RESUMO
BACKGROUND: Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. METHODS: HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage. RESULTS: Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0). CONCLUSION: The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.
RESUMO
OBJECTIVE: To estimate human papillomavirus (HPV) vaccination coverage and course completion rates for Indigenous adolescents in four Australian states and territories. PARTICIPANTS, SETTING: Adolescents who were 12 years old in 2015 and received the quadrivalent HPV vaccine (three doses: 0, 2, 6 months) as part of the National HPV Vaccination Program in 2015 or 2016 in New South Wales, Queensland, the Northern Territory, or the Australian Capital Territory. MAIN OUTCOME MEASURES: Estimated HPV vaccination coverage by dose and by Indigenous status and sex, based on National HPV Vaccination Program Register data; vaccination course completion rates (proportion of dose 1 recipients who received dose 3) for 12-year-olds vaccinated during 2013-2016, by sex, jurisdiction, and Indigenous status. RESULTS: Dose 1 coverage exceeded 80% for all Indigenous status/jurisdiction/sex groups (range, 83.3-97.7%). Coverage was similar for Indigenous and non-Indigenous girls in Queensland (87.3% v 87.0%), lower for Indigenous girls in the ACT (88.7% v 97.7%) and the NT (91.1% v 97.0%), and higher in NSW (95.9% v 89.9%); it was similar for Indigenous and non-Indigenous boys in all jurisdictions except the NT (88.6% v 96.3%). Dose 3 coverage (range, 61.2-87.7%) was markedly lower for Indigenous than non-Indigenous 12-year-olds in all jurisdictions, except for girls in NSW (82.6% v 83.6%). CONCLUSION: HPV vaccine coverage is high, but course completion is generally lower for Indigenous adolescents. Strategies for improving completion rates for Indigenous Australians are needed to end the higher burden of cervical cancer among Indigenous than non-Indigenous women.