Knowledge of Cervical Cancer and Acceptability of Prevention Strategies Among Human Papillomavirus-Vaccinated and Human Papillomavirus-Unvaccinated Adolescent Women in Eldoret, Kenya

Cervical cancer is a critical public health concern in sub-Saharan Africa. This study was conducted to compare the knowledge and source of information of cervical cancer and acceptability of prevention strategies among vaccinated and unvaccinated adolescent girls after a human papillomavirus (HPV) vaccination initiative in Eldoret, Kenya that was carried out from 2012 to 2013.

This cross-sectional comparative study was carried out in Eldoret 3 years later, between May and October 2016 in 6 randomly selected public schools that had participated in the Gardasil Access Program's hospital-based HPV vaccination initiative. Sixty vaccinated adolescents from 3 of the schools were compared to 120 unvaccinated adolescents from the remaining 3 schools. Data collection was performed using interviewer-administered questionnaires derived from factual statements based on information from print material used for community sensitisation on cervical cancer. The median age of the participants was 14 years, with a range of 12–18 years.

Selected findings are described in terms of:

• Knowledge: Of the vaccinated adolescents, 96.7% (58/60) had heard of cervical cancer, as compared with 50.8% (61/120) of the unvaccinated adolescents (p<0.001). HPV was correctly identified as a sexually transmitted infection (STI) by 41.7% (25/60) of vaccinated adolescents but only by 5% (6/120) of unvaccinated adolescents (p<0.001).
• Source of information: Both cohorts selected the school as the main source of information for cervical cancer. Despite the vaccination process being hospital based, only 22.4% (13/60) of the vaccinated adolescents reported having heard about cervical cancer from a doctor. The same percentage of vaccinated adolescents (22/4%) heard about it through social media, compared with slightly more (31.1%) of unvaccinated adolescents citing that source.
• Acceptance of cervical cancer prevention strategies: An assessment of the individual perceived risk of infection by HPV showed that 53.3% (32/60) of the vaccinated participants reported a higher sense of self-perceived risk, compared with 22.5% (27/120) of the unvaccinated cohort (p<0.001). The 2 groups showed similarity in selection of strategies acceptable to them, such as delaying sexual debut, limiting number of sexual partners, and using condoms for protection against STIs. Seventy-five of 118 unvaccinated adolescents (63.6%) would accept the HPV vaccine, with a majority of those who would not accept it (43.2%, 16/37) citing their reason as not knowing what it is.

In this study, receiving the HPV vaccine was associated with a higher knowledge of cervical cancer. The researchers recommend that education offered during vaccination be comprehensive and sufficient. Sources of health information other than school, like FightHPV™, an interactive game developed in Norway that can be downloaded on various android and Apple devices, need to be availed to adolescents.

Although both cohorts of adolescents showed high acceptability for cervical cancer prevention strategies, the researchers stress that prevention strategies should be made more accessible to adolescents. Increasing HPV vaccination should be complemented by behavioural modifications like using condoms, limiting number of sexual partners, and screening for cervical cancer regularly.