Acceptability of HPV Vaccination for Cervical Cancer Prevention Amongst Emerging Adult Women in Rural Mysore, India: a Mixed-methods Study

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2024 Aug 7

PMID 39112938

Authors

Kate Coursey

Kiranmayee Muralidhar

Vijaya Srinivas

Poornima Jaykrishna

Fazila Begum

Nagalambika Ningaiah

Sung-Jae Lee

Purnima Madhivanan

Affiliations

Soon will be listed here.

Abstract

Background: India has the highest number of estimated deaths from cervical cancer globally, with most cases attributed to Human papillomavirus (HPV). The World Health Organization recommends primary HPV vaccination for girls ages 9-14, with catch-up vaccination for young women ≥ 15 if feasible. India authorized a new, inexpensive HPV vaccine in 2022; given anticipated vaccine expansion, we conducted a mixed-methods study exploring acceptability of HPV catch-up vaccination for young emerging adult women in rural Mysore, India.

Methods: Between September 2022-April 2023, participants were recruited with assistance from community health workers. In the qualitative phase, gender-stratified, audio-recorded focus group discussions (FGDs) were conducted in Kannada with emerging adults ages 18-26. FGDs were transcribed, translated, and analyzed using rapid approach to identify key HPV vaccination attributes. In the quantitative phase, a conjoint analysis was conducted to assess the impact of seven vaccination attributes on likelihood to vaccinate (LTV). Women ages 18-26 ranked LTV in eight hypothetical vaccination scenarios, and the relative impact of each attribute on LTV was calculated. All participants received education about cervical cancer, HPV, and HPV vaccination.

Results: Fifty-two young adults (female = 31, male = 21) participated in seven FGDs, and 101 women participated in the conjoint analysis. Average age of the 153 participants was 22.5 years, 66.7% had married, and all had completed high school. Only 17.9% had heard of cervical cancer, and 2.7% knew of the HPV vaccine. FGDs identified seven HPV vaccination attributes: cost, vaccination location, family support, peer influence, dose number, side effects, and risk of acquiring HPV. In the conjoint analysis, all attributes except dose number significantly impacted LTV. Family support (impact score = 19.37, p < 0.0001) and peer influence (impact score = 18.01, p < 0.0001) had the greatest influence, followed by cost (impact score = 16.64, p < 0.0001) and HPV risk (impact score = 12.31, p < 0.0001). Vaccination location (government centers preferred) and side effects were also significant.

Conclusion: Participants had poor knowledge of cervical cancer and HPV. Social attributes (family support, peer influence) had greatest impacts on LTV, and future studies should explore family-based interventions and peer education. Providing free vaccines at government centers through India's national immunization program would maximize catch-up HPV vaccination for rural young women.

References

Rashid S, Labani S, Das B . Knowledge, Awareness and Attitude on HPV, HPV Vaccine and Cervical Cancer among the College Students in India. PLoS One. 2016; 11(11):e0166713. PMC: 5115771. DOI: 10.1371/journal.pone.0166713. View

Lee S, Brooks R, Bolan R, Flynn R . Assessing willingness to test for HIV among men who have sex with men using conjoint analysis, evidence for uptake of the FDA-approved at-home HIV test. AIDS Care. 2013; 25(12):1592-8. PMC: 3751974. DOI: 10.1080/09540121.2013.793272. View

Serrano B, Alemany L, Ruiz P, Tous S, Lima M, Bruni L . Potential impact of a 9-valent HPV vaccine in HPV-related cervical disease in 4 emerging countries (Brazil, Mexico, India and China). Cancer Epidemiol. 2014; 38(6):748-56. DOI: 10.1016/j.canep.2014.09.003. View

Joshi S, Chaudhari H, Chaudhari N . Effect of Education on Awareness, Knowledge, and Willingness to Be Vaccinated in Females of Western India. J Cancer Educ. 2018; 35(1):61-68. DOI: 10.1007/s13187-018-1440-7. View

Sankaranarayanan R, Basu P, Kaur P, Bhaskar R, Singh G, Denzongpa P . Current status of human papillomavirus vaccination in India's cervical cancer prevention efforts. Lancet Oncol. 2019; 20(11):e637-e644. DOI: 10.1016/S1470-2045(19)30531-5. View

