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. 2021 Apr 17:34:100836.
doi: 10.1016/j.eclinm.2021.100836. eCollection 2021 Apr.

Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis

Thinley Dorji  1   2 , Tanawin Nopsopon  3 , Saran Tenzin Tamang  4 , Krit Pongpirul  3   5   6
Affiliations

Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis

Thinley Dorji et al. EClinicalMedicine. .

Abstract

Background: The proportion of incident cases of HPV-attributable cancers is highest in the low- and middle-income countries (LMICs) but many are yet to initiate HPV vaccination programs. This meta-analysis was performed to assess the uptake of HPV vaccination in LMICs at the beginning of the global strategy to eliminate cervical cancer and describes the gaps and challenges.

Methods: A systematic search was conducted in PubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases for observational studies that reported the uptake of HPV vaccination until October 2020. The meta-analysis was done using a random-effects model to assess the pooled estimate of HPV uptake. CRD42021218429.

Findings: During 2008-2020, an estimated 3.3 million females received at least one dose of HPV vaccine with 61.69% of the target population vaccinated. In countries with high uptake, the pooled estimate of uptake was higher in females than males (45.48% vs 8.45%) and showed significant decline in 2015-2020 compared to 2006-2014 (89.03% vs 41.48%). In countries with low uptake, the estimate of uptake was low in both males and females (5.31% vs 2.93%) and showed increase in uptake in 2015-2020 compared to 2006-2014 (0.76% vs 5.22%). In countries with high uptake, compared to routine programs, the estimate was higher when delivered through demonstration programs (89.94% vs 59.74%).

Interpretation: The major concern was a significant drop in the uptake in countries that started with high uptake, challenges in the maintenance of vaccine uptake, sustainability of funding and the lack of standard monitoring and reporting.

Keywords: 2vHPV, bivalent HPV vaccine; 4vHPV, quadrivalent HPV vaccine; 9vHPV, 9-valent HPV vaccine; CENTRAL, cochrane central register of controlled trials; CI, confidence interval; CIN2+, cervical intra-epithelial neoplasia grade II; Cervical cancer elimination; EMBASE, excerpta medica dataBASE; GNI, gross national income; HPV vaccine; HPV, human papillomavirus; LMICs, Low- and middle-income countries; Low-and middle-income countries; MSM, men having sex with men; Meta-analysis; RR, relative risk; STROBE, strengthening the reporting of observational studies in epidemiology; Systematic review; US, United States; Vaccine uptake; WHO, World Health Organization.

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Conflict of interest statement

All authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart presenting the study selection with the preferred reporting Items for systematic reviews and meta-analyses (PRISMA) guidelines for the meta-analysis on human papillomavirus vaccine uptake in low- and middle-income countries, 2020.
Fig. 2
Fig. 2
Risk of bias assessment in prevalence studies based on Hoy's eleven-item criteria for the studies included in the meta-analysis on human papillomavirus vaccine uptake in low- and middle-income countries, 2008–2020.
Fig. 3
Fig. 3
The overall uptake of HPV vaccination in low- and middle-income countries, 2008–2020.
See this image and copyright information in PMC

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