A qualitative study of HPV vaccine acceptability among health workers, teachers, parents, female pupils, and religious leaders in northwest Tanzania

Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Vaccine (Impact Factor: 3.62). 06/2012; 30(36):5363-7. DOI: 10.1016/j.vaccine.2012.06.025
Source: PubMed


As human papillomavirus (HPV) vaccines become available in developing countries, acceptability studies can help to better understand potential barriers and facilitators of HPV vaccination and guide immunisation programs.
Prior to a cluster-randomised phase IV trial of HPV vaccination delivery strategies in Mwanza Region, Tanzania, qualitative research was conducted to assess attitudes and knowledge about cervical cancer and HPV, and acceptability of and potential barriers to HPV vaccination of Tanzanian primary schoolgirls. Semi-structured interviews (n=31) and group discussions (n=12) were conducted with a total of 169 respondents (parents, female pupils, teachers, health workers and religious leaders).
While participants had heard of cancer in general, most respondents had no knowledge of cervical cancer, HPV, or HPV vaccines. Only health workers had heard of cervical cancer but very few knew its cause or had any awareness about HPV vaccines. After participants were provided with information about cervical cancer and HPV vaccination, the majority stated that they would support HPV vaccination of their daughter to protect them against cervical cancer. Opt-out consent for vaccination was considered acceptable. Most preferred age-based vaccination, saying this would target more girls before sexual debut than class-based vaccination. Potential side effects and infertility concerns were raised by 5/14 of participating male teachers.
Reported acceptability of HPV vaccination amongst parents, teachers and other community members was high in this population. Respondents stressed the need to provide adequate information about the vaccine to parents, that also addresses side effects and infertility concerns.

Download full-text


Available from: David Ross, Apr 03, 2014
  • Source
    • "This finding reiterates themes previously identified in the literature and has specifically been identified as a general barrier to vaccine delivery among HSPs [41]. Though problematic, it is not completely surprising that frontline HSPs – and particularly third-line HSPs – reported lack of time as a barrier to vaccine recommendation given the known lack of health – and human resources in India, particularly in rural districts [42], and other low-and middle-income countries [43]. This deep-seated issue will not be a " quick fix " and will require serious political commitment, organisation, and forethought to be properly addressed. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The HIV epidemic in the south Indian state of Karnataka disproportionately burdens key populations of men who have sex with men and female sex workers. Despite having successfully reduced HIV incidence among certain key populations through the use of targeted intervention, India's HIV epidemic remains one of its greatest public health issues. The best long-term strategy for managing the global HIV epidemic might involve a preventive vaccine; however, vaccine availability cannot guarantee its accessibility or acceptability. Vaccine recommendations from frontline health service providers have previously been identified as useful strategies to enhance vaccine uptake among target groups. This study used structured interviews to explore frontline health service providers' self-identified likelihood to recommend a future, preventive HIV vaccine to key populations in Karnataka. A modified social ecological model was then used to categorise factors that might prevent health service providers from recommending an HIV vaccine. Overall, 83% of health service providers reported that they would be very likely to recommend an HIV vaccine to men who have sex with men and female sex workers, while less than one-third of participants identified one or more barrier to vaccine recommendation. Intrapersonal, interpersonal, and structural/political factors were most commonly reported to act as potential barriers to future HIV vaccine recommendation among health service providers in Karnataka. This study adds to the limited body of literature focussing on future HIV vaccine acceptability in low- and middle-income countries and highlights some of the several complexities surrounding vaccine acceptability and uptake among key populations in Karnataka. Copyright © 2014. Published by Elsevier Ltd.
    Full-text · Article · Dec 2014 · Vaccine
  • Source
    • "A qualitative study conducted among women aged 18–45 years in Malawi highlighted that before the study none of the participants heard of a HPV vaccine, but after given basic information, all the participants were willing to accept HPV vaccination [23]. Another study conducted in Tanzania among parents, female pupils, teachers, health workers, and religious leaders reported that after providing information about cervical cancer and HPV vaccination, most of the participants agreed that they would give HPV vaccination to their daughters [24]. A systematic review study highlighted that more information and recommendation from health care workers are the most important factors affecting parental decision making towards HPV vaccination for their daughters [25]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cervical cancer is a preventable public health problem. The two new human papillomavirus (HPV) vaccines are available but not accessible to everyone in South Africa, as they are very expensive. This study aimed to investigate educated peoples acceptability regarding HPV vaccination. This was a cross-sectional survey conducted among 146 master of business administration students by self-administered, anonymous questionnaire. The majority (74%) of the participants ever heard of cervical cancer, but only 26.2% heard about HPV. After reading the fact information regarding cervical cancer and HPV, the intention to vaccinate their daughters increased from 88% to 97.2% ( P = 0.003 ) . The majority (75.4%) indicated that HPV vaccination should be given before their daughters are mature enough to understand about sex, and 80.3% reported that they will discuss matters related to sex with their daughters if their daughters want to know about the vaccine. Those who did not want to vaccinate their daughters highlighted that they want more information regarding safety of the vaccine which might change their decision towards HPV vaccination. A health education information method can increase the vaccination acceptance rate in South Africa.
    Full-text · Article · Aug 2014 · BioMed Research International
  • Source
    • "Tracking girls for all three doses and coordinating the dosing schedule with the school calendar have also been noted to be difficult for others [7,16,19,20]. Most programs have reported an increase in the workload for health workers to implement HPV vaccinations, but nearly all reported that this situation was temporary, short-lived, did not affect routine services significantly, and could be managed well if careful planning was done [17,19,37]. Binagwaho and colleagues noted that having six fixed days for each of the three doses of HPV vaccine facilitated high coverage, as it was easier to mobilize communities, coordinate activities, and commandeer resources because everyone was aware of what would happen and when [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Introduction of human papillomavirus (HPV) vaccine in national programs has proceeded apace since 2006, mostly in high-income countries. Recently concluded pilots of HPV vaccination in low-income countries have provided important lessons learned for these settings; however, rigorous evaluations of the feasibility of these delivery strategies that effectively reach young adolescents have been few. This paper presents results from a qualitative evaluation of a demonstration program which implemented school-based and health center–based HPV vaccinations to all girls in grade 6, or 11 years of age, for two years in four districts of Vietnam. Methods Using semi-structured interviews of 131 health and education staff from local, district, province, and national levels and 26 focus-group discussions with local project implementers (n = 153), we conducted a qualitative two-year evaluation to measure the impact of HPV vaccinations on the health and education systems. Results HPV vaccine delivery at schools or health centers was made feasible by: a. close collaboration between the health and education sectors, b. detailed planning for implementation, c. clearly defined roles and responsibilities for project implementers, d. effective management and supervision of vaccinations during delivery, and e. engagement with community organizations for support. Both the health and education systems were temporarily challenged with the extra workload, but the disruptions were short-lived (a few days for each of three doses) and perceived as worth the longer-term benefit of cervical cancer prevention. Conclusion The learning from Vietnam has identified critical elements for successful vaccine delivery that can provide a model for other countries to consider during their planning of national rollout of HPV vaccine.
    Full-text · Article · Jun 2014 · BMC Public Health
Show more