Fatores associados à hesitação da vacina contra o Papilomavírus Humano na população brasileira: um estudo transversal

Abstract

HPV related tumors continue to be a global leading cause of cancer mainly due tocervicalcancer (CC) burden. In Brazil, CC is the third most common cancer and the fourthhighestcancer mortality rate among women. HPV vaccine mass immunization represents thecurrentmost promising intervention for CC prevention. It was first implemented in the Brazilianpublic health system in 2014, however, despite a history of excellent coverage for othervaccines, HPV vaccine uptake is below the necessary threshold for CC elimination. Theaimof this study is to know whether or not Brazilians are resistant to HPVvaccinationandtodetermine the factors and variables that influence this decision. This is a population-basedcross-sectional study which used quantitative methodology through personal interviews. Atotal of 2.010 interviews were planned to result in error margins of 2 percentage points, moreor less considering a 95% confidence level, encompassing all five Brazilian regions. Theresearch was carried out with the Brazilian population aged 16 and over, intervieweeswereapproached at points of population flow. Between June 12 th and 16 th 2023, a total of 2.010personal interviews were done, with participants from all five Brazilian regions. Theprevalence of vaccine resistance was 5.97% (95% confidence interval [CI], 4.93–7.23) amongthose interviewed. A multivariate analysis demonstrated greater resistance to thevaccineamong men (prevalence ratios (PR): 1.58; 95%CI, 1.06–2.34; p: 0.023) and residentsinthe South region of the country (PR: 1.77; 5%CI, 1.06–2.94; p: 0.028). The threemainreasons for refusing the vaccine reported by the participants were: lack of knowledgeaboutthe HPV vaccine; difficulty in accessing the vaccine; and lack of vaccine prescriptionbyhealth professionals. Safety was the main reason not to vaccinate, cited by 10 %. DespiteHPV vaccine availability in Brazil at the public health system, vaccination coverageremainsbelow the target for both genders. However, according to this analysis, there is a lowrateofHPV vaccination hesitancy in the country, being lack of knowledge, difficulty inaccessingthe vaccine and lack of vaccine prescription by health professionals the main obstaclestoadequate adherence. The COVID-19 pandemic doesn’t seem to have affectedHPVvaccination resistance in the country. Proper strategies for vaccine implementation, includingschool-based programs, patient-provider communication and education, andintegratedmonitoring and evaluation strategies are needed, otherwise, HPV vaccine programsriskrepeating problems like other cancer prevention programs in low- and middle-incomecountries. The HPV vaccine is an efficient tool for preventing cancer, which saves lives, butin Brazil it is being underused.