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Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries

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Abstract

Purpose

The World Health Organization revised its human papillomavirus (HPV) vaccination recommendations to include a two (2-) dose schedule for girls aged ≤ 15 years. We investigated acceptability of 2- versus 3-dose schedule among adolescent vaccination providers and mothers of adolescent girls in five countries.

Methods

Adolescent vaccination providers (N = 151) and mothers of adolescent girls aged 9–14 years (N = 118) were recruited from Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers’ preference for a 2- versus 3-dose HPV vaccination schedule via quantitative surveys. Mothers’ attitudes towards a 2-dose schedule were assessed through focus group discussions.

Results

Most adolescent providers preferred a 2- over a 3-dose HPV vaccination schedule (overall: 74%), with preference ranging from 45.2% (South Africa) to 90.0% (South Korea). Lower cost, fewer clinic visits, and higher series completion were commonly cited reasons for 2-dose preference among providers and mothers. Safety and efficacy concerns were commonly cited barriers to accepting a 2-dose HPV vaccination schedule among providers and mothers. Mothers generally accepted the reduced schedule, however requested further information from a trusted source.

Conclusions

Adolescent vaccination providers and mothers preferred the 2-dose over 3-dose HPV vaccination schedule. Acceptability of a 2-dose HPV vaccination could be improved with additional information to providers and mothers on HPV vaccination safety and efficacy.

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Abbreviations

HIV:

Human immunodeficiency virus

HPV:

Human  papillomavirus

LMIC:

Low- and middle-income country

SAGE:

Strategic Advisory Group of Experts

STI:

Sexually transmitted infections

WHO:

World Health Organization

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Acknowledgments

The authors gratefully acknowledge the participants of this study. The authors thank Suzanne Landi, Shoshana Goldberg, and Sara Smith for their assistance in developing this manuscript. JYI was supported by a NIH NRSA individual predoctoral fellowship (F31-CA210474-01A1). Cervarix is a trademark owned by or licensed to the GSK group of companies.

Funding

This study was funded by GlaxoSmithKline Biologicals SA (Study ID: 117339); all data collection, analysis, and interpretation was conducted by study co-authors, and GSK had the opportunity to review this paper. GSK did not have input into the research data collection, analysis, or interpretation of results.

Author information

Author notes

  1. Jessica Yasmine Islam and Alexis M. Hoyt have equally contributed to this manuscript.

Authors and Affiliations

  1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA

    Jessica Yasmine Islam

  2. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA

    Alexis M. Hoyt, Virginia Senkomago & Jennifer S. Smith

  3. Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina

    Silvina Ramos

  4. Perdana University School of Medicine, Seri Kembangan, Malaysia

    Karen Morgan

  5. Royal College of Surgeons, Dublin, Ireland

    Karen Morgan

  6. Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, St. Paul’s Hospital, Seoul, South Korea

    Chan Joo Kim

  7. Infections and Cancer, Cancer Epidemiology Research Programme, Institut Català d’Oncologia, Barcelona, Spain

    Sylvia de Sanjose

  8. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA

    Nicole Butera

  9. Department of Medical Virology, University of Pretoria, National Health Laboratory Service, Pretoria, South Africa

    Karin L. Richter

  10. Center on Genomics, Race, Identity, Difference, Duke University, Durham, NC, USA

    Mary Anne McDonald

  11. Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Nadja A. Vielot

  12. UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Jennifer S. Smith

  13. Department of Epidemiology, UNC Gillings School of Global Public Health, 2103 McGavran Greenberg CB7435, Chapel Hill, NC, 27599, USA

    Jennifer S. Smith

Authors
  1. Jessica Yasmine Islam
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  2. Alexis M. Hoyt
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  3. Silvina Ramos
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  4. Karen Morgan
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  5. Chan Joo Kim
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  6. Sylvia de Sanjose
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  7. Nicole Butera
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  8. Virginia Senkomago
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  9. Karin L. Richter
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  10. Mary Anne McDonald
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  11. Nadja A. Vielot
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  12. Jennifer S. Smith
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Corresponding author

Correspondence to Jennifer S. Smith.

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Conflict of interest

Jennifer S. Smith has received research grants, served on paid advisory boards, and/or been a paid speaker for GSK group of companies and Merck & Co., Inc. over the past 5 years. The remaining authors have no conflicts of interest to disclose.

Appendices

Appendix 1

See Table 5.

Table 5 Site-specific recruitment procedures of providers and adolescent mothers
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Appendix 2

See Table 6.

Table 6 Quantitative questions that assessed healthcare provider’s willingness for initiation and for completion of a 2- versus 3-dose HPV vaccination schedule
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Appendix 3

See Table 7.

Table 7 Qualitative questions in focus group discussion (FGD) guide surrounding maternal attitudes towards a 2- versus 3-dose vaccination schedule
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Islam, J.Y., Hoyt, A.M., Ramos, S. et al. Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries. Cancer Causes Control 29, 1115–1130 (2018). https://doi.org/10.1007/s10552-018-1085-1

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