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Title: A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers
Authors: Katz, Ingrid T.;Nkala, Busisiwe;Dietrich, Janan;Wallace, Melissa;Bekker, Linda-Gail;Pollenz, Kathryn;Bogart, Laura M.;Wright, Alexi A.;Tsai, Alexander C.;Bangsberg, David R.;Gray, Glenda E.
subject: Medicine;Clinical Immunology;Immunity;Vaccination;Vaccines;Global Health;Infectious Diseases;Viral Diseases;HIV;Human Papillomavirus Infection;Sexually Transmitted Diseases;Non-Clinical Medicine;Health Care Policy;Sexual and Gender Issues;Socioeconomic Aspects of Health;Oncology;Cancers and Neoplasms;Gynecological Tumors;Cervical Cancer;Public Health;Behavioral and Social Aspects of Health;Preventive Medicine
Year: 2013
Publisher: Public Library of Science
Description: Background: In South Africa, the prevalence of oncogenic Human Papillomavirus (HPV) may be as high as 64%, and cervical cancer is the leading cause of cancer-related death among women. The development of efficacious prophylactic vaccines has provided an opportunity for primary prevention. Given the importance of psycho-social forces in vaccine uptake, we sought to elucidate factors influencing HPV vaccination among a sample of low-income South African adolescents receiving the vaccine for the first time in Soweto. Methods: The HPV vaccine was introduced to adolescents in low-income townships throughout South Africa as part of a nationwide trial to understand adolescent involvement in future vaccine research targeting human immunodeficiency virus (HIV). We performed in-depth semi-structured interviews with purposively-sampled adolescents and their care providers to understand what forces shaped HPV vaccine uptake. Interviews were recorded, transcribed, translated, and examined using thematic analysis. Results: Of 224 adolescents recruited, 201 initiated the vaccine; 192 (95.5%) received a second immunization; and 164 (81.6%) completed three doses. In our qualitative study of 39 adolescent-caregiver dyads, we found that factors driving vaccine uptake reflected a socio-cultural backdrop of high HIV endemnicity, sexual violence, poverty, and an abundance of female-headed households. Adolescents exercised a high level of autonomy and often initiated decision-making. Healthcare providers and peers provided support and guidance that was absent at home. The impact of the HIV epidemic on decision-making was substantial, leading participants to mistakenly conflate HPV and HIV. Conclusions: In a setting of perceived rampant sexual violence and epidemic levels of HIV, adolescents and caregivers sought to decrease harm by seeking a vaccine targeting a sexually transmitted infection (STI). Despite careful consenting, there was confusion regarding the vaccine’s target. Future interventions promoting STI vaccines will need to provide substantial information for participants, particularly adolescents who may exercise a significant level of autonomy in decision-making.
Standard no: Katz, I. T., B. Nkala, J. Dietrich, M. Wallace, L. Bekker, K. Pollenz, L. M. Bogart, et al. 2013. “A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers.” PLoS ONE 8 (8): e72094. doi:10.1371/journal.pone.0072094.
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