Implementation of the second dose of human papillomavirus vaccine in ilala municipality Dar es salaam, Tanzania.

Abstract

Background. Cervical cancer represents the most common neoplastic pathology among women and accounts for 83% of HPV attributable cancer with an estimated 500,000 diagnosed cases each year, resulting in more than 250,000 deaths globally. The highest incidence rates of cervical cancer worldwide occur in eastern, western and southern Africa, with age standardized rates of 34.5, 33.7 and 26.8 cases per 100,000 populations respectively. Cervical cancer is strongly associated with Human Papilloma Virus (HPV) infections, Serotype 16 and 18 of HPV being responsible for approximately 70% of invasive cervical cancer cases worldwide while serotypes 6 and 11 are responsible for 90% of anogenital warts cases. Vaccination against HPV which requires two doses together with cervical cancer screening are the major public health strategies for preventing cervical cancer in the general population. However, the second dose has been noted to have low coverage compared to the first dose in both high income and developing countries including Tanzania which had only 50% coverage of the second dose compared to 79% of the first dose in 2019. Aim of the study. The aim of the study was to assess the factors associated with implementation and uptake of the second dose of HPV vaccine in Ilala municipality – Dar es Salaam, Tanzania. Methods and Materials. A cross sectional study using a mixed method was conducted, data were collected from participants by using structured questionnaire and interview guide for quantitative and qualitative data respectively. Quantitative data were analyzed using SPSS software after being cleaned and checked for consistency and quality. Multivariate Logistic regression was conducted to determine factors independently associated with uptake of the second dose of HPV vaccine. Qualitative data were analyzed by using Thematic Content Analysis. Triangulation of both qualitative and quantitative was conducted to address the specific objectives for this study.Results. Findings from this study showed that, out of 389 respondents participating in the study, only 83 respondents received the second dose of HPV vaccine, equivalent to 21.3% level of uptake compared to the first dose which was 35.2% level of uptake. A total of 306 respondents equivalent to 78.7% did not receive the second HPV vaccine shot. Multivariate analysis done revealed that, school girls aged 12-13 years old were 86% less likely to receiving HPV-2 vaccine compared to their reference age group (14 years or above) (AOR: 0.14; 95% CI: 0.03-0.59), P-value=0.008. Those with positive attitude towards HPV 2 vaccine were 2.04 times more likely to receiving HPV-2 vaccine compared to those with negative attitude (AOR: 2.04; 95% CI: 1.10-3.76), P-value=0.023. Respondents with awareness about HPV vaccine second dose, were 9.16 times more likely to receiving HPV 2 vaccine compared to the group without awareness (AOR: 9.16; 95% CI: 2.11-39.85), P value=0.003. Shortage of health care providers as well as inconsistence provision of transport to health care providers to reach vaccination sites were one of the factors that set back implementation and uptake of the second dose of HPV vaccine. Conclusion and recommendations: The uptake of second dose of HPV vaccine among adolescent girls in Ilala municipality was low. Factors associated with second HPV vaccine uptake included young age group of adolescent girls, good attitude on HPV vaccine and awareness about HPV vaccine second dose. Adequate health care providers as well as consistent availability of HPV vaccines together with timely payment of transport allowances to health care providers to reach vaccination sites were resources that could enhance implementation of HPV-2 vaccine and its uptake. Owing to the evidence gathered, it is recommended that, the Government of Tanzania through the Ministry of health, community development, gender, elderly and children to conduct HPV vaccination community sensitizations to build positive attitudes and change community negative perception on HPV vaccines that they cause cancer and infertility to their adolescent girls and strengthen HPV vaccination community outreaches