Sebastian Bruera

Human papillomavirus vaccine uptake in ethnically diverse women living with systemic lupus erythematosus

Background Women with systemic lupus erythematosus (SLE) are at an increased risk of infection from the human papillomavirus (HPV) and subsequently HPV-mediated malignancies and genital warts. The HPV vaccine is a highly effective intervention in preventing HPV infection and is recommended in SLE patients. We determined HPV vaccination rates and factors associated with decreased vaccination uptake in women living with SLE. Methods We conducted a cross-sectional study in which we enrolled women with SLE (aged 21–45) for whom the HPV vaccine is recommended for by the US Food and Drug Administration (FDA). The primary outcome was self-reported HPV vaccination as recommended by the Advisory Committee on Immunization Practices (ACIP). We collected demographics, clinical characteristics, knowledge on HPV and vaccines, and items for constructs of the Health Belief Model (HBM) and determined associations between these covariates and HPV vaccination status. Results We enrolled 75 women with SLE. Median age was 33 (IQR 27–40) and 20 (27%) had received HPV vaccination. Older women and Spanish-speaking patients were less likely to have received the HPV vaccine. When examining HBM constructs an increase in ‘perceived barriers’ (e.g. not knowing where to get the vaccine) was associated with no vaccination (r = −0.41, p < 0.01). Increased report of ‘cues to action’ (e.g. My doctors told me lupus increases risk for cervical cancer) was associated with increased HPV vaccination (r = 0.30, p < 0.01). After multivariable adjustment of significant covariates, age remained at significantly decreased odds for HPV vaccination (OR 0.82, 95% CI 0.73–0.93). Conclusion We found low HPV vaccine uptake among racial and ethnically diverse women with SLE. Older age, Spanish language, increased perceived barriers, and increased cues to action were significantly correlated with HPV vaccination. This data highlights potential strategies for providers to use to improve HPV vaccination in this patient population.

Factors Associated With Adherence of Cervical Cancer Screening in Women With Systemic Lupus Erythematosus

ObjectiveThe objective is to determine cervical cancer screening rates and factors associated with decreased cervical cancer screening in women with systemic lupus erythematosus (SLE).MethodsWe conducted a cross‐sectional study that enrolled consecutive women (age 21–64 years) with SLE. We collected demographics, clinical characteristics, constructs of the Health Beliefs Model (HBM) (ie, susceptibility, severity, barriers, benefits, cues to action, and self‐efficacy), and self‐reported cervical cancer screening (confirmed with the electronic medical record). The primary outcome was adherence to cervical cancer screening according to current guidelines. Multivariable logistic regression models were used to examine the association between SLE disease activity and cervical cancer screening and explore mediation effects from HBM constructs.ResultsWe enrolled 130 women with SLE. The median age was 42 years (interquartile range 32–52 years). The cervical cancer screening adherence rate was 61.5%. Women with high SLE disease activity were less likely to have cervical cancer screening versus those with low disease activity (odds ratio 0.59, 95% confidence interval [CI] 0.39–0.89; P = 0.01), which remained statistically significant after adjusting for baseline demographics and drug therapy in a multivariable model (odds ratio 0.25, 95% CI 0.08–0.79; P = 0.02). Regarding the HBM constructs, increased perceived barriers to cervical cancer screening (r = −0.30, P < 0.01) and decreased self‐efficacy (r = −0.21, P = 0.02) correlated with decreased cervical cancer screening.ConclusionPatients with SLE with high disease activity undergo cervical cancer screening less frequently than those with low disease activity. Perceived barriers to cervical cancer screening are moderately correlated with decreased screening. These data highlight the need to develop strategies to increase cervical cancer screening in this high‐risk patient population.