Zhu F, Hu S, Hong Y, Hu Y, Zhang X, Zhang Y . Efficacy, immunogenicity and safety of the AS04-HPV-16/18 vaccine in Chinese women aged 18-25 years: End-of-study results from a phase II/III, randomised, controlled trial. Cancer Med. 2019; 8(14):6195-6211. PMC: 6797633. DOI: 10.1002/cam4.2399. View

Galea J, Kinsler J, Salazar X, Lee S, Giron M, Sayles J . Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations. Int J STD AIDS. 2011; 22(5):256-62. PMC: 3096991. DOI: 10.1258/ijsa.2009.009255. View

Giduthuri J, Purohit V, Kudale A, Utzinger J, Schindler C, Weiss M . Antenatal influenza vaccination in urban Pune, India: clinician and community stakeholders' awareness, priorities, and practices. Hum Vaccin Immunother. 2020; 17(4):1211-1222. PMC: 8018408. DOI: 10.1080/21645515.2020.1806670. View

Gore M, Kawade A, Smith P, Pinnock H, Juvekar S . Working as frontline health facilitators, service providers, program supporters, and social health activists in Indian hilly terrain areas: A qualitative study of accredited social health activists' experiences before and during the COVID-19 pandemic. J Glob Health. 2022; 12:05052. PMC: 9798346. DOI: 10.7189/jogh.12.05052. View

10.

Reichheld A, Mukherjee P, Rahman S, David K, Pricilla R . Prevalence of Cervical Cancer Screening and Awareness among Women in an Urban Community in South India-A Cross Sectional Study. Ann Glob Health. 2020; 86(1):30. PMC: 7082824. DOI: 10.5334/aogh.2735. View

11.

Newman P, Duan N, Lee S, Rudy E, Seiden D, Kakinami L . HIV vaccine acceptability among communities at risk: the impact of vaccine characteristics. Vaccine. 2005; 24(12):2094-101. PMC: 2819665. DOI: 10.1016/j.vaccine.2005.11.013. View

12.

Ryan M, McIntosh E, Shackley P . Methodological issues in the application of conjoint analysis in health care. Health Econ. 1998; 7(4):373-8. DOI: 10.1002/(sici)1099-1050(199806)7:4<373::aid-hec348>3.0.co;2-j. View

13.

Mandal R, Banerjee D, Gupta K, Chatterjee P, Vernekar M, Ray C . Experience of Human Papillomavirus Vaccination Project in a Community Set Up-An Indian Study. Asian Pac J Cancer Prev. 2021; 22(3):699-704. PMC: 8286678. DOI: 10.31557/APJCP.2021.22.3.699. View

14.

Batura N, Poupakis S, Das S, Bapat U, Alcock G, Skordis J . Factors associated with women's healthcare decision-making during and after pregnancy in urban slums in Mumbai, India: a cross-sectional analysis. BMC Public Health. 2022; 22(1):743. PMC: 9009007. DOI: 10.1186/s12889-022-13216-7. View

15.

Bridges J, Hauber A, Marshall D, Lloyd A, Prosser L, Regier D . Conjoint analysis applications in health--a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force. Value Health. 2011; 14(4):403-13. DOI: 10.1016/j.jval.2010.11.013. View

16.

Pilcher F, Carney J, Stein G . Overcoming barriers to HPV vaccination in rural Vermont through a multicomponent peer-based approach. Hum Vaccin Immunother. 2022; 18(6):2122494. PMC: 9746368. DOI: 10.1080/21645515.2022.2122494. View

17.

Birje S, Patil A, Munne K, Chavan V, Joshi B, Akula A . Enablers & challenges of tribal women & health system for implementation of screening of non-communicable diseases & common cancers: A mixed-methods study in Palghar district of Maharashtra, India. Indian J Med Res. 2023; 156(2):319-329. PMC: 10057353. DOI: 10.4103/ijmr.ijmr_3240_21. View

18.

Harikrishna B, Jothula K, Nagaraj K, Prasad V . Utilisation of Anganwadi services among pregnant women in rural Telangana: A cross sectional study. J Family Med Prim Care. 2020; 9(7):3343-3348. PMC: 7567272. DOI: 10.4103/jfmpc.jfmpc_408_20. View

19.

Burki T . India rolls out HPV vaccination. Lancet Oncol. 2023; 24(4):e147. DOI: 10.1016/S1470-2045(23)00118-3. View

20.

. Human papillomavirus vaccines: WHO position paper, May 2017-Recommendations. Vaccine. 2017; 35(43):5753-5755. DOI: 10.1016/j.vaccine.2017.05.069. View