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

Abstract

Cervical cancer rates in Sub-Saharan Africa (SSA) are amongst the highest worldwide. All three of the Human Papillomavirus (HPV) vaccines (9-valent, quadrivalent and bivalent HPV vaccine) provide primary protection against the most common cancer-causing strains of HPV (types 16 and 18) that are known to cause 70% of cervical cancers. Over the last five years, there has been an increase in Sub-Saharan African countries that have introduced the HPV vaccine. The majority of research has been conducted on supply-side barriers and facilitators to HPV vaccination uptake in SSA, yet little research has been conducted on demand-side or end-user perspectives of, and decisions around, HPV vaccination. In order to complement existing research, and inform current and future HPV vaccination implementation approaches, this qualitative systematic review explored Stakeholders’ understandings of HPV vaccination in SSA. This review searched the following databases: Embase (via Scopus), Scopus, MEDLINE (via PubMed), PubMed, EBSCOhost, Academic Search Premier, Africa-Wide Information, CINAHL, PsycARTICLES, PsycINFO, SocINDEX, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) and found a total of 259 articles. Thirty-one studies were found eligible for inclusion and were analyzed thematically using Braun and Clarke’s methods for conducting a thematic analysis. The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Three major themes emerged from this analysis; knowledge of HPV vaccination and cervical cancer is intertwined with misinformation; fear has shaped contradictory perceptions about HPV vaccination and gender dynamics are relevant in how stakeholders understand HPV vaccination in SSA.

Associated Factors with Vaccination among Girls Aged between (11) and (13) against Papillomaviruses in Koumpentoum Health District (Senegal)

“…This finding was also found during the pilot phase in 2016 by Sy K. et al in West Dakar [7]. Indeed, the target young girls aged between (9) and ( 14) are mainly in primary and secondary school. Consequently, awareness, involvement and collaboration with the national education sector are imperative in order to reach this school target and the vaccination coverage objective of (90%).…”

“…Vaccination of girls aged between (11) and (13) years against HPV should be the central element of national prevention strategies [6]. After a pilot phase (2014)(2015)(2016) in the health districts of Dakar West and Mékhé, the quadrivalent HPV vaccine (Gardasil®) has been introduced in the Expanded Program on Immunization (EPI) since November (2018) at a rate of (2) doses spaced (6) months apart for girls aged (9) to (10) years. During the pilot phase, complete vaccination coverage in Dakar West was (90.5%) in ( 2015) and (96%) in (2016) [7].…”

“…Caroline D et al in their systematic review conducted in sub-Saharan Africa with a majority of articles from South Africa, Uganda and Kenya, found that the causes of non-vaccination against HPV were lack of information of mothers or guardians and fear of infertility associated with the disease [9].…”

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

“…These factors include unreasonable parental fears, personal, cultural and religious reasons, and parental misinformation among other factors [35][36][37]. Stakeholders' acceptance determines the compliance to the vaccination exercise and greatly contributes to its success [38]. Health care providers and all stakeholders affected by the introduction of HPV vaccination need to address the concerns of parents and children in order to ensure effective HPV vaccination.…”

“…Generally, the perception of the communities in Kenya in regards to HPV vaccination revolve around perceived mistrust towards new vaccinations, insufficient knowledge about HPV infections and HPV vaccination, and high levels of misinformation due to inadequate top down training of stakeholders [36][37][38]40]. A study that sought to compare vaccine acceptability and knowledge in Eldoret, Kenya highlighted the need to increase exposure of the HPV vaccine which in turn could improve knowledge on cervical cancer, HPV infection, HPV vaccination, and its prevention strategies [37].…”