Does the number of doses matter? A qualitative study of HPV vaccination acceptability nested in a dose reduction trial in Tanzania

doi:10.1016/j.tvr.2021.200217

Randomized Controlled Trial

. 2021 Dec:12:200217.

doi: 10.1016/j.tvr.2021.200217. Epub 2021 May 26.

Does the number of doses matter? A qualitative study of HPV vaccination acceptability nested in a dose reduction trial in Tanzania

K R Mitchell¹, T Erio², H S Whitworth³, G Marwerwe⁴, J Changalucha⁵, K Baisley⁶, C J Lacey⁷, R Hayes⁸, S de SanJosé⁹, D Watson-Jones¹⁰

Affiliations

¹ MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley St, Glasgow, G3 7HR, UK. Electronic address: kirstin.mitchell@glasgow.ac.uk.
² Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania. Electronic address: tusajigwe.erio@gmail.com.
³ Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: Hilary.Whitworth@lshtm.ac.uk.
⁴ Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania. Electronic address: mutani.mwanagindu@mitu.or.tz.
⁵ Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania. Electronic address: jchangalucha@yahoo.com.
⁶ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: Kathy.Baisley@lshtm.ac.uk.
⁷ York Biomedical Research Institute & Hull York Medical School, University of York, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK. Electronic address: Charles.Lacey@hyms.ac.uk.
⁸ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: Richard.Hayes@lshtm.ac.uk.
⁹ Catalan Institute of Oncology, Avinguda de La Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain. Electronic address: sdesanjose@path.org.
¹⁰ Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: Deborah.Watson-Jones@lshtm.ac.uk.

PMID: 34051389
PMCID: PMC8233223
DOI: 10.1016/j.tvr.2021.200217

Randomized Controlled Trial

Does the number of doses matter? A qualitative study of HPV vaccination acceptability nested in a dose reduction trial in Tanzania

K R Mitchell et al. Tumour Virus Res. 2021 Dec.

. 2021 Dec:12:200217.

doi: 10.1016/j.tvr.2021.200217. Epub 2021 May 26.

Authors

K R Mitchell¹, T Erio², H S Whitworth³, G Marwerwe⁴, J Changalucha⁵, K Baisley⁶, C J Lacey⁷, R Hayes⁸, S de SanJosé⁹, D Watson-Jones¹⁰

Affiliations

¹ MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley St, Glasgow, G3 7HR, UK. Electronic address: kirstin.mitchell@glasgow.ac.uk.
² Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania. Electronic address: tusajigwe.erio@gmail.com.
³ Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: Hilary.Whitworth@lshtm.ac.uk.
⁴ Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania. Electronic address: mutani.mwanagindu@mitu.or.tz.
⁵ Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania. Electronic address: jchangalucha@yahoo.com.
⁶ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: Kathy.Baisley@lshtm.ac.uk.
⁷ York Biomedical Research Institute & Hull York Medical School, University of York, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK. Electronic address: Charles.Lacey@hyms.ac.uk.
⁸ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: Richard.Hayes@lshtm.ac.uk.
⁹ Catalan Institute of Oncology, Avinguda de La Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain. Electronic address: sdesanjose@path.org.
¹⁰ Mwanza Intervention Trials Unit, National Institute of Medical Research, Isamilo, Mwanza, Tanzania; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: Deborah.Watson-Jones@lshtm.ac.uk.

PMID: 34051389
PMCID: PMC8233223
DOI: 10.1016/j.tvr.2021.200217

Abstract

Background: The multi-dose regimen is a known barrier to successful human papillomavirus (HPV) vaccination. Emerging evidence suggests that one vaccine dose could protect against HPV. While there are clear advantages to a single dose schedule, beliefs about vaccine dosage in low and middle income countries (LMICs) are poorly understood. We investigated acceptability of dose-reduction among girls, and parents/guardians of girls, randomised to receive one, two or three doses in an HPV vaccine dose-reduction and immunobridging study (DoRIS trial) in Tanzania.

Methods: Semi-structured interviews with girls (n = 19), and parents/guardians of girls (n = 18), enrolled in the study and completing their vaccine course.

