Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries
The World Health Organization revised its human papillomavirus (HPV) vaccination recommendations to include a two (2-) dose schedule for girls aged ≤ 15 years. We investigated acceptability of 2- versus 3-dose schedule among adolescent vaccination providers and mothers of adolescent girls in five countries.
Adolescent vaccination providers (N = 151) and mothers of adolescent girls aged 9–14 years (N = 118) were recruited from Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers’ preference for a 2- versus 3-dose HPV vaccination schedule via quantitative surveys. Mothers’ attitudes towards a 2-dose schedule were assessed through focus group discussions.
Most adolescent providers preferred a 2- over a 3-dose HPV vaccination schedule (overall: 74%), with preference ranging from 45.2% (South Africa) to 90.0% (South Korea). Lower cost, fewer clinic visits, and higher series completion were commonly cited reasons for 2-dose preference among providers and mothers. Safety and efficacy concerns were commonly cited barriers to accepting a 2-dose HPV vaccination schedule among providers and mothers. Mothers generally accepted the reduced schedule, however requested further information from a trusted source.
Adolescent vaccination providers and mothers preferred the 2-dose over 3-dose HPV vaccination schedule. Acceptability of a 2-dose HPV vaccination could be improved with additional information to providers and mothers on HPV vaccination safety and efficacy.
KeywordsAdolescent vaccination Acceptability Human papillomavirus Dose Adolescent Providers Parents Focus groups
Human immunodeficiency virus
Low- and middle-income country
Strategic Advisory Group of Experts
Sexually transmitted infections
World Health Organization
The authors gratefully acknowledge the participants of this study. The authors thank Suzanne Landi, Shoshana Goldberg, and Sara Smith for their assistance in developing this manuscript. JYI was supported by a NIH NRSA individual predoctoral fellowship (F31-CA210474-01A1). Cervarix is a trademark owned by or licensed to the GSK group of companies.
This study was funded by GlaxoSmithKline Biologicals SA (Study ID: 117339); all data collection, analysis, and interpretation was conducted by study co-authors, and GSK had the opportunity to review this paper. GSK did not have input into the research data collection, analysis, or interpretation of results.
Compliance with ethical standards
Conflict of interest
Jennifer S. Smith has received research grants, served on paid advisory boards, and/or been a paid speaker for GSK group of companies and Merck & Co., Inc. over the past 5 years. The remaining authors have no conflicts of interest to disclose.
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