Posted: Feb 13, 2017
High Burden of Human Papillomavirus (HPV) Infection among Young Women in KwaZulu- Natal, South Africa
Objectives: HPV infection causes cervical cancer, yet information on prevalence and risk factors for HPV in Africa remain sparse. This study describes the prevalence of HPV genotypes and risk factors associated with HPV among young women more or less 30 years of age in KwaZulu-Natal (KZN), South Africa.
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Methods: Cervicovaginal lavage samples were tested for HPV genotypes in 224 women enrolled in a prospective cohort study. Clinical, behavioural and demographic data were collected. We measured prevalence of HPV genotypes and using logistic regression, examined for factors associated with HPV.
Results: Median age of participants was 21 years [interquartile range (IQR):18–23]. The overall prev-alence of HPV was 76.3% (171/224) with multiple and single genotypes prevalent in 56.3%and 20.1% of women respectively. Proportion of women with high-risk genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56 and 58) was 54.5%. Women not living with their partner [adjusted odds ratio (aOR)] = 3.42 95% CI1.22–9.60; p = 0.019), was significantly associ-ated with HPV infection and high-risk HPV genotype infection.
Conclusion: The high burden of HPV and associated risk behaviours highlight the need to intensify behavioural interventions to prevent HPV acquisition in young women. The large scale delivery of HPV vaccine should be prioritised to prevent HPV acquisition and reduce HPV-related morbidity.
EBRAHIM, S., MNDENDE, X. K., KHARSANY, A. B., MBULAWA, Z. Z., NARANBHAI, V., FROHLICH, J., WERNER, L., SAMSUNDER, N., KARIM, Q. A. & WILLIAMSON, A. L. 2016. High Burden of Human Papillomavirus (HPV) Infection among Young Women in KwaZulu-Natal, South Africa. PLoS One, 11, e0146603.
Posted: Nov 15, 2016
Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa
Eastern Africa has the world’s highest cervical cancer incidence and mortality rates. We used epidemiologic data from Kenya, Mozambique, Tanzania, Uganda, and Zimbabwe to develop models of HPV-related infection and disease. For each country, we assessed HPV vaccination of girls before age 12 followed by screening with HPV DNA testing once, twice, or three times per lifetime (at ages 35, 40, 45). For women over age 30 we assessed only screening (with HPV DNA testing up to three times per lifetime or VIA at age 35). Assuming no waning immunity, mean reduction in lifetime cancer risk associated with vaccination ranged from 36-45%, and vaccination followed by screening once per lifetime at age 35 with HPV DNA testing ranged from 43-51%. For both younger and older women, the most effective screening strategy was HPV DNA testing three times per lifetime. Provided the cost per vaccinated girl was less than I$10 (I$2 per dose), vaccination had an incremental cost-effectiveness ratio (I$ [international dollars]/year of life saved [YLS]) less than the country-specific per capita GDP, a commonly cited heuristic for “very cost-effective” interventions. If the cost per vaccinated girl was between I$10 (I$2 per dose) and I$25 (I$5 per dose), vaccination followed by HPV DNA testing would save the most lives and would be considered good value for public health dollars. These results should be used to catalyze design and evaluation of HPV vaccine delivery and screening programs, and contribute to a dialogue on financing HPV vaccination in poor countries.
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CAMPOS, N. G., KIM, J. J., CASTLE, P. E., ORTENDAHL, J. D., O'SHEA, M., DIAZ, M. & GOLDIE, S. J. 2012. Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa. International journal of cancer, 130, 2672-2684
Posted: Nov 15, 2016
Knowledge and Awareness of HPV Vaccine and Acceptability to Vaccinate in Sub-Saharan Africa: A Systematic Review
Objectives: We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination.
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Methods: We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990–2011 were extracted from the World Health Organization database.
Findings: The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above.
Conclusion: There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support.
PERLMAN, S., WAMAI, R. G., BAIN, P. A., WELTY, T., WELTY, E. & OGEMBO, J. G. 2014. Knowledge and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: a systematic review. PLoS ONE, 9, e90912
Posted: Nov 15, 2016
A qualitative analysis of South African women’s knowledge, attitudes, and beliefs about HPV and cervical cancer prevention, vaccine awareness and acceptance, and maternal-child communication about sexual health
In South Africa, cervical cancer is the second leading cause of death among women. Black South Africa women are disproportionately affected by cervical cancer and have one of the highest mortality rates from this disease. Although the body of literature that examines HPV and cervical cancer prevention is growing in the developing world; there is still a need for a better understanding of women’s knowledge and beliefs around HPV and cervical cancer prevention. Therefore, this formative study sought to examine women’s attitudes, beliefs and knowledge of HPV and cervical cancer, HPV vaccine acceptance, maternal-child communication about sexuality, and healthcare decision-making and gender roles within an urban community in South Africa.
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Women ages 18–44 were recruited from an antenatal clinic in a Black township outside of Johan-nesburg during the fall of 2008. Twenty-four women participated in three focus groups. Findings indicated that the women talked to their children about a variety of sexual health issues; had lim-ited knowledge about HPV, cervical cancer, and the HPV vaccine. Women were interested in learning more about the vaccine although they had reservations about the long-term affect; they reinforced that grandmothers played a key role in a mother’s decisions’ about her child’s health, and supported the idea that government should provide the HPV vaccine as part of the country’s immunization program.
Our ﬁndings indicate the need to develop primary prevention strategies and materials that will pro-vide women with basic cervical cancer prevention messages, including information about HPV, cervical cancer, the HPV vaccine, screening, and how to talk to their children about these topics. Prevention strategies should also consider the cultural context and the role that grandmothers play in the family unit.
FRANCIS, S. A., BATTLE-FISHER, M., LIVERPOOL, J., HIPPLE, L., MOSAVEL, M., SOOGUN, S. & MOFAMMERE, N. 2011. A qualitative analysis of South African women's knowledge, attitudes, and beliefs about HPV and cervical cancer prevention, vaccine awareness and acceptance, and maternal-child communication about sexual health. Vaccine, 29, 8760-8765
Posted: Nov 15, 2016
Preparing for HPV vaccination in South Africa: Key challenges and opinions
This article reports on qualitative research investigating key challenges and barriers towards human papil-lomavirus (HPV) vaccine introduction in the Western Cape Province, South Africa. A total of 50 in-depth interviews and 6 focus groups were conducted at policy, health service and community levels of enquiry. Respondents expressed overall support for the HPV vaccine, underscored by difﬁculties associated with the current cervical screening programmes and the burgeoning HIV/AIDS epidemic in South Africa. Over-all poor community knowledge of cervical cancer and the causal relationship between HPV and cervical cancer suggests the need for continued education around the importance of regular cervical screening. The optimal target populations for HPV vaccination was inﬂuenced by the perceived median age of sexual activity in South African girls (9–15 years), with an underlying concern that high levels of sexual abuse had signiﬁcantly decreased the age of sexual exposure suggesting vaccination should commence as early as 9 years. Vaccination through schools with the involvement of other stakeholders such as sexual and reproductive health and the advanced programme on immunization (EPI) were suggested. Opposition to the HPV vaccine was not anticipated if the vaccine was marketed as preventing cervical cancer rather than a sexually transmitted infection. The ﬁndings assist in identifying potential barriers and facilitating factors towards HPV vaccines and will inform the development of policy and programs to support HPV vaccination introduction in South Africa and other African countries.
HARRIES, J., MOODLEY, J., BARONE, M. A., MALL, S. & SINANOVIC, E. 2009. Preparing for HPV vaccination in South Africa: key challenges and opinions. Vaccine, 27, 38-44