Background Since 2008, in the United Kingdom the HPV vaccine has been made routinely available to young women aged 12 to 13 years. A course of three doses of the vaccine offered protection against HPV 16 and 18, responsible for approximately 70% of cases of cervical cancer. Although uptake of the HPV vaccine is high, it is unknown whether the vaccine is being delivered equitably by ethnicity or deprivation. This study aimed to investigate factors associated with HPV vaccine initiation and completion within the routine HPV vaccination programme in the South West of England.
Methods Young women eligible for routine HPV vaccination from 2008/09 to 2010/11 from three Primary Care Trusts/local authorities were included in this study. The following data were retrieved: (i) date of birth; (ii) postcode; (iii) ethnicity; (iv) dates of receipt of HPV and Measles, Mumps and Rubella (MMR) vaccinations, and; (v) name and code of school. Deprivation was assigned using the 2010 Index of Multiple Deprivation. Multivariable logistic regression models were developed to examine factors associated with uptake of HPV vaccination.
Results Of 14,282 eligible young women, 12,658 (88.6%) initiated, of whom 11,725 (92.6%) completed the course. Initiation varied by programme year (86.5 to 89.6%) and Primary Care Trusts/local authorities (84.8 to 91.6%). There was no strong evidence for an overall association between deprivation quintile and initiation (p = 0.48) or completion (p = 0.10). In comparison to White British young women, young women classified as Asian or British Asian (AOR 0.50 [95% CI 0.44, 0.80]), Black or British Black (0.50 [0.32, 0.79]), and Chinese or other (0.48 [0.33, 0.71]), were less likely to initiate HPV vaccination. However, once initiated, were as likely to complete the course. Young women educated in non-mainstream educational settings were less likely to initiate (0.16 [0.11, 0.24]) and, if initiated, less likely to complete (0.27 [0.17, 0.44). Uptake of MMR vaccination was found to be patterned by ethnicity and deprivation (both <0.001). Young women who had received MMR vaccination were more likely to initiate HPV vaccination (OR 3.64 [3.27, 4.04]).
Conclusion HPV vaccination uptake did not vary markedly by social deprivation. However, associations with ethnicity and substantially lower uptake in non-mainstream educational settings were observed. Research to identify reasons for low vaccine uptake in these population groups is required.
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