Emily Dema

Are there any sociodemographic factors associated with non-uptake of HPV vaccination of girls in high-income countries with school-based vaccination programmes? A systematic review

Background Uptake of human papillomavirus (HPV) vaccination is generally high in high-income countries with school-based vaccination programmes; however, lower uptake in certain population subgroups could continue pre-immunisation inequalities in cervical cancer. Methods Six electronic databases were searched for quantitative articles published between 1 September 2006 and 20 February 2023, which were representative of the general population, with individual-level data on routine school-based vaccination (with >50% coverage) and sociodemographic measures. Titles, abstracts and full-text articles were screened for eligibility criteria and assessed for bias. A second independent reviewer randomly screened 20% of articles at each stage. A narrative synthesis summarised findings. Results 24 studies based in eight countries (Australia, Belgium, Canada, New Zealand, Norway, Sweden, Switzerland, UK) were included. Studies reported vaccination uptake by individual-level and area-level socioeconomic status (SES), parental education, religion, ethnicity and/or country of birth. 19 studies reported that more than 70% were vaccinated (range: 50.7%–93.0%). Minority ethnic groups and migrants were more likely to have lower vaccination uptake than White groups and non-migrants (11/11 studies). Lower SES was also associated with lower uptake of vaccination (11/17 studies). Associations with other sociodemographic characteristics, such as parental education and religion, were less clear. Conclusions Even in high-income countries with high coverage school-based vaccination programmes, inequalities are seen. The totality of available evidence suggests girls from lower SES and minority ethnic groups tend to be less likely to be vaccinated. Findings could inform targeted approaches to mop-up vaccination and cervical cancer screening amidst changing HPV epidemiology in a vaccine era. Trial registration number CRD42023399648.

How did the COVID-19 pandemic affect access to condoms, chlamydia and HIV testing, and cervical cancer screening at a population level in Britain? (Natsal-COVID)

Objectives To investigate how differential access to key interventions to reduce STIs, HIV and their sequelae changed during the COVID-19 pandemic. Methods British participants (18–59 years) completed a cross-sectional web survey 1 year (March–April 2021) after the initial lockdown in Britain. Quota-based sampling and weighting resulted in a quasi-representative population sample. We compared Natsal-COVID data with Natsal-3, a household-based probability sample cross-sectional survey (16–74 years) conducted in 2010–2012. Reported unmet need for condoms because of the pandemic and uptake of chlamydia testing/HIV testing/cervical cancer screening were analysed among sexually experienced participants (18–44 years) (n=3869, Natsal-COVID; n=8551, Natsal-3). ORs adjusted for age and other potential confounders describe associations with demographic and behavioural factors. Results In 2021, 6.9% of women and 16.2% of men reported unmet need for condoms because of the pandemic. This was more likely among participants: aged 18–24 years, of black or black British ethnicity, and reporting same-sex sex (past 5 years) or one or more new relationships (past year). Chlamydia and HIV testing were more commonly reported by younger participants, those reporting condomless sex with new sexual partners and men reporting same-sex partners; a very similar distribution to 10 years previously (Natsal-3). However, there were differences during the pandemic, including stronger associations with chlamydia testing for men reporting same-sex partners; with HIV testing for women reporting new sexual partners and with cervical screening among smokers. Conclusions Our study suggests differential access to key primary and secondary STI/HIV prevention interventions continued during the first year of the COVID-19 pandemic. However, there was not strong evidence that differential access has changed during the pandemic when compared with 2010–2012. While the pandemic might not have exacerbated inequalities in access to primary and secondary prevention, it is clear that large inequalities persisted, typically among those at greatest STI/HIV risk.