…A recent review reported an association between high HPV vaccination and ethnic majority populations, high socio-economic status, as well as mother’s preventive attitude assessed through cervical screening participation and previous vaccination during childhood. 46 The relationship between HPV vaccination and cervical cancer screening participation was thoroughly discussed. Recently, many studies reported a positive association between HPV vaccination history and attendance of cervical cancer screening ( figure 2 ).…”

Tendencias en la investigación del virus de papiloma humano en Latinoamérica frente a los países de altos ingresos

“…Lo primero que resalta es una postura individualizada en cada país para investigar los genotipos propios de mayor frecuencia en sus comunidades, discriminados por sus grupos poblaciones, factores de riesgo y prioridades sanitarias para la prevención (3,6,8,9,57).…”

“…Afecta en mayor medida a los países con bajos y medianos ingresos (PMBI) donde, además de ser más frecuente, se concentra la mayor mortalidad con el 85 % de las muertes por CCU (2,3). En los PMBI existen limitaciones no solo en la cobertura y el acceso a los servicios médicos de atención y prevención de la salud, sino también por la presencia de determinantes de la salud como el bajo ingreso económico y las disparidades socioepidemiológicas, que han impedido la disminución de las tasas de CCU bajo los programas de tamización basados de citología exfoliativa de Papanicolaou, tal como ocurrió en el siglo pasado en los países con altos ingresos (4)(5)(6)(7).…”