The Role of Anticipated Regret & Health Beliefs in HPV Vaccination Intentions among Young Adults

Although cognitions have predicted young adults' human papillomavirus (HPV) vaccine decision-making, emotion-based theories of healthcare decision-making suggest that anticipatory emotions may be more predictive. 

This study examined whether anticipated regret was associated with young adults' intentions to receive the HPV vaccine above and beyond the effects of commonly studied cognitions. 

Unvaccinated undergraduates (N = 233) completed a survey assessing Health Belief Model (HBM) variables (i.e., perceived severity of HPV-related diseases, perceived risk of developing these diseases, and perceived benefits of HPV vaccination), anticipatory emotions (i.e., anticipated regret if one were unvaccinated and later developed genital warts or HPV-related cancer), and HPV vaccine intentions. 

Anticipated regret was associated with HPV vaccine intentions above and beyond the effects of HBM variables among men. Among women, neither anticipated regret nor HBM variables showed consistent associations with HPV vaccine intentions. 

Findings suggest that anticipatory emotions should be considered when designing interventions to increase HPV vaccination among college men.

Purchase full article at:   http://goo.gl/iFbrji

By:  Christy SM1,2, Winger JG3, Raffanello EW4, Halpern LF4, Danoff-Burg S5, Mosher CE3.

• 1Health Outcomes and Behavior Program, Division of Population Science, Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., MRC-CANCONT, Tampa, FL, 33612, USA. shannon.christy@moffitt.org.
• 2Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA. shannon.christy@moffitt.org.
• 3Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
• 4Department of Psychology, University at Albany-SUNY, Albany, NY, USA.
• 5New Knowledge Organization, Oceanside, CA, USA. 
• J Behav Med. 2016 Jan 18. 

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Prospective One Year Follow Up of HIV Infected Women Screened for Cervical Cancer Using Visual Inspection with Acetic Acid, Cytology and Human Papillomavirus Testing in Johannesburg South Africa

Background

Cervical cancer is the most common cancer in Sub-Saharan Africa. There are little of HIV-infected women one-year after screening using visual inspection with acetic acid (VIA), HPV or cytology in sub-Saharan Africa.

Methods

HIV-infected women in Johannesburg South Africa were screened one year later by Pap smear, VIA and human papillomavirus (HPV) testing. Women qualified for the 12 month follow-up visit if they had a negative or cervical intra-epithelial neoplasia (CIN) 1 results at the baseline visit. Modified Poisson regression was used to analyse associations between patient baseline characteristics and progression.

Results

A total of 688 of 1,202 enrolled at baseline study who were CIN-2+ negative and qualified for a 12 month follow-up visit. Progression to CIN-2+ was higher in women with positive VIA results (12.6%; 24/191) than those VIA-negative (4.4%; 19/432). HPV-positive women at baseline were more likely to progress to CIN-2+ (12.3%; 36/293) than those HPV-negative (2.1%; 7/329). Cytology-positive women at baseline were more likely to progress to CIN-2+ (9.6%; 37/384) than cytology-negative women (2.5%; 6/237). Approximately 10% (10.4%; 39/376) of women with CIN 1 at baseline progressed to CIN 2+. Women who were VIA or HPV positive at baseline were more likely to progress aIRR 1.85, CI 95% (1.46 to 2.36), aIRR 1.41 CI 95% (1.14 to 1.75) respectively.

Conclusion

Progression to CIN-2+ in HIV-infected women is significant when measured by baseline positive VIA, HPV or Pap and yearly screening by any method should be considered in this population if possible.

Below:  Consort diagram of participant follow-up one year later

Full article at:   http://goo.gl/vMOeT8

By:  

Cynthia Firnhaber, Avril Swarts

Clinical HIV Research Unit, Faculty of Health Sciences, Department of Internal Medicine, University Witwatersrand, Johannesburg, South Africa

Cynthia Firnhaber, Bridgette Goeieman, Mark Faesen, Simon Levin, Sophie Williams, Sibongile Rameotshela, Kate Schnippel

Right to Care, Johannesburg, South Africa

Simon Levin

Department of OB/GYN, Coronation Hospital, University of Witwatersrand, Johannesburg, South Africa

Pam Michelow

Cytology Unit, Department of Anatomical Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa

Pam Michelow, Tanvier Omar

National Health Laboratory Service, Johannesburg, South Africa

Anna-Lise Williamson

Institute of Infectious Disease and Division of Medical Virology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa

Anna-Lise Williamson, Bruce Allan

National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa

Jennifer S. Smith

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America

Jennifer S. Smith

Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America

  

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Girls’ Explanations for Being Unvaccinated or Under Vaccinated Against Human Papillomavirus

Background

In England HPV vaccination is offered to all girls age 12–13 years, free-at-the-point-of-receipt, mostly in schools. Coverage is good, but around 20 % of girls remain unvaccinated. This research sought to explore reasons for being un-/under vaccinated.

