Prevalence and factors associated with HPV-vaccine uptake among adolescent girls living with HIV attending Joint Clinical Research Centre (JCRC) HIV Clinic, Kampala

Abstract

Background Women living with HIV are more prone to HPV-related cancers and illnesses. HPV vaccination is the best tool for decreasing the burden of HPV-associated-disease yet HPV vaccination uptake among teenagers including those living with HIV still remains poor despite vaccine availability. This study aimed to determine the HPV vaccination uptake, completion rates and factors associated with HPV vaccination uptake among adolescent girls living with HIV attending the Joint Clinical Research Centre (JCRC) HIV clinic, Kampala. Methods In a mixed methods cross-sectional study, quantitative data was collected from HIV positive adolescent girls aged 10-19years using a pretested questionnaire to asses for factors associated with HPV vaccine uptake, while qualitative data was obtained through adolescent focused group discussions (FGDs), and health worker key informant interviews (KIIs). Having received at least one of the three vaccine doses denoted HPV vaccine uptake while having all 3 doses of the vaccine, i.e., at 0-, 2- and 6-months denoted vaccine completion. Quantitative data was entered into epi-data v4.2 and imported into R v4.1 software for analysis. Comparison of participant characteristics, and HPV vaccine uptake was done. Bivariate and multivariate models were fitted using logistic regression for factors associated with HPV vaccine uptake. For qualitative: notes and recorded audio data were transcribed and analysed using thematic content approach. Results Two hundred and seventy-three adolescent girls living with HIV participated in the quantitative study while the qualitative study had 4 adolescents and 6 health workers. The overall mean age of the adolescent girls was 15.23years (SD +/-3.54), majority (60.4%) were aged between 15-19 years. Overall, 94.1% had less than 50% knowledge about HPV vaccination. Only 70 out of 273 had got at least one HPV vaccine dose and only 4 had completed the 3 doses, giving HPV vaccine uptake and completion rates of 25.6% and 1.5% respectively. Factors independently associated with HPV vaccine uptake included: an HPV vaccine knowledge score of >75% (aOR=5.25, 95%CI=1.40-22.05, p=0.015), being currently in school (aOR=3.15, 95%CI:1.03-3.77, p=0.049), and being WHO stage III odds (aOR=0.32, 95%CI:0.11-0.81, p=0.021) or WHO stage IV (aOR=0.23, 95%CI:0.03-0.94, p=0.049). Major themes for perceived facilitators of HPV vaccine uptake included; peer pressure, provider-initiated vaccination, and enhanced HPV vaccine school delivery programs, while barriers to uptake included; unavailability of the HPV vaccine at some health facilities, fear of vaccine side effects, and lack of HPV vaccine awareness. Major suggestions for improvement of HPV vaccine uptake and completion included; awareness creation, availability of vaccines, provider-initiated vaccination and incorporation of HPV vaccination in routine services. Conclusion The uptake and completion rates of the HPV vaccine among adolescent girls living with HIV in our setting is very low. An adolescent girl having HPV vaccine knowledge score of >75%, being in school, and having advanced WHO clinical disease stages III or IV are associated with increased odds of HPV vaccine uptake. Empowerment of school delivery programs, peer support mechanisms and provider-initiated vaccination are perceived to encourage HPV vaccine uptake while health system inadequacies are a major barrier to its uptake. Suggested means of improving HPV vaccine uptake and completion majorly highlighted the need for awareness creation and overcoming of supply and delivery chain bottlenecks.