Determinants of Human Papillomavirus Vaccine Uptake by Adult Women Attending Cervical Cancer Screening in 9 European Countries
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Introduction: Human papillomavirus–vaccinated cohorts, irrespective of age, will likely reduce their subsequent screening requirements, thus opening opportunities for global cost reduction and program sustainability. The determinants of uptake and completion of a 3-dose human papillomavirus vaccination program by adult women in a European context were estimated. Study design: This was an intervention study. Setting/participants: Study participants were women aged 25–45 years, attending opportunistic or population-based cervical cancer screening in Belgium, Denmark, Finland, France, Germany, Slovenia, Spain, Sweden, and the United Kingdom between April 2016 and May 2018. Intervention: Study participants completed a questionnaire on awareness and attitudes on adult female human papillomavirus vaccination and were invited to receive free human papillomavirus vaccination. Main outcome measures: Main outcome measures were acceptance, uptake, and completion of vaccination schedule. Determinants of vaccine uptake were explored using multilevel logistic models in 2019. Results: Among 3,646 participants, 2,748 (range by country=50%–96%) accepted vaccination, and 2,151 (range=30%–93%) received the full vaccination course. The factors associated with higher vaccine acceptance were previous awareness of adult female (OR=1.22, 95% CI=1.00, 1.48) and male (OR=1.59, 95% CI=1.28, 1.97) vaccination. Women in stable relationships (OR=0.56, 95% CI=0.45, 0.69) or with higher educational level (OR=0.76, 95% CI=0.63, 0.93) were more likely to refuse vaccination. Recruitment by postal invitation versus personal invitation from a healthcare professional resulted in lower vaccine acceptance (OR=0.13, 95% CI=0.02, 0.76). Vaccination coverage of >70% of adolescent girls in national public programs was of borderline significance in predicting human papillomavirus vaccine uptake (OR=3.23, 95% CI=0.95, 10.97). The main reasons for vaccine refusal were vaccine safety concerns (range=30%–59%) and the need for more information on human papillomavirus vaccines (range=1%–72%). No safety issues were experienced by vaccinated women. Conclusions: Acceptance and schedule completion were largely dependent on recruitment method, achieved coverage of national vaccination programs, and personal relationship status. Knowledge of benefits and safety reassurance may be critical to expanding vaccination target ages. Study results suggest that there are no major opinion barriers in adult women to human papillomavirus vaccination, especially when vaccination is offered face to face in healthcare settings. Trial Registration: EudraCT Number 2014-003177-42.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | American Journal of Preventive Medicine |
| Vol/bind | 60 |
| Udgave nummer | 4 |
| Sider (fra-til) | 478-487 |
| Antal sider | 10 |
| ISSN | 0749-3797 |
| DOI | |
| Status | Udgivet - 2021 |
Bibliografisk note
Funding Information:
The authors would like to acknowledge the study contributions from Steven Weyers and Catherine Van Pachterbeke in Belgium; Katja Harjula, Kaisa Heikkil?, Mari Hokkanen, and Mervi Nummela in Finland; Prof. Olivier Graesslin, Dr. Jean-Paul Bory, Dr. Emilie Raimond, Dr. Philippe Benoit, Dr. Coralie Barbe, Mrs. Nathalie Rau, and Mrs. Florine Hardy in France; Jo?efa Ke?ar and Lara Beseni?ar Pregelj in Slovenia; Marta Felez, Laura Monfil, Esther Roura, Carlos Amselem, Nuri Boadas, Merc? Llad?, Eva Barn?s, Elisabeth Merino, Alexandra Bonmat?, and Mar Cadi?anos in Spain; Miriam Elfstr?m, Angelica