A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers

Ingrid T. Katz, Busisiwe Nkala, Janan Dietrich, Melissa Wallace, Linda Gail Bekker, Kathryn Pollenz, Laura M. Bogart, Alexi A. Wright, Alexander C. Tsai, David Bangsberg, Glenda E. Gray

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numbere72094
JournalPLoS One
Volume8
Issue number8
DOIs
StatePublished - Aug 30 2013
Externally publishedYes

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Papillomavirus Vaccines
Papillomaviridae
health care workers
qualitative analysis
South Africa
Caregivers
Statistical Factor Analysis
Vaccines
vaccines
uptake mechanisms
Viruses
Human immunodeficiency virus
HIV
Decision Making
Decision making
Sex Offenses
sexually transmitted diseases
decision making
violence
Sexually Transmitted Diseases

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Katz, I. T., Nkala, B., Dietrich, J., Wallace, M., Bekker, L. G., Pollenz, K., ... Gray, G. E. (2013). A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers. PLoS One, 8(8), [e72094]. https://doi.org/10.1371/journal.pone.0072094

A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers. / Katz, Ingrid T.; Nkala, Busisiwe; Dietrich, Janan; Wallace, Melissa; Bekker, Linda Gail; Pollenz, Kathryn; Bogart, Laura M.; Wright, Alexi A.; Tsai, Alexander C.; Bangsberg, David; Gray, Glenda E.

In: PLoS One, Vol. 8, No. 8, e72094, 30.08.2013.

Research output: Contribution to journalArticle

Katz, IT, Nkala, B, Dietrich, J, Wallace, M, Bekker, LG, Pollenz, K, Bogart, LM, Wright, AA, Tsai, AC, Bangsberg, D & Gray, GE 2013, 'A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers', PLoS One, vol. 8, no. 8, e72094. https://doi.org/10.1371/journal.pone.0072094
Katz, Ingrid T. ; Nkala, Busisiwe ; Dietrich, Janan ; Wallace, Melissa ; Bekker, Linda Gail ; Pollenz, Kathryn ; Bogart, Laura M. ; Wright, Alexi A. ; Tsai, Alexander C. ; Bangsberg, David ; Gray, Glenda E. / A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers. In: PLoS One. 2013 ; Vol. 8, No. 8.
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abstract = "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.",
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AU - Bekker, Linda Gail

AU - Pollenz, Kathryn

AU - Bogart, Laura M.

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