Methods

An ethnically diverse sample of girls aged 15–16 years attending one of twelve London schools completed a survey three years after being offered HPV vaccination. Girls reported their HPV vaccine status and those who were unvaccinated (had not received any doses of the vaccine) or under vaccinated (had not completed the recommended 3-dose course) recorded reasons for their un-/under vaccinated status. Reasons were reported using free-text and content analysis was used to analyse responses.

Results

Around 74 % of un-/under vaccinated girls provided a reason for their vaccination status (n = 259). Among unvaccinated girls, the most common reasons related to lack of perceived need for vaccination, concerns about safety and lack of parental consent. Girls who were under vaccinated gave practical reasons, including the need for more information (e.g. not knowing that multiple doses were needed), administrative issues (e.g. school absence), health and procedural concerns (e.g. fear of needles). Descriptively, there were few differences in the reasons given between girls from different ethnic backgrounds. Girls from Black and Asian backgrounds more commonly thought that the vaccine was not needed. Lack of parental consent without providing further explanation was most often cited by girls from Black backgrounds.

Conclusions

Safety concerns and lack of perceived need should be addressed to encourage informed uptake of HPV vaccination. Immunisation programme coordinators may be able to increase series completion by tackling practical problems facing under vaccinated girls.

Table 2

Reasons provided by unvaccinated and under vaccinated participants to explain their vaccination status

Major theme (subthemes)	Examples	n (%) Unvaccinated	n (%) Under vaccinated
		n = 202	n = 57
Lack of parental consent (without explanation)	My parents don’t want me to get it	30 (14.9)	1 (1.8)
Lack of parental consent (with explanation)	Provided below under major themes	52 (25.7)	3 (5.3)
Safety concerns (concern about side effects or long term effects, the novelty of the vaccine, wanting more research, seeing press reports about the death of a girl from HPV vaccine, prefer to delay vaccination)	I was scared about the long-term effects as the vaccine hasn't been around for long My Mum felt it was as if we were being tested on	51 (25.3)	2 (3.5)
The vaccine isn’t needed (not sexually active, not planning on being sexually active, no history of cervical cancer in the family, don’t need it)	Because I am not sexually active and will not be until I get married My Mum didn’t think it was necessary for me to have the vaccine since I won’t be sleeping around	38 (18.8)	1 (1.8)
Administrative reasons (being absent from school, moving schools, being out of the country, recent migration, not having a consent form, didn’t want the vaccine in school, not offered vaccination doses).	I wasn’t in school the day the 3rd injections happened  My parents …preferred me to have it at the doctors, not school.	26 (12.8)	29 (50.9)
Need for more information (was not aware of the vaccine, didn’t understand it, not enough information)	I didn’t know about it My Mum wasn’t sure what it was	8 (4.0)	6 (10.5)
Procedural issues (afraid of or dislike needles, pain)	I’m scared of needles	22 (10.9)	3 (5.3)
General vaccination beliefs (don’t believe in vaccinations, don’t’ believe in manmade treatments)	…I wouldn’t want a man-made treatment Mum didn’t think it was natural to have it	5 (2.5)	0 (0)
Health reasons (existing health condition, got ill after previous dose, allergic to ingredients, unwell when vaccine offered).	I have not had it because I suffer from other conditions and therefore was more likely for me to have a negative reaction. My Mum… thinks I might be allergic to HPV vaccine	9 (4.5)	5 (8.8)
Other reasons (don’t know/can’t remember, didn’t want it with no explanation, other)	Because I didn’t want to	22 (10.9)	11 (19.3)

Note: Column percent may not be equal 100 % as multiple reasons were given by participants.

Full article at:   http://goo.gl/nNSuuX

By:   Alice S. Forster, Jo Waller, Harriet L. Bowyer, and Laura A. V. Marlow

Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, WC1E 6BT London, UK

Alice S. Forster, Email: ku.ca.lcu@retsrof.ecila.

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High Frequency of Human Papillomavirus Type 53 in Oral Cavity of Asymptomatic HIV-Infected People

In this way, we conducted a descriptive, case–control study in 197 individuals aged from 18 to 75 years and asymptomatic for oral lesions. The target group consisted of 77 HIV-positive individuals who attended at the University Hospital's ambulatory, Niterói City, Rio de Janeiro, Brazil, between 2009 and 2010. The control group included 120 volunteers from University Hospital's blood donors service, located in the same city. The Ethics Committee of the College of Medicine of the University provided ethical clearance for the protocol and informed consent, under the registration 357.085. Demographic and behavioral data were collected through a structured questionnaire. For HIV-positive people, CD4 counts were determined and plasma HIV-1 RNA levels were measured. An oral mucosal sample was harvested from all participants. The DNA extracted was submitted to PCR assay for HPV detection using MY09/11 consensus primers and HPV positive samples were typified by restriction fragment length polymorphism analysis (RFLP) or automated sequencing. A databank was generated in the SPSS-18 statistical packet to identify associations between variants and the presence of HPV.

