HPV VACCINATION UPTAKE IN CANADA: A SYSTEMATIC REVIEW AND META ANALYSIS. Olatunji Obidiya (PhD Student) University of Saskatchewan

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1 HPV VACCINATION UPTAKE IN CANADA: A SYSTEMATIC REVIEW AND META ANALYSIS Olatunji Obidiya (PhD Student) University of Saskatchewan

2 DISCLOSURE STATEMENT I have no affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.

3 OUTLINE Introduction & Rationale Objective Methods Result Public Health Implication

4 INTRODUCTION & RATIONALE HPV, a risk factor for cervical cancer affects approx. 55,0000 Canadians annually Govt funded vaccines (Gardasil-4 & Cervarix) made available in Canada since Gardasil-9 approved by Health Canada in Vaccination coverage is variable & not reported for some jurisdictions

5 INTRODUCTION & RATIONALE Documented racial & ethnic disparities in the burden of HPV infection in the US, Australia & Canada Limited pooled systematic study of HPV vaccine uptake in Canada

6 OBJECTIVE Determine the level of HPV vaccine uptake in Canada Determine if disparities exist in Canadian HPV vaccination uptake amongst subpopulations

7 METHODS Databases Searched using Keywords & MesH Pubmed MEDLINE EMBASE Global Health Proquest Public Health JSTOR Cochrane Library

8 METHODS Search Strategy Based on finding articles incorporating all four domains AND (i.e. 1 AND 2 AND 3 AND 4) Sub domains incorporating a single term using OR statements to make eligible (i.e. HPV or HPV Infection). 1.HPV 2.Vaccine 3.Uptake HPV or HPV Infection Viral Vaccines or HPV Vaccine or Gardasil or Cervarix or Immunization Coverage or Rates or Uptake or Disparity 4.Canada Provinces/Territories

9 METHODS Study Inclusion/Exclusion Criteria Participants: Human Canadian population (adult & children). Intervention: HPV vaccination. Outcomes: Uptake of HPV vaccine in the Canadian population. Years: 2006 onwards. Language: English language (articles in French had English translation) Data: Quantitative Publicly accessible articles.

10 METHODS Study Selection Process 1. Calibration between 2 screeners 2. