A high coverage of human papillomavirus (HPV) vaccination is
required to achieve a clinically significant reduction in disease burden.
Countries implementing free-of-charge national vaccination program for
adolescent girls are still challenged by the sub-optimal uptake rate. Voluntary
on-site school-based mass vaccination programs have demonstrated high coverage.
Here, we tested whether this could be an option for countries without a
government-supported vaccination program as in Hong Kong.
A Home-School-Doctor model was evolved based on extensive
literature review of various health promotion models together with studies on
HPV vaccination among adolescent girls. The outcome measure was uptake of
vaccination. Factors associated with the outcome were measured by validated
surveys in which 4,631 students from 24 school territory wide participated.
Chi-square test was used to analyze association between the categorical
variables and the outcome. Multivariate analysis was performed to identify
independent variables associated with the outcome with vaccine group as case
and non-vaccine group as control.
In multivariate analysis, parental perception of usefulness
of the Home-School-Doctor model had a very high odds ratio for uptake of HPV
vaccination (OR 26.6, 95 % CI 16.4, 41.9). Paying a reasonable price was
another independent factor associated with increased uptake (OR 1.71, 95 %
CI 1.39, 2.1 for those with parents willing to pay US$125-250 for vaccination).
For parents and adolescents who were not sure where to get vaccination, this
model was significantly associated with improved uptake rate (OR 1.66,
95 % CI 1.23, 2.23). Concerns with side effects of vaccine (OR 0.70,
95 % CI 0.55, 0.88), allowing daughters to make their own decisions (OR
0.49, 95 % CI 0.38, 0.64) and not caring much about daughters’ social life
(95 % CI 0.45, 0.92) were factors associated with a lower uptake.
The findings of this study have added knowledge on how a
school-based vaccination program would improve vaccine uptake rate even when
the users need to pay. Our findings are consistent with other study that
the most acceptable way to achieve high uptake of HPV vaccine is to offer
voluntary school-based vaccination.
A model of care incorporating the efforts and expertise of
academics and health professionals working closely with school can be applied
to improve the uptake of vaccine among adolescent girls. Subsidized voluntary
school-based vaccination scheme can be an option.
Below: Reasons not refusing HPV vaccination in the past
1JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, School of Public Heath, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
2Department of Microbiology, The Chinese University of Hong Kong, 1st Floor, Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
3Centre for Health Education and Health Promotion, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4th Floor, Lek Yuen Health Centre, Shatin, New Territories
No comments:
Post a Comment