Regarding HIV infection status, 68.4% of patients had undetectable HIV viral load, 76.6% reported HIV diagnostic more than 4 four years prior, and 88.3% were undergoing antiviral therapy. At the time of our study, 90.9% of patients had above 200 CD4+ cells/mL. Demographic variables did not affect HPV infection in HIV positive or negative people. However, oral HPV infection was significantly associated with HIV-positive individuals (59.7% versus 38.3%, p = 0.004). Table 1 displays the spectrum of HPV genotypes found in oral cavity from both populations. They are categorized according to the criterion based on the risk for cervical cancer...²

Table 1.

Occurrence of oral HPV genotypes in HIV-positive and negative people.

HPV genotypes	HPV genotypes frequency		Odds ratio (95% CI)	χ2
	HIV+ N (%)	HIV− N (%)		p-Value
Low risk
6	11 (14.3)	33 (27.5)	0.43 (0.20–0.93)	0.021
11	6 (7.8)	0.0	1.08 (1.01–1.15)	0.003
13	1 (1.3)	0.0
72	0.0	1 (0.8)
High risk
18	1 (1.3)	1 (0.8)
52	0.0	1 (0.8)
Probable high risk
53	17 (22.1)	1 (0.8)	33.72 (4.38–259.4)	0.000
82	2 (2.6)	0.0
Undetermined risk
32	0.0	1 (0.8)
71	0.0	2 (1.7)
84	0.0	1 (0.8)
Beta-papillomavirus
110	1 (1.3)	0.0
120	2 (2.6)	0.0
Co-infections	15 (89.1)	5 (10.9)	3.96 (1.30–12.09)	0.021
Unidentified types	20 (26.0)	11 (9.2)	3.47 (1.55–7.75)	0.002
Negative samples	31 (40.3)	74 (61.7)

Full article at:   http://goo.gl/WgjIZw

By:   Silva CO¹, Santos LS¹, Pereira OM², Azevedo KM³, Oliveira LH⁴.

¹Department of Microbiology and Parasitology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.

²Blood Bank of University Hospital, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.

³Infectious and Parasitic Diseases Service, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.

⁴Department of Microbiology and Parasitology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil. Electronic address: virologia.uff@gmail.com.

  

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Association of High-Risk Human Papillomavirus with Genital Tract Mucosal Immune Factors in HIV-Infected Women

PROBLEM:

High-risk human papillomavirus (HR-HPV) is prevalent in HIV-infected women and may be associated with mucosal changes that promote HIV replication.

METHOD OF STUDY:

Innate immune molecules, antimicrobial activity, HIV RNA, and HPV DNA genotypes were measured in a cross-sectional study of 128 HIV-infected women categorized into HPV-16 (n = 8), other HR-HPV (n = 41), and non-HR-HPV controls (n = 79).

RESULTS:

Compared to controls, HR-HPV groups had higher plasma viral loads (P = 0.004), lower CD4 cells (P = 0.02), more genital tract HIV RNA (P = 0.03), greater number of different HPV types (P < 0.001), higher cervicovaginal lavage (CVL) IL-1α (P = 0.03) and human beta-defensin 2 (HBD2) (P = 0.049), and less anti-HIV_B al activity (P = 0.03). HPV-16 remained significantly associated with higher HBD2 (P = 0.03), higher IL-1α (P = 0.009), and lower anti-HIV_B aL activity (P = 0.03) compared to controls after adjusting for plasma viral load and CD4 T cell count.

CONCLUSION:

HR-HPV is associated with mucosal changes in HIV-infected women that could adversely impact genital tract health.

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By:   Buckley N1, Huber A1, Lo Y2, Castle PE2, Kemal K1, Burk RD1,2, Strickler HD2, Einstein MH3, Young M4, Anastos K5, Herold BC1,3,6.

• 1Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.
• 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
• 3Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.
• 4Department of Medicine, Georgetown University, Washington, DC, USA.
• 5Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
• 6Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA. 

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Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children

Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. 

New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure. 

For child sexual assault (CSA) survivors, recommendations include targeted diagnostic testing with increased use of NAATs when appropriate; routine follow-up visits within 6 months after the last known sexual abuse; and use of HPV vaccination in accordance with national immunization guidelines as a preventive measure in the post-sexual assault care setting. For CSA patients, NAATs are considered to be acceptable for identification of gonococcal and chlamydial infections from urine samples, but are not recommended for extragenital testing due to the potential detection of nongonococcal Neisseria species. 

Several research questions were identified regarding the prevalence, detection, and management of STI/HIV infections among adult, adolescent, and pediatric sexual assault survivors.

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By:  Seña AC1, Hsu KK2, Kellogg N3, Girardet R4, Christian CW5, Linden J6, Griffith W7, Marchant A8, Jenny C9, Hammerschlag MR10.

• 1Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill.
• 2Division of STD Prevention, Bureau of Infectious Diseases, Massachusetts Department of Public Health, Jamaica Plain.
• 3Division of Child Abuse Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio.
• 4Division of Child Protection Pediatrics, Department of Pediatrics, University of Texas Health Science Center at Houston.
• 5Child Abuse and Neglect Prevention, Children's Hospital of Philadelphia, Pennsylvania.
• 6Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Massachusetts Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston.
• 7Women's Emergency Services, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas.
• 8Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston.
• 9Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle.
• 10Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn. 

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