Determinants of acceptance and subsequent uptake of the HPV vaccine in a cohort in Eldoret, Kenya
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Heleen Vermandere, Violet Naanyu, Hillary Mabeya, Davy Vanden Broeck, Kristien Michielsen, Olivier Degomme
The development of Human Papillomavirus (HPV) vaccines provides new opportunities in the fight against cervical cancer. Many acceptability studies have revealed a high interest in these vaccines, but acceptance is only a precursor of behavior, and many factors, at the personal, community and provider level, may inhibit the translation of willingness to vaccinate into actual uptake. Through a longitudinal study in Eldoret, Kenya, HPV vaccine acceptability was measured before the implementation of a vaccination program (n=287) and the actual vaccine uptake, as reported by mothers, once the program was finished (n=256). In between baseline and follow-up, a pilot HPV vaccination program was rolled out via the GARDASIL Access Program, in which parents could have their daughter vaccinated free of cost at the referral hospital. The program was promoted at local schools: health staff informed teachers who were then asked to inform students and parents regarding cervical cancer prevention and the vaccination program. Even though baseline acceptance was very high (88.1%), only 31.1% of the women reported at follow-up that their daughter had been vaccinated. The vaccine was declined by 17.7%, while another 51.2% had wanted the vaccination but were obstructed by practical barriers such as a lack of information or time constraints. Being well-informed about the program and baseline awareness of cervical cancer were independently associated with vaccine uptake, while baseline acceptance was correlated in bivariate analysis. Side effects were of great concern, even among those whose daughter was vaccinated. Possible partner disapproval lowered acceptance at baseline, and women indeed reported at follow-up that they had encountered his opposition. In Kenya, women prove to be very willing to have their daughter vaccinated against cervical cancer. However, in this study, uptake was more determined by program awareness than by HPV vaccine acceptance. School-based vaccination might improve coverage since it reduces operational problems for parents. In addition, future HPV vaccination campaigns should address concerns about side effects, targeting men and women, given both their involvement in HPV vaccination decision-making.
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