Predictors of HPV Knowledge and HPV Vaccine Awareness Among Women in Panama City, Panama

• Date: 01 March 2019
• Author: Lourdes Baezconde‐Garbanati,Lisa Gantz,Fiorella Gonzales,Joyee S. Chatterjee,Sheila Murphy,Lourdes Alguero,Morgan Hess‐Holtz,Lauren B. Frank,Paula Amezola de Herrera,Arlene Calvo,Meghan Moran
• DOI: http://doi.org/10.1002/wmh3.293
• Published date: 01 March 2019

Predictors of HPV Knowledge and HPV Vaccine

Awareness Among Women in Panama City, Panama

Lisa Gantz , Arlene Calvo, Morgan Hess-Holtz, Fiorella Gonzales,

Lourdes Alguero, Sheila Murphy, Meghan Moran, Lauren B. Frank,

Joyee S. Chatterjee, Paula Amezola de Herrera,

and Lourdes Baezconde-Garbanati

In 2008, Panama became the f‌irst country in Latin America to offer the Human Papilloma Virus

(HPV) vaccine at no cost to 10-year-old girls as part of its National Immunization Program.

Vaccine completion rates remain suboptimal, and knowledge is limited regarding public perceptions

of the HPV vaccine in Panama. A cross-sectional survey of 333 Panamanian women aged 18–65

was conducted in Panama City, Panama. Although 93 percent of respondents had heard of HPV,

only 59.8 percent had heard of the HPV vaccine. Acceptability of HPV vaccination of daughters

was high (95 percent). In multivariate analyses, HPV vaccine awareness was associated with age

and education, but not with income, Internet use as preferred source of health information,

indigenous race, or marital status. Additionally, after controlling for age, education, income, race,

and Internet use, women who completed a pap test in the past 36 months were 3.12 times more

likely to have heard of the HPV vaccine when compared to those who had not (95%CI 1.04–9.34).

Future efforts to educate Panamanian women about the HPV vaccine should include special

attention to vulnerable populations, including those of younger age and limited education.

KEY WORDS: HPV vaccine, HPV, Panama

Background

Globally, cervical cancer kills over 250,000 women each year, with over 85

percent of these deaths occurring in developing countries (Forman et al., 2012).

Cervical cancer is caused by infection with the human papilloma virus (HPV),

which is also responsible for cancers of the vulva, vagina, anus, penis, and

oropharynx. Cancers caused by HPV account for more than half of infection-

attributed cancers in women worldwide (Plummer et al., 2016). The HPV vaccine

brings new hope to resource-limited settings, with the potential to prevent

infections with HPV strains responsible for over 70 percent of cervical cancers

globally (Mu~

noz et al., 2008; Schiffman, Castle, Jeronimo, Rodriguez, &

World Medical & Health Policy, Vol. 11, No. 1, 2019

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doi: 10.1002/wmh3.293

#2019 Policy Studies Organization

Wacholder, 2007). In the Latin American and Caribbean (LAC) region, an

estimated 1.1 million cases of invasive cervical cancer could be prevented within

this region with 70 percent coverage of the HPV vaccine over a 10-year period

(Goldie et al., 2008).

Despite the immense potential of the HPV vaccine to prevent cancer-related

morbidity and mortality, in many settings, initiation and completion of the vaccine

series has been lower than expected, including in the United States (Holman et al.,

2014; Walker et al., 2017). When evaluating the success of a vaccine campaign,

numerous factors must be considered. These factors include practical barriers, such

as vaccine cost and access to health care, but should also include public

perceptions, including vaccine acceptability, endorsement from health-care pro-

viders, knowledge attitudes, and beliefs related to the vaccine. Studies have shown

that even when practical barriers are eliminated, misinformation, stigma, lack of

knowledge, and safety concerns can impede the success of a vaccine program

(Larson et al., 2016; Ogilvie et al., 2010), highlighting the importance of understand-

ing public perceptions of the HPV vaccine to inform ongoing messaging via mass

media and awareness campaigns to educate the public and dispel rumors. This is

especially important for the HPV vaccine, which has been particularly controversial

due to the sexually transmitted nature of the virus and the recommended age of

administration (in adolescents, prior to sexual debut) (Holman et al., 2014, Kane,

Serrano, de Sanjose, & Wittet, 2012). Sexually transmitted infection immunization

programs may face unique stigma based on sexual morality or religion, and are

often met with resistance from those who fear that these programs may condone or

encourage premarital sex (Zimet, Mays, & Fortenberry, 2000).

Cervical Cancer and HPV in Panama

Panama is an upper-middle-income country located in Central America with

a population of approximately 4 million people (Fantom & Serajuddin, 2016).

Cervical cancer rates have historically been extremely high in Panama, where

epidemiologic case-control studies of women in the 1980s f‌irst identif‌ied the

causal link between HPV and cervical cancer (Herrero et al., 1990). Although

Panama offers universal access to free health care, cervical cancer, a disease that

is preventable with timely screening and treatment of precancerous lesions,

continues to rank second in both incidence (25.3 per 100,000) and mortality (7.4

per 100,000) among female cancers (MINSA, 2013). The HPV vaccine represents a

tremendous opportunity for Panama to reduce rates of cervical cancer, as pap

coverage rate estimates are as low as 14.1 percent (MINSA, 2010). Effective

screening programs can be costly and diff‌icult to implement even when there is

universal access to health care, as there are many practical barriers to the patients

themselves (such as transportation, long wait times in clinic), as well as systemic

barriers that pose challenges to government health agencies (such as coordinating

follow-up appointments, maintaining quality control of specimen handling, and

training a suff‌icient number of pathologists for accurate interpretation) (Mu ~

noz

et al., 2008). Despite the high prevalence of both HPV and cervical cancer among

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