Transcript Style D 24 by 48

“Exploring issues around Knowledge of the Human Papillomavirus, cervical cancer, perception of risk,
and vaccine acceptance among women in Alexandra township, South Africa”
Shelley A. Franics, DrPH, MPH, CHES; Joan Liverpool, EdD, CHES; Jenny A. Nelson, MPH; Roland H. Thorpe, PhD, MS; Soji Shogun, MBBS, FACHE; Nokuthula Mofammere
Abstract
Background: Developing countries account for 85% of the nearly 500,000 yearly cases of
cervical cancer worldwide with approximately 250,000 deaths occurring in Sub-Saharan Africa,
South Asia, and Latin America. In South Africa, cervical cancer is the 3rd leading cause of death
among women. Although cervical cancer can be prevented with regular Pap screening, access
to preventive screenings may be nearly non-existent in resource poor settings that have limited
public health infrastructure and where women may lack basic health education. The World
Health Organization estimates that even once in a life time screening, performed by women in
their 30s or 40s, could reduce the risk of cervical cancer by 25-30%.
Results: The majority of participants were unfamiliar with HPV and cervical cancer, were
concerned about their child’s and their own risk for HPV, faced numerous barriers to accessing
screening, and were willing to vaccinate their child.
Discussion/conclusion: Women in developing countries need increased access to screening
and education about cervical cancer and HPV prevention.
Background
Significance
Cervical cancer 2nd most common cancer worldwide
The World Health Organization found that women in developing countries accounted for 85% of
500,000 yearly cases with 250,000 annual deaths; most occurring in Sub-Saharan Africa, South
Asia, and Latin America
HPV is the major risk factor. Six types of HPV account for 85% of cases worldwide
Four of the most common types include HPV 6, 11, 16, 18
HPV 6, 11 are associated with genital warts while
HPV 16, 18 are associated with 70-80% of cervical cancer
Cervical Cancer in Developing World & South Africa
#1 cause of cancer related deaths; attributed to over 3400 deaths of South African women
Will affect 1 in 26 South African women
Strong association between HIV and HPV
Women with limited access to routine PAP tests are at risk
Pap tests and early detection are the KEY to prevention
Key findings from empirical research on HPV, cervical cancer, and vaccine acceptability in
Sub-Sahara Africa
Adult women had limited knowledge of HPV and cervical cancer
Women had limited access to care
Women with limited access to routine PAP tests at risk included availability/accessibility of trained
clinicians and modern labs
Countries lacked cervical cancer prevention programs
There is growing interest in vaccine uptake; however, numerous challenges exist
Gaps in the literature
In developing countries:
1. There are a limited number of empirical studies assessing HPV and cervical related issues
2. Previous studies found women had limited understanding/knowledge of HPV and cervical
cancer related issues
3. Lack of studies assessing maternal/parental attitudes
1. Describe the socio-demographic context of clinic attendees;
Specific
aim #3: Assess participants’ perception of risk for HPV and cervical cancer
•
2. Assess knowledge of Human Papillomavirus (HPV) and cervical cancer;
•1/3 of women feel they are at low risk for HPV
•½ of women feel their risk for cervical cancer is about the same as other women
•75% of women are somewhat/very concerned that they will get HPV
3. Assess the participants’ perception of risk for HPV and cervical cancer risk as
well as their child’s risk
Purpose: to assess women’s knowledge about STDs, cancer risk, vaccine acceptance, and
maternal-child communication about STDs and cervical cancer.
Methods: Eighty-eight women ,ages 18-44 with at least one child who presented at an
antenatal clinic in township in Johannesburg were recruited to complete a brief
questionnaire. Using both descriptive and multivariate statistics, we assessed knowledge of
cervical cancer, HPV, and the vaccine; assessed maternal-child communication about sex and
STDs, assessed willingness to vaccinate child; and identified barriers to assessing medical
care and the vaccine.
Results – Specific Aim #3
Specific Aims
Methods
Study recruitment
Results – Specific Aim #1-2
Specific aim #1: Describe the socio-demographic context of clinic attendees
Prevention Messages
•68% had seen/heard cervical cancer messages
•23% had seen /heard HPV messages
•Most had seen/heard messages from clinicians,
media, books/magazines
• One local part-time research assistant assisted
with study recruitment/survey administration
Phase 2 – Qualitative phase
• Recruited approximately 30 participants who completed survey
• Women must have completed Phase 1 and consented to participate in focus groups
• Recruited 10-12 traditional healers
• Total of 4 focus groups held
• Groups held in the community at the clinic
• Participants were compensated for participation in Phase1 and Phase 2
• IRB approval granted by Case Western Reserve University and Witwatersrand
University
Data analysis
• Given the exploratory nature of the study,
descriptive and univariate analyses was used to explore
relationships among variables
• Data cleaning and analyses was performed by
study staff.
• All analyses performed using SAS 16.0 and Stata 9.0
37%
Low
Moderate
High
Summary
• Up to 75 women attending a private clinic in
Phase 1 - Quantitative phase
• Eligible participants completed a brief 15-20 minute survey
• Survey assessed the following areas:
1. Demographic characteristics
2. Cervical cancer knowledge, screening, and risk
3. HPV knowledge, screening, and risk
4. Vaccine knowledge and acceptance
5. HPV prevention messages and services
6. Maternal-child communication
19%
44%
• Study was based outside of Johannesburg,
South Africa in Alexandra township
Study inclusion criteria:
1. Be female
2. Be between the ages of 18 and 44 years old
3. Have at least one child
4. Provide consent to participate in the study
Perception of HPV
Risk
•
•
•
•
Employment status
•48% of women employed
Women are unfamiliar with HPV, cervical cancer, and the vaccines
Women are concerned about their risk for HPV
Women lacked access to screening
Education on issues related to cervical cancer and HPV is needed for
women and providers
Marital status
Limitations and Strengths
•59% of women single, never married
Demographics’ of Children
•53% have a daughter
Mean age of daughter - 5.7 yrs (SD=4.5)
Mean age of son - 6.99 yrs (SD=5.8)
Specific aim #2: Assess knowledge of HPV and cervical cancer
•39% have not heard of cervical cancer
•71% have not heard of the HPV virus
Limitations
•Descriptive study
•Generalizable to clinic population only
•Small sample size
Strengths
•Explored an understudied area
•Provides a better understanding of issues around knowledge and attitudes about
HPV, cervical cancer, and vaccine acceptance
•Assesses traditional healers attitudes, beliefs ,and knowledge
•Used mixed analytical methods
•Assessed participant religiosity
Ever Had Pap Exam
•56% had never had a PAP
When did you have your most recent PAP?
Clinic services price list
Public Health Implications
Barriers to Getting a PAP
•Cost
•Lacked medical aid/assistance
•Fear, “it’s painful”
•“Took the womb out”
•“I don’t know much about it”
•Findings have consequences for both health education and health policy
•Women and providers need information on HPV and cervical cancer
•Need to utilize media in awareness campaigns
•Need to increase availability of screening and vaccine (at prices they can afford)
Acknowledgments
The South Africa Women’s Health study is supported by an investigator initiated award
from Merck Pharmaceuticals, Inc. The contents of this presentation are solely the
responsibility of the authors and do not necessarily represent the official views of
Merck Inc.
Bibliography available upon request