Determinants of acceptance and subsequent uptake of the HPV vaccine in a cohort in Eldoret, Kenya

PLoS One. 2014 Oct 9;9(10):e109353. doi: 10.1371/journal.pone.0109353. eCollection 2014.

Abstract

The development of Human Papillomavirus (HPV) vaccines provides new opportunities in the fight against cervical cancer. Many acceptability studies have revealed high interest in these vaccines, but acceptance is only a precursor of behavior, and many factors, at 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 a vaccination program (n = 287) and 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 implemented via the GARDASIL Access Program, in which parents could have their daughter vaccinated for free at the referral hospital. The program was promoted at schools: Health staff informed teachers who were then asked to inform students and parents. 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. 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Decision Making
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Immunization Programs / methods
  • Kenya
  • Longitudinal Studies
  • Male
  • Papillomavirus Infections / immunology*
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines / immunology*
  • Parents
  • Patient Acceptance of Health Care / psychology*
  • Schools
  • Students
  • Surveys and Questionnaires
  • Uterine Cervical Neoplasms / immunology
  • Uterine Cervical Neoplasms / prevention & control
  • Vaccination / methods

Substances

  • Papillomavirus Vaccines

Grants and funding

Funding of the Research Foundation Flanders (FWO) supported Heleen Vermandere and the study (#1194113N). Funds for the vaccination pilot program were provided by the Moi University (Kenya)—VLIR UOS (Belgium) collaborative program. The vaccines were donated to Moi Teaching and Referral Hospital by Axios Healthcare Development (AHD) as part of the Gardasil Access Program, which was made possible by a pledge from Merck & Co., Inc. This donation was used for the study presented in this manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.