Lind?n Hirschberg, and Berit Legerstam in Sweden; and Janet Austin, Lorna Sutcliffe, Lesley Ashdown-Barr, and Tony Hollingworth in the United Kingdom. HPV vaccines used in the study were provided at no cost by GlaxoSmithKline Biologicals SA and Sanofi Pasteur Merck Sharp & Dohme (MSD), which had no role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit for publication. GlaxoSmithKline Biologicals SA and Sanofi Pasteur MSD were provided the opportunity to review a preliminary version of this manuscript for factual accuracy, but the authors are solely responsible for final content and interpretation. This research was funded by the European Commission FP7 Framework Health 2013 Innovation 1 (Grant 603019; Comparing Health Services Interventions for the Prevention of HPV-Related Cancer project). This work was also partially supported in Spain by the Instituto de Salud Carlos III (Spanish Government), cofunded by FEDER funds/European Regional Development Fund?a way to build Europe (Redes tem?ticas de investigaci?n cooperativa en salud RD12/0036/0056 [FXB, LB], Juan de la Cierva de Incorporacion IJCI-2016-29502 [CR], Centro de Investigaci?n Biom?dica en Red: Epidemiologia y Salud P?blica CB06/02/0073 [SDS], Centro de Investigaci?n Biom?dica en Red: Oncologia CB16/12/00401 [LB, FXB]), and the Ag?ncia de Gesti? d'Ajuts Universitaris i de Recerca (Catalan Government 2014SGR756 [SDS, CR], 2014SGR1077 [FXB, LB], 2017SGR793 [AA] and 2017SGR1718 [FXB, LB], and 2017SGR1085 [SDS]). The authors thank CERCA Programme/Generalitat de Catalunya for institutional support at the Catalan Institute of Oncology. Tasks completed by each author are as follows: study design (CR, MP, ML, JD, SKK, KUP, MA, JC, CC, SDS, and FXB); collection, analysis, and interpretation of data (all authors); draft manuscript writing (CR and FXB); and critical review, discussion, and approval of the final manuscript (all authors). The following authors declare receiving research funding through their institution from GlaxoSmithKline Biologicals SA (CR, LB, ML, SDS, and FXB), MSD (CR, LB, ML, JD, CM, SKK, SDS, and FXB), or Sanofi Pasteur MSD (CR, LB, ML, MH, JD, SKK, KUP, SDS, and FXB); reimbursement of travel expenses for attending symposia, meeting, or conferences from GlaxoSmithKline Biologicals SA (SDS and FXB), MSD (FXB), MSD (CC), or Sanofi Pasteur MSD (MTF, SDS, and FXB); or honorarium as a speaker or scientific advisory board member from GlaxoSmithKline Biologicals SA (KUP), MSD (SKK, JC, and FXB), MSD (CC), or Sanofi Pasteur MSD (SKK and FXB). No other financial disclosures were reported.
Funding Information:
This research was funded by the European Commission FP7 Framework Health 2013 Innovation 1 (Grant 603019 ; Comparing Health Services Interventions for the Prevention of HPV-Related Cancer project). This work was also partially supported in Spain by the Instituto de Salud Carlos III (Spanish Government) , cofunded by FEDER funds/ European Regional Development Fund —a way to build Europe ( Redes temáticas de investigación cooperativa en salud RD12/0036/0056 [FXB, LB], Juan de la Cierva de Incorporacion IJCI-2016-29502 [CR], Centro de Investigación Biomédica en Red : Epidemiologia y Salud Pública CB06/02/0073 [SDS], Centro de Investigación Biomédica en Red : Oncologia CB16/12/00401 [LB, FXB]), and the Agència de Gestió d'Ajuts Universitaris i de Recerca (Catalan Government 2014SGR756 [SDS, CR], 2014SGR1077 [FXB, LB], 2017SGR793 [AA] and 2017SGR1718 [FXB, LB], and 2017SGR1085 [SDS]). The authors thank CERCA Programme/Generalitat de Catalunya for institutional support at the Catalan Institute of Oncology.
Publisher Copyright:
© 2020 American Journal of Preventive Medicine
ID: 302545333