Factors associated with timely human papillomavirus vaccine completion among girls 9-14 years at Mulago Hospital.

Abstract

Background: Globally 10% of women with normal cytological findings are estimated to carry a detectable cervical HPV infection. Oncogenic HPV types 16 and 18 have been proved to have a causative role in cervical cancer. Both human papillomavirus (HPV) infection and cervical cancer are preventable diseases. WHO recommended vaccination against HPV for girls before sexual debut. Uganda started HPV vaccination in 2008 as pilot programs in 2 districts and did national roll out in 2015. Despite the availability of vaccines in preventing these diseases, there has been low human papillomavirus (HPV) vaccine coverage with very poor completion of doses globally including in Uganda. Little is known about the timely completion of HPV vaccine and the factors associated with timely HPV vaccination completion in a health-facility based approach. Objectives: To determine HPV-2 vaccine timely completion and describe the factors associated with timely HPV vaccine completion and non-completion among girls 9-14 years attending the adolescent clinic at Mulago hospital. Methods: A retrospective cohort study with a cross-sectional qualitative component was conducted in Mulago National Referral hospital adolescent clinic. The quantitative component generated information on the proportion of girls that completed the 2 doses of HPV vaccine and gave us the percentage of HPV vaccine timely completion level from November 2015 to July 2017. Qualitative data was collected through focus group discussions (FGDs) with adolescents and caretakers and provided insights on factors associated with timely vaccine completion and non-completion. Quantitative data was coded, entered using Epi-data version 3.1 and analyzed with STATA 14. Qualitative data was transcribed and analyzed manually using a thematic approach. Results: A total of 326 girls aged 9-14 years were enrolled in the clinic between November 2015 and July 2017 with a median age of 12 years (IQR10-13). Of those girls, 288 received xiii

HPV-1 vaccine and were enrolled in the study. Out of 288 girls, 201 (69.8%) received two doses of the HPV-2 vaccine and 87 (30.2%) received one dose of the vaccine. Out of the 201, 87 girls (43.3%) had timely completion of the HPV vaccination. At individual level, knowledge about HPV and vaccine benefits positively influenced timely HPV vaccine completion. At relationship level, peer influence and healthcare worker recommendation at health facility level were associated with timely completion of HPV vaccine. The major factors associated with non-completion of HPV vaccine were: inadequate information about HPV and HPV vaccine, concerns about vaccine efficacy and safety, unclear communication with adolescent/caretaker from healthcare workers and stock out of the vaccine. Conclusion: This study showed that timely completion of HPV-2 vaccine among girls 9-14 years was low at (43.3%) but higher when compared to studies done in developed countries and national completion level in Uganda. Factors associated with timely completion of HPV vaccine were having knowledge about HPV, peer influence, knowledge about vaccine benefits and healthcare worker recommendation. Barriers to completion of HPV vaccine included inadequate information about HPV and HPV vaccine, concerns about vaccine efficacy and safety, unclear communication with adolescent/caretaker from HCWs and lack of availability of vaccine.