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. 2021 Jul 7;11(7):e044980.
doi: 10.1136/bmjopen-2020-044980.

Secondary analyses to test the impact on inequalities and uptake of the schools-based human papillomavirus (HPV) vaccination programme by stage of implementation of a new consent policy in the south-west of England

Harriet Fisher  1 , Karen Evans  2 , Rosy Reynolds  3 , Julie Yates  4 , Marion Roderick  5 , Jo Ferrie  4 , John Macleod  3   6 , Matthew Hickman  3 , Suzanne Audrey  3
Affiliations

Secondary analyses to test the impact on inequalities and uptake of the schools-based human papillomavirus (HPV) vaccination programme by stage of implementation of a new consent policy in the south-west of England

Harriet Fisher et al. BMJ Open. .

Abstract

Objectives: To test the impact on inequalities and uptake of the schools-based human papillomavirus (HPV) vaccination programme by stage of implementation of a new policy providing additional opportunities to consent.

Setting: Two local authorities in the south-west of England.

Participants: Young women (n=7129) routinely eligible for HPV vaccination aged 12-13 years during the intervention period (2017/2018 to 2018/2019 programme years).

Interventions: Local policy change that included additional opportunities to provide consent (parental verbal consent and adolescent self-consent).

Outcomes: Secondary analyses of cross-sectional intervention data were undertaken to examine uptake by: (1) receipt of parental written consent forms and; (2) percentage of unvaccinated young women by stage of implementation.

Results: During the intervention period, 6341 (89.0%) eligible young women initiated the HPV vaccination series. Parental written consent forms were less likely to be returned where young women attended alternative education provider settings (p<0.001), belonged to non-white British ethnic groups (p<0.01) or more deprived quintiles (p<0.001). Implementation of parental verbal consent and adolescent self-consent reduced the percentage of unvaccinated young women from 21.3% to 16.5% (risk difference: 4.8%). The effect was greater for young women belonging to the most deprived compared with the least deprived quintile (risk difference: 7.4% vs 2.3%, p<0.001), and for young women classified as Unknown ethnic category compared with white British young women (6.7% vs 4.2%, p<0.001). No difference was found for non-white British young women (5.4%, p<0.21).

Conclusions: Local policy change to consent procedures that allowed parents to consent verbally and adolescents to self-consent overcame some of the barriers to vaccination of young women belonging to families less likely to respond to paper-based methods of gaining consent and at greater risk of developing cervical cancer.

Trial registration number: 49 086 105.

Keywords: community child health; infectious diseases; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Percentage of HPV vaccine eligible young women unvaccinated by stage of implementation of consent procedure. HPV, human papillomavirus.
See this image and copyright information in PMC

References

    1. Drolet M, Bénard Élodie, Pérez N, et al. Population-Level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet 2019;394:497–509. 10.1016/S0140-6736(19)30298-3 - DOI - PMC - PubMed
    1. Simms KT, Steinberg J, Caruana M, et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study. Lancet Oncol 2019;20:394–407. 10.1016/S1470-2045(18)30836-2 - DOI - PubMed
    1. Johnson HC, Lafferty EI, Eggo RM, et al. Effect of HPV vaccination and cervical cancer screening in England by ethnicity: a modelling study. Lancet Public Health 2018;3:e44–51. 10.1016/S2468-2667(17)30238-4 - DOI - PMC - PubMed
    1. Baker D, Middleton E. Cervical screening and health inequality in England in the 1990s. J Epidemiol Community Health 2003;57:417–23. 10.1136/jech.57.6.417 - DOI - PMC - PubMed
    1. Shack L, Jordan C, Thomson CS, et al. Variation in incidence of breast, lung and cervical cancer and malignant melanoma of skin by socioeconomic group in England. BMC Cancer 2008;8:271. 10.1186/1471-2407-8-271 - DOI - PMC - PubMed

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