Assessment of factors impacting cervical cancer screening among low-income women living with HIV-AIDS.

Very little is currently known about factors impacting the prevalence of cervical cancer screening among women living with HIV-AIDS (WLHA). To better understand this issue, we surveyed low-income, medically underserved women receiving subsidized gynecologic care through an integrated HIV clinic. A self-administered questionnaire was completed by 209 women who self-identified as HIV positive. A total of 179 subjects (85.7%) reported having had a Pap test in the last three years. The majority of WLHA (95%) knew that the Pap test screens for cervical cancer. However, overall knowledge of cervical cancer risk factors, such as multiple sexual partners or sex with a man with multiple partners, was low (43% and 35%, respectively). Unscreened women were younger and more likely to be single with multiple current sexual partners. In multivariable analyses, the only factors associated with Pap testing were a woman's perception that her partner wants her to receive regular screening (aOR 4.64; 95% CI: 1.15-23.76; p = .04), number of clinic visits during the past year (aOR 1.36, 95% CI: 1.05-1.94; p = .04) and knowledge that the need for a Pap test does not depend on whether or not a woman is experiencing vaginal bleeding (aOR 6.52, 95% CI: 1.04-49.71; p = .05). We conclude that support from male partners in addition to effective contact with the health system and knowledge of cervical cancer risk factors influence Pap utilization among low-income WLHA. Future measures to improve the care for this population should increase knowledge of cervical cancer risk factors and encourage social support for cervical cancer screening among WLHA.

Factors Impacting Vaccine Uptake during Pregnancy: A Retrospective Analysis.

Background and Objective: Vaccine uptake rates during pregnancy remain below target goals due to a convergence of factors. In particular, women of lower socioeconomic means and racial minorities typically have reduced rates of vaccine acceptance. This study aims to identify additional factors contributing to vaccine acceptance within a sample population of women receiving prenatal care in Houston, Texas, United States of America. Methods: We performed a retrospective cross-sectional analysis of 11,500 pregnant women covered by Medicaid or ChipPerinate who received prenatal care during 2013-2021, assessing influenza (flu) and combined Tetanus, Diphtheria, Acellular Pertussis (TDAP) vaccine acceptance in the patient population. We examined temporal trends in flu and TDAP vaccination rates using Joinpoint regression analyses and evaluated the factors associated with single or concomitant vaccine acceptance during the study period and during the COVID-19 pandemic using adjusted log-binomial regression models. Results: In our population, 54% of patients received flu vaccination, and 76.1% received TDAP. TDAP rates increased from 2013-2015 but have shown an overall decline since then, as with the flu vaccine. Earlier entry to prenatal care (Prevalence Ratio [PR] 6.32; Confidence Interval [CI] 3.28-12.24) and pregnancy comorbidity such as gestational diabetes (PR 1.32; CI 0.82-2.19) were positively associated with uptake. In contrast, the NH-Black race was negatively associated with vaccine acceptance (PR 0.51 CI; 0.25-0.99). Otherwise, age and history of pre-pregnancy comorbidities were not significant predictors. Conclusion and Global Health Implications: Within demographic groups identified as at-risk for vaccine refusal, modifying factors further impact vaccine hesitancy. Identifying these elements will guide targeted patient efforts to promote vaccine uptake, both for routine prenatal recommendations and for COVID vaccination.

HPV vaccine acceptability in Ghana, West Africa.

OBJECTIVE: Cervical cancer is a leading cause of cancer-related mortality among women in Ghana. As of this writing no data are available concerning knowledge, attitudes and acceptability of human papillomavirus (HPV) vaccination by women in Ghana. METHODS: Between November and December 2009, a self-administered survey was used to elicit information from 264 Ghanaian women, ages 18-65. RESULTS: Overall, 40% had heard about HPV vaccine and 94% were willing to vaccinate themselves or their daughters. Ideal age for vaccination was 12.7 years. Most women (75%) thought the vaccine should be received regardless of one's number of sex partners. The most prevalent concerns were whether the vaccine would be administered safely using clean needles (82%), and possible future side effects (77%). Concerns about cost and vaccine encouraging earlier sex were reported by nearly half. Significant barriers to vaccine acceptance were women's lack of knowledge about the gravity of cervical cancer in Ghana and utility of Pap test in detecting it, low perceived risk for cervical cancer, low social support to vaccine use, and low self-efficacy to find a doctor or clinic to get vaccinated (p<05). About 55% of the women did not know the vaccine only works among those who are not yet infected with HPV. Schools and television were the most preferred methods of educating the public and cervical cancer prevention ranked as the ideal message (80%). Most respondents believed the decision to vaccinate their daughter should be made by both parents (34%) or in conjunction with the daughter (37%), as opposed to the government (17%). CONCLUSIONS: Educational programs addressing specific barriers identified in the current study have the potential to significantly improve HPV vaccine uptake in Ghana.