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THREE ABSTRACTS ON GLOBAL ASPECTS OF HPV VACCINATION

Sunday, 12th of August 2012

ABSTRACTS ON GLOBAL ASPECTS OF HPV VACCINATION

From http://www.hpv2011.org/pics/1/4/Abstract%20Book%201%20EP-PH%20WEBB%20110922.pdf

1) PROSPECTS FOR RAPID WORLDWIDE REDUCTION OF CERVICAL CANCER

J Peto, London School of Hygiene and Tropical Medicine, London, UNITED KINGDOM

S Franceschi, International Agency for Research on Cancer, Lyon, FRANCE

C Gilham, London School of Hygiene and Tropical Medicine, London, UNITED KINGDOM

Most HPV16/18 vaccination programmes target adolescent girls who have not yet been infected. However, restricting HPV vaccination to young women will have little effect on overall cancer rates for several decades, as most of the 10 million women who will develop cervical cancer over the next 20 years have already been infected with HPV. The majority of HPV infections disappear within a year or two, and these confer little risk of progression to cancer. A screen-and-treat policy based on a single HPV test therefore entails substantial overtreatment, and does not protect against subsequent reinfection. Polyvalent HPV vaccines that prevent the large majority of incident infections with high-risk HPV types (notably HPV L2 vaccines) and rapid HPV testing may soon be available at affordable cost, and this will have important implications for vaccination and screening policy, particularly in older women. Polyvalent HPV vaccination, followed 3 years later by a rapid HPV test and immediate ablative treatment of all persisting HR-HPV infections (irrespective of cytology or colposcopy), would greatly reduce cervical cancer incidence in women at all ages. This once in a lifetime intervention might be a cost-effective alternative to regular screening in developed countries, and in developing countries where regular cervical screening is impractical it may be the only way to produce a large and rapid reduction in cervical cancer incidence and mortality. The EUROGIN 2010 Roadmap on Cervical Cancer Prevention suggests that in developing countries this might be achieved more easily by a programme of mass vaccination followed a few years later by mass HPV testing than by attempting to follow up individual women after vaccination.

Declaration of interest

None declared.

2) PROGRAM COSTS TO INTRODUCE HPV VACCINE IN FOUR LOW-RESOURCE SETTINGS

C Levin, PATH, Seattle, UNITED STATES

H Van Minh, Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam

J Odaga, Child Health and Development Centre, Makarere University, Kampala, Uganda

S Sarit Rout, Centre for Operations Research and Training, Vadodara, India

D Nguyen, PATH, Hanoi, Vietnam

L Menezes, PATH, New Delhi, India

M A Mendoza Araujo, Estrategia Sanitaria Nacional de Inmunización, Ministry of Health, Peru, Lima, Peru

Background: The advent of HPV vaccines is estimated to have a significant impact on the reduction of cervical cancer incidence and mortality. As developing countries consider whether they can afford to introduce HPV vaccine, much of the attention has focused on the vaccine price (the reported public-sector price is now around US$20 per dose). While vaccine price will remain a key driver on the cost side, national governments will also need to consider additional resources to support implementation costs associated with new delivery strategies to reach pre-adolescent girls.

Objectives: Estimate incremental program costs associated with reaching pre-adolescent girls for HPV vaccination in four low-resource settings—Peru, Uganda, India, and Vietnam.

Methods: Microcosting methods were used to guide primary data collection on resource use (staff, supplies, equipment), combined with existing expenditure reports and price data from government, project, or health center administrative records. Data were collected at multiple levels of the health system from a sub-sample of health facilities participating in HPV vaccine demonstration projects for both start-up and recurring activities. Costs exclude project-related expenses and are incremental to existing services.

Results: Delivery cost per dose ranged from US$1.44 per dose in Uganda’s outreach-based strategy to US$4.67 per dose in Vietnam’s school-based strategy, and averaged around US$2.70 per dose in pulsed campaigns in Peru and India. Start-up costs account for as much as 50% of the total cost in some country settings.

Conclusions: HPV vaccine implementation costs per dose are likely to be higher compared to Expanded Programme on Immunization vaccines, but may decline as they become better integrated into immunization and school-based health services. These findings can inform the budgetary requirements of donors and national governments, providing useful information about actual resource needs to introduce and eventually scale up HPV vaccinations.

Declaration of interest

None declared

3) HPV VACCINE ACCEPTABILITY ACROSS THE GLOBE

T Weiss, Merck/MSD, West Point, PA, UNITED STATES, C Nwankwo, Merck/MSD, West Point, PA, UNITED STATES, M Wagner, BioMedCom, Montreal, CANADA, P Singhal, Merck/MSD, West Point, PA, UNITED STATES, S Rosenthal, Columbia Univ. and NY Presbyterian Children's Hospital, New York, NY, UNITED STATES, G Zimet, Indiana Univ., Indianapolis, IN, UNITED STATES

Background: HPV vaccine acceptability research can aid in understanding factors that can lead to successful implementation of HPV vaccination programs.

Objective: Determine factors that drive acceptance of HPV vaccination internationally, including knowledge, attitudes, and beliefs.

Methods: Search of recent, English-language scientific literature to determine acceptability of HPV vaccination across countries around the globe. Initial search identified research primarily conducted in 2007 and 2008. This search is being expanded to include more recent research, as well as research conducted before the adoption of HPV vaccines.

Results: Willingness to receive the vaccine for oneself or one’s child is high in many populations, sometimes despite significant knowledge gaps. Nevertheless, more knowledge about HPV and associated diseases is often linked to higher willingness to receive the vaccine. Not having sufficient information is sometimes cited as a reason for refusing vaccination. Others include affordability of the vaccine, concerns about safety and efficacy, and the belief that oneself or one’s child is not at risk.

Awareness of HPV and knowledge of its relationship to cervical cancer and genital warts varies globally, even within the same country. There is evidence that acceptance of HPV vaccination improves once individuals are informed about HPV infection, its repercussions, and the characteristics of the vaccine. For many individuals, acceptance of the vaccine depends upon recommendation by trusted healthcare providers, such as nurses or doctors.

Conclusions: Knowledge and provider recommendations are some key factors of HPV vaccine acceptability. Willingness to receive the vaccine for oneself or one’s child is high in many populations, but barriers related to knowledge and provider recommendations continue to exist. Public education, training of healthcare providers and development of vaccine recommendations by national bodies are important steps towards integrating HPV vaccination into national vaccination programs and ensuring appropriate uptake.

Declaration of interest

Lead author is full-time employee of Merck.

PS is full-time employee of Merck.

CN is research fellow at Merck.

MW is full-time employee of BioMedCom. BioMedCom received funding as part of this project.

Research is funded by Merck.

SR and GZ have received investigator grants from Merck.