Factors related to non-compliance to HPV vaccination in Roraima—Brazil: a region with a high incidence of cervical cancer

Abstract

BackgroundTo evaluate the HPV vaccination coverage in Boa Vista, Roraima (Brazil) and to identify personal and socioeconomic factors related to non-compliance to HPV vaccination.MethodsA school-based, cross-sectional study was conducted by distributing a self-administered questionnaire to the parents or guardians of pre-adolescent girls. The questionnaire addressed compliance to, knowledge about and perception of HPV and the HPV vaccine. Between July and November 2015, 13 private and public schools were visited based on a random cluster sampling method.ResultsA total of 1337 questionnaires were distributed to all female students in the target age group, and 797 were completed and returned (the participation rate was 59.6 %). The vaccination coverage rate was 82.7 % and was higher among public school students than among private school students (84.1 % vs 56.3 %; p = 0.003). Most parents (60 %) incorrectly answered more than half of the questions related to HPV knowledge, and limited knowledge about HPV and the HPV vaccine correlated with lower compliance to vaccination (adjusted OR = 1.42; 95 % CI: 1.01 to 2.76). In the perception analysis, the belief that the HPV vaccine is important for the daughter was an important protective factor (adjusted OR = 0.62; 95 % CI: 0.23 to 0.93), and concern about adverse effects of the HPV vaccine was a risk factor for non-compliance (adjusted OR = 1.66; 95 % CI: 1.01 to 2.71). Family income, religion and education level of the parents or guardians did not correlate with compliance to vaccination.ConclusionHPV vaccination coverage was high in Boa Vista, Brazil, but knowledge about the vaccine was deficient. This deficiency was associated with a distorted perception and was negatively associated with compliance to vaccination. Actions aimed at informing the public about the HPV vaccine, including its risks and benefits, are needed to attain higher vaccination coverage in Brazil.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1677-y) contains supplementary material, which is available to authorized users.

Knowledge about cervical cancer and HPV immunization dropout rate among Brazilian adolescent girls and their guardians

“…In this study, only 65.5% of adolescent girls adhered to HPV vaccination. Previous research described that adequate knowledge about HPV infection and awareness of prevention against this virus result in higher vaccine acceptance rates [18,21,23]. However, in our study, HPV knowledge was not associated with vaccine uptake.…”

“…In 2016, a study conducted in the northern state of Roraima, Brazil, showed a relatively high rate of nonadherence to HPV vaccination (17.3%). The authors reported that the lack of HPV knowledge negatively influenced the acceptance of HPV vaccine by parents/ guardians of girls [18]. Other studies reported that mothers/guardians play a key role in the decisionmaking regarding vaccination uptake [23,[38][39][40].…”

“…Additional improvements in public health strategies for HPV vaccine and cervical cancer should include educational interventions tailored to different audiences with the support of health care professionals and teachers. These are considered to be potentially influential groups to promote the increase of HPV vaccine uptake [18,19,38,41].…”

“…In 2018, uptake to the initial dose remained high (79.2%), but there was also a drop in adherence to the second dose (48.7%) [15,16]. Studies have shown some barriers regarding vaccination such as the belief that adolescents are too young to receive a vaccine against a sexually transmitted infection (STI), concerns about adverse effects of the vaccine, and lack of information about the HPV vaccine [17][18][19]. Knowledge about HPV and HPV vaccine varies in the general population and is an important factor in the acceptance of vaccination [17,20].…”

Challenges in the Introduction of Nation-Wide School-Based Vaccination against HPV in Peru

“…Some studies have examined these school based programs, comparing with health service based vaccination [7,8] and have generally found them effective, often achieving more than 80% coverage. However, few have been in low or middle income countries, especially Latin America, and with one exception, a state wide HPV vaccination program through schools in Brazil, [9] these have been demonstration project or GAVI assisted programs.…”