HPV Vaccination Uptake: Identifying Gaps, Barriers and Disparities in Canadian Population

Human papillomavirus (HPV) causes the most common viral infection of the reproductive tract worldwide. It is implicated in cervical, anal, oropharyngeal cancers and genital warts in males and females. Infections with HPV are common, it is estimated that 550,000 Canadians are infected yearly. Without prevention measures, it is projected that 75% of the population will contract HPV infection at one point in their lifetime. The World Health Organization recognizes vaccination as a strategic approach in the prevention of HPV-related diseases. In Canada, the HPV vaccine was approved in 2006. In spite of proven benefits, HPV vaccine uptake is suspected to be low and variable across Canada. To maximize obtainable benefits from HPV vaccination, it is crucial to understand the dynamics and interplay of factors underpinning HPV vaccine uptake in Canada. Using systematic literature review, meta-analysis and analysis of reliable secondary data; this thesis examined rates of HPV vaccine uptake, identified determinants of uptake and HPV vaccination gaps among different sub-populations in Canada. From the pooled result of meta-analysis; the proportion of HPV vaccination uptake was 47.0% (male) and 57.0% (female). Using the American College Health Assessment-National College Health Assessment (ACHA-NCHA), proportion of HPV vaccine uptake was 56.1% (female) and 22.2% (male). Furthermore, using the Childhood National Immunization Coverage Survey (CNICS) 2015; proportion of HPV vaccine uptake is 73.7% in girls. In terms of HPV vaccination trend; proportion of HPV vaccine uptake is 41.1%, 68.6% and 73.7% for CNICS 2011, 2013 and 2015 respectively. The observed HPV vaccine uptake proportions across Canadian subpopulations were well below the >80% target set by the Government of Canada. Significant determinants of HPV vaccine uptake were: age, birthplace of child, province of residence, race/ethnicity, history of vaccination, history of sexually transmitted infections and marital status. There were significant gaps in the HPV vaccine uptake among different sub-populations namely: male, men-sleeping-with-men (MSM), older age individuals, international and Aboriginal students (p-value <0.05). To improve on current HPV vaccination uptake in Canada, health education programs and intentional HPV catch-up vaccination programs are required. This is crucial especially for sub-populations with evidence of gaps in HPV vaccine uptak

Human papillomavirus vaccination uptake in Canada: A systematic review and meta-analysis

Human papillomavirus (HPV) is the most commonly sexually transmitted infection in the world and the primary cause of cervical cancer. Canada introduced publicly funded HPV vaccination programs in 2006. The objectives of this study are twofold and aim to (1) determine the levels and (2) examine the various factors influencing vaccine uptake among the general Canadian population. A literature search was conducted on seven databases, followed by screening, methodological quality review (using modified Newcastle-Ottawa Scale), and data extraction. Pooled meta-analysis and a subgroup analysis were conducted stratifying by a number of variables (age, sex, type of program, and method of payment) determined apriori. A total of 718 peer-reviewed articles were initially identified with 12 remaining after screening and underwent methodological quality review. HPV vaccination uptake in Canada varied from 12.40% (95% confidence interval [CI] 6.77–20.26) to 88.20% (95% CI 85.72–90.39). The pooled random effects model showed the HPV vaccination uptake to be 55.92% (95% CI 44.87–66.65). The subgroup analysis showed that vaccination uptake was 66.95% (95% CI 55.00–77.89) in participants ≤ 18 years as compared to 13.58% (95% CI 10.93–16.46) in participants > 18 years. Uptake for females was higher 57.23% (95% CI: 45.40–68.66) when compared to that of 47.01% (95% CI: 0.82–97.75) in males. HPV vaccine uptake among school-based programs was 69.62% (95% CI 57.27–80.68) as compared to 18.66% (95% CI 6.66–34.92) for community-based programs. Vaccination uptake for publicly funded programs was significantly higher 66.95% (95% CI 55.00–77.89) when compared to 13.58% (95% CI 10.92–16.46) for programs where participants had to pay out of pocket. To prevent infections and reduce the burden of HPV-related diseases (including cervical cancer), communities should be made aware and encouraged to vaccinate their children. There is a documented need to direct effort and focus interventions toward improving HPV vaccination uptake in Canada