A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers

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dc.contributor.authorKatz, Ingrid Ten_ZA
dc.contributor.authorNkala, Busisiween_ZA
dc.contributor.authorDietrich, Jananen_ZA
dc.contributor.authorWallace, Melissaen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorPollenz, Kathrynen_ZA
dc.contributor.authorBogart, Laura Men_ZA
dc.contributor.authorWright, Alexi Aen_ZA
dc.contributor.authorTsai, Alexander Cen_ZA
dc.contributor.authorBangsberg, David Ren_ZA
dc.date.accessioned2015-11-23T12:28:30Z
dc.date.available2015-11-23T12:28:30Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: 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.en_ZA
dc.identifier.apacitationKatz, I. T., Nkala, B., Dietrich, J., Wallace, M., Bekker, L., Pollenz, K., ... Bangsberg, D. R. (2013). A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers. <i>PLoS One</i>, http://hdl.handle.net/11427/15289en_ZA
dc.identifier.chicagocitationKatz, Ingrid T, Busisiwe Nkala, Janan Dietrich, Melissa Wallace, Linda-Gail Bekker, Kathryn Pollenz, Laura M Bogart, Alexi A Wright, Alexander C Tsai, and David R Bangsberg "A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/15289en_ZA
dc.identifier.citationKatz, 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. doi:10.1371/journal.pone.0072094en_ZA
dc.identifier.ris TY - Journal Article AU - Katz, Ingrid T AU - Nkala, Busisiwe AU - Dietrich, Janan AU - Wallace, Melissa AU - Bekker, Linda-Gail AU - Pollenz, Kathryn AU - Bogart, Laura M AU - Wright, Alexi A AU - Tsai, Alexander C AU - Bangsberg, David R AB - 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. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0072094 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers TI - A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers UR - http://hdl.handle.net/11427/15289 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15289
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0072094
dc.identifier.vancouvercitationKatz IT, Nkala B, Dietrich J, Wallace M, Bekker L, Pollenz K, et al. A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers. PLoS One. 2013; http://hdl.handle.net/11427/15289.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Katz et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherVaccinesen_ZA
dc.subject.otherAdolescentsen_ZA
dc.subject.otherHIV epidemiologyen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherDecision makingen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherVaccination and immunizationen_ZA
dc.subject.otherChildrenen_ZA
dc.titleA qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregiversen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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