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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers
PLoS ONE, Volume 8, No. 8, Article e72094, Year 2013
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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. © 2013 Katz et al.
Authors & Co-Authors
Katz, Ingrid T.
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
United States, Boston
Massachusetts General Hospital
Nkala, B.
South Africa, Johannesburg
University of the Witwatersrand
Dietrich, Janan Janine
South Africa, Johannesburg
University of the Witwatersrand
Wallace, Melissa L.
South Africa, Cape Town
University of Cape Town
Bekker, Linda-Gail Gail
South Africa, Cape Town
University of Cape Town
Pollenz, Kathryn
United States, Boston
Harvard Medical School
Bogart, Laura M.
United States, Boston
Harvard Medical School
United States, Boston
Boston Children's Hospital
Wright, Alexi A.
United States, Boston
Harvard Medical School
United States, Boston
Dana-farber Cancer Institute
Tsai, Alexander C.
United States, Boston
Harvard Medical School
United States, Boston
Massachusetts General Hospital
Bangsberg, David R.
United States, Boston
Harvard Medical School
United States, Boston
Massachusetts General Hospital
Gray, Glenda E.
South Africa, Johannesburg
University of the Witwatersrand
Statistics
Citations: 56
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0072094
e-ISSN:
19326203
Research Areas
Cancer
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Violence And Injury
Study Design
Cross Sectional Study
Study Approach
Qualitative
Study Locations
South Africa
Participants Gender
Female