Results: Most participants said they entrusted decisions about the number of HPV vaccine doses to experts. Random allocation to the different dose groups did not feature highly in the decision to participate in the trial. Given a hypothetical choice, girls generally said they would prefer fewer doses in order to avoid the pain of injections. Parental views were mixed, with most wanting whichever dose was most efficacious. Nonetheless, a few parents equated a higher number of doses with greater protection.

Conclusion: Vaccine trials and programmes will need to employ careful messaging to explain that one dose offers sufficient protection against HPV should emerging evidence from ongoing dose-reduction clinical trials support this.

Keywords: Acceptability; Dose reduction; HPV vaccination; Qualitative; Randomisation; Trial participation.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1**
Card exercise showing extent to which factors were considered in decision to participate in trial.

See this image and copyright information in PMC

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References

1. SAGE Meeting of the strategic advisory group of experts on immunization, october 2018 - conclusions and recommendations. Wkly. Epidemiol. Rec. 2018;49:661–680.
1. PATH . 2020. Global HPV Vaccine Introduction Overview.https://path.azureedge.net/media/documents/Global_HPV_Vaccine_Intro_Over... (last accessed June 14th, 2020)
1. Bruni L., Diaz M., Barrionuevo-Rosas L., Herrero R., Bray F., Bosch F.X., de Sanjosé S., Castellsagué X. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. The Lancet Global Health. 2016;4(7):e453–e463. - PubMed
1. Kessels S.J., Marshall H.S., Watson M., Braunack-Mayer A.J., Reuzel R., Tooher R.L. Factors associated with HPV vaccine uptake in teenage girls: a systematic review. Vaccine. 2012;30(24):3546–3556. - PubMed
1. Becker-Dreps S., Otieno W.A., Brewer N.T., Agot K., Smith J.S. HPV vaccine acceptability among Kenyan women. Vaccine. 2010;28(31):4864–4867. - PMC - PubMed

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[1] SAGE Meeting of the strategic advisory group of experts on immunization, october 2018 - conclusions and recommendations. Wkly. Epidemiol. Rec. 2018;49:661–680.

[2] SAGE Meeting of the strategic advisory group of experts on immunization, october 2018 - conclusions and recommendations. Wkly. Epidemiol. Rec. 2018;49:661–680.

[3] PATH . 2020. Global HPV Vaccine Introduction Overview.https://path.azureedge.net/media/documents/Global_HPV_Vaccine_Intro_Over... (last accessed June 14th, 2020)

[4] PATH . 2020. Global HPV Vaccine Introduction Overview.https://path.azureedge.net/media/documents/Global_HPV_Vaccine_Intro_Over... (last accessed June 14th, 2020)

[5] Bruni L., Diaz M., Barrionuevo-Rosas L., Herrero R., Bray F., Bosch F.X., de Sanjosé S., Castellsagué X. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. The Lancet Global Health. 2016;4(7):e453–e463. - PubMed

[6] Bruni L., Diaz M., Barrionuevo-Rosas L., Herrero R., Bray F., Bosch F.X., de Sanjosé S., Castellsagué X. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. The Lancet Global Health. 2016;4(7):e453–e463. - PubMed

[7] Kessels S.J., Marshall H.S., Watson M., Braunack-Mayer A.J., Reuzel R., Tooher R.L. Factors associated with HPV vaccine uptake in teenage girls: a systematic review. Vaccine. 2012;30(24):3546–3556. - PubMed

[8] Kessels S.J., Marshall H.S., Watson M., Braunack-Mayer A.J., Reuzel R., Tooher R.L. Factors associated with HPV vaccine uptake in teenage girls: a systematic review. Vaccine. 2012;30(24):3546–3556. - PubMed

[9] Becker-Dreps S., Otieno W.A., Brewer N.T., Agot K., Smith J.S. HPV vaccine acceptability among Kenyan women. Vaccine. 2010;28(31):4864–4867. - PMC - PubMed

[10] Becker-Dreps S., Otieno W.A., Brewer N.T., Agot K., Smith J.S. HPV vaccine acceptability among Kenyan women. Vaccine. 2010;28(31):4864–4867. - PMC - PubMed

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Does the number of doses matter? A qualitative study of HPV vaccination acceptability nested in a dose reduction trial in Tanzania

Affiliations

Does the number of doses matter? A qualitative study of HPV vaccination acceptability nested in a dose reduction trial in Tanzania

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Publication types

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Medical