Knowledge of cervical cancer and acceptability of Prevention Strategies among HPV-Vaccinated and Nonvaccinated Adolescents in Eldoret, Kenya

Abstract

Background: Primary prevention of cervical cancer with the introduction of the human papilloma virus (HPV) vaccines is the next generation means to reduction of the disease burden in developing countries. Sexually active adolescents have the highest rates of prevalent and incident HPV infection rates with over 50%–80% having infections within 12 months of initiating intercourse. From May 2012 to March 2013, through the Gardasil Access Program, Eldoret received 9600 vaccine doses and vaccinated over 3000 girls aged 9-14. Despite this, there is little information on the knowledge of cervical cancer among adolescents and their amenability to accepting cervical cancer prevention strategies. Aim: To compare the knowledge of cervical cancer and acceptability of prevention strategies among vaccinated and nonvaccinated adolescents after an HPV vaccination initiative in Eldoret, Kenya. Methods: A cross-sectional comparative study carried out in 6 public schools which were clustered into 2 groups of 2. 60 vaccinated and 120 nonvaccinated adolescents were randomly selected from each of the schools by proportionate allocation. IREC approval obtained and signed consent got from the parents. Data collection was then carried out using interviewer-administered questionnaires. Results: The median age of the participants was 14.0 (IQR: 13.0-15.0). Of 60 vaccinated adolescents, 56 (93.3%) had heard of the HPV vaccine compared with 6 (5%) of unvaccinated participants (P < 0.001). Fifty-eight (96.7%) of vaccinated participants heard of cervical cancer compared with 61 (50.8%) unvaccinated participants (P < 0.001). The participants were not different in their knowledge of risk factors for developing cervical cancer or its symptoms but overall, the vaccinated participants had a significantly higher knowledge score compared with the unvaccinated participants 14.4 (95% CI: 12.2-16.7). Both cohorts identified the school as the commonest source of information for health matters as compared with social media or hospitals. The 2 groups also showed similarity in their selection of cervical cancer prevention strategies acceptable to them like delaying sexual debut until after the teenage years and frequency of using barrier method for protection against sexually transmitted infections. Similar proportions of participants from both cohorts showed high acceptability of screening modalities for cervical cancer (85% vs 86.7%, P = 0.940). Of the unvaccinated participants, 63.7% expressed willingness to be vaccinated. Conclusion: Exposure to the HPV vaccine was associated with a higher knowledge of cervical cancer. The adolescents predominantly rely on the school for their information. They show remarkable acceptability for cervical cancer prevention strategies but are limited by the dearth of information they have