Fathers' intentions to accept human papillomavirus vaccination for sons and daughters: exploratory findings from rural Honduras.

OBJECTIVES: Little is known about fathers' attitudes toward human papillomavirus (HPV) vaccination in low-resource settings. We sought to determine the awareness of HPV vaccination among Honduran fathers, and to assess their intention to accept HPV vaccination for their sons and daughters. METHODS: We conducted 100 structured interviews of fathers recruited from medical and business settings between May 2007 and June 2008. After assessing baseline knowledge, fathers received a brief explanation of HPV infection, cervical cancer, genital warts, and HPV vaccination. They were then asked whether they would accept HPV vaccination for their sons and daughters. RESULTS: Prior to receiving information about HPV, 85% of fathers believed that cervical cancer was preventable, over two-thirds could correctly name some form of prevention, 22% of fathers had heard of HPV, and 17% had heard of HPV vaccination. After receiving HPV-related information, 100% of fathers intended to accept HPV vaccination for their sons and 94% intended to accept HPV vaccination for their daughters. CONCLUSIONS: Few Honduran fathers were aware of HPV or HPV vaccination, but after receiving information, most would accept HPV vaccination for their sons and daughters.

Maternal support for human papillomavirus vaccination in Honduras.

BACKGROUND: Cervical cancer is a leading cause of cancer death for women in Latin America, and vaccinating against human papillomavirus (HPV) has the potential to limit this disease. We sought to determine Honduran women's awareness of HPV vaccination and interest in vaccinating their daughters against HPV. METHODS: We interviewed mothers aged ≥17 at primary care clinics in Honduras. First, we collected demographic information and assessed knowledge related to cervical cancer prevention and awareness of HPV and HPV vaccination. Because most participants were not familiar with HPV, education about the relationships among HPV, sexual activity, and cervical cancer was provided before we asked participants if they would accept HPV vaccination for a 9-year-old daughter. We used multivariable logistic regression to determine predictors of vaccine acceptance. RESULTS: We interviewed 632 mothers. Only 13% had heard of HPV vaccination before the interview. After education, 91% would accept HPV vaccination for a 9-year-old daughter. Mothers who intended to vaccinate knew more at baseline about cervical cancer prevention than did those who did not endorse vaccination. Demographic characteristics did not predict vaccine acceptance. CONCLUSIONS: Few Honduran mothers were aware of HPV or HPV vaccination. However, most Honduran mothers would accept HPV vaccination for their daughters after receiving education about the relationship between HPV infection and cervical cancer. Baseline cervical cancer knowledge was associated with vaccine acceptance.

Impact of patient adherence and test performance on the cost-effectiveness of cervical cancer screening in developing countries: the case of Honduras.

OBJECTIVE: We examined the impact of patient adherence and screening test performance on the cost-effectiveness of visual inspection with acetic acid (VIA) and Pap smears when used with colposcopy for diagnosis. MATERIALS AND METHODS: Cost-effectiveness analysis was performed using computer modeling. The primary outcome was cancer prevalence in the 10 years after screening. Three hypothetical populations of 35-year-old women were compared: never-screened women, women screened with VIA, and women screened with Pap smears. We used community-based data from our screening program in Honduras to estimate screening test sensitivity and specificity, adherence to follow-up, and costs of screening and colposcopy services. Published data were used to model disease outcomes. RESULTS: VIA was more sensitive than Pap smears (70% vs. 4%), less expensive (U.S. 0.23 dollars vs. 3.17 dollars), and the 2-vist VIA system had a higher rate of adherence to follow-up than the 3-visit Pap smear system (84% vs. 38%). VIA had a higher false-positive rate than Pap smears resulting in higher colposcopy referral rates, but more dysplasia was detected and treated. Cost-effectiveness analysis revealed that screening with VIA would cost U.S. 3,198 dollars per cancer case avoided and reduce cancer cases by 42%, versus U.S. 36,802 dollars and 2% for Pap screening. Although Pap smear quality was low in Honduras, sensitivity analysis showed that VIA was more cost-effective than Pap smears, even when test accuracy was equivalent. CONCLUSION: In developing countries, systems barriers can limit the cost-effectiveness of Pap smears. VIA may be a cost-effective alternative for some resource-poor settings, although systems barriers, quality control, and feasibility issues must be considered.