Nancy Innocentia Ebu Enyan

Acceptance of HPV Vaccination: A Systematic Review of Knowledge, Attitudes and Barriers Among Healthcare Practitioners in Low‐ and Middle‐Income Countries

Background Cervical cancer is one of the diseases that reflects global inequities. Vaccination against the human papillomavirus (HPV) is one of the main pillars of the World Health Organization (WHO) 2030 cervical cancer 90:70:90 elimination strategy. The role of healthcare practitioners in HPV vaccination acceptance cannot be overemphasized. This review investigated healthcare practitioners′ knowledge, attitudes and barriers to promoting HPV vaccination in low‐ and middle‐income countries (LMICs). Methods A comprehensive search for relevant literature from 2006 to 2024 was conducted in the following databases: Web of Science, Scopus, MEDLINE, EMBASE, PsycINFO (via Ovid), Cochrane Library and CINAHL PLUS (via EBSCOhost). The included studies were published in the English language. Screening of eligible studies, data extraction and quality assessment were conducted in duplicate. The data was synthesise using narrative synthesis. Results A total of 671 papers were identified from the database search, with seven studies meeting the criteria for inclusion. This review demonstrates varied levels of awareness, knowledge and attitudes of 136 healthcare practitioners in LMICs towards HPV vaccination. Although some studies demonstrated a positive attitude, others reported resistance towards the vaccine. The perceived barriers to HPV vaccination by healthcare practitioners identified were interpersonal, community‐level and systemic in nature. Additionally, acceptance of HPV vaccination varied across the studies. Conclusions This review highlights the need for capacity building programmes for healthcare practitioners in the area of HPV vaccination to enhance their knowledge and attitudes and develop contextually relevant interventions to eliminate the many barriers they encounter.

Culturally adapting and evaluating an evidence-based communication intervention with HPV self-sampling to improve cervical cancer screening among women living with HIV in Ghana: a mixed-methods study

Objectives We aimed to refine and culturally adapt an evidence-based communication intervention (EBCI), which consists of the 3R message framing model (Reframe, Reprioritise, Reform) and human papillomavirus self-sampling (HPVSS) for use in a teaching hospital in Ghana, and evaluated its acceptability, feasibility, appropriateness and adoption potential among stakeholders. Design Convergent mixed-methods design. Setting The study was conducted at a teaching hospital and its surrounding communities in the Central Region of Ghana. Participants A 36-member stakeholder advisory board comprising women living with HIV (WLHIV) (n = 14), healthcare providers (HCPs) (n = 11) and community members (n = 11) participated in Nominal Group Technique sessions to adapt the intervention. The adapted EBCI was subsequently evaluated by 45 participants (WLHIV=30 and HCPs=15). Outcome measures included key characteristics of the EBCI, acceptability, feasibility, appropriateness and its potential for adoption, which were assessed using validated Likert-type scales and structured interview guides. Results Core components of the intervention (HPVSS+3R) were retained. Hospitals and community pharmacies were the preferred self-sampling venues (97%). WhatsApp audio in English and Fante/Akan was the most favoured delivery mode for 3R messages (81%). Evaluation results revealed high acceptability (mean=22.84), feasibility (mean=22.40) and adoption (mean=21.73) on a 5–25 point scale, as well as appropriateness (mean=13.3) on a 3–15 point scale. Qualitative findings highlighted convenience, privacy, empowerment and cultural relevance, which reduced fear and increased participant engagement. Conclusion The adapted EBCI demonstrated high acceptability, feasibility, appropriateness and adoption potential among key stakeholders, supporting its integration into the Ghanaian health systems to advance cervical cancer elimination goals. Trial registration number NCT06739772 .

Understanding cervical cancer prevention in Africa: a qualitative systematic review of the role of men

Background Cervical cancer (CC) is a preventable noncommunicable disease if detected early through screening for precancers and appropriately managed. The causal link with high-risk human papillomavirus infection is established, making elimination possible through the WHO multipronged 90:70:90 strategy. However, practical CC elimination efforts need to address issues within the sociocultural context that can facilitate or hinder prevention strategies. In this regard, the role of men in promoting reproductive health, especially in Africa, cannot be overemphasised. Objective This systematic review examined the extent of involvement of men in CC prevention in Africa and its impact on the WHO CC elimination strategy. Methods A comprehensive search for relevant literature was conducted from 2008 to 2023 in the following electronic databases: Embase, Medline, Global Health, APA PsycINFO, Scopus, Web of Science, CINAHL Plus and the WHO website. Eligible studies explored the views of n=592 men. Screening of abstracts and titles, data extraction and quality assessment were performed in duplicate. A narrative synthesis was performed, as developed by the Economic and Social Research Council Methods Programme, to synthesise the qualitative data. Results Out of the 1961 studies identified through the electronic database search, 16 met all inclusion criteria. This review revealed varying levels of awareness of CC among men; while some had little to no knowledge, others demonstrated a comprehensive understanding. Gaps in knowledge and perception of CC were evident across studies. Both individual and systemic challenges shaped the perspectives of men on screening as a preventive measure, resulting in a range of attitudes and concerns regarding human papillomavirus vaccination. Though male participation in CC prevention was generally low, it was noted that males were willing to play an active role in CC screening and vaccination by supporting the process. Men believed that aggressive education and awareness creation among men were required. Conclusions This review highlights the need for targeted interventions to improve awareness, knowledge and perception of CC among men. Such efforts are essential to help men recognise their crucial role in supporting CC elimination within the African context. PROSPERO registration number The review protocol was registered on 26 June 2023 in PROSPERO with registration number CRD42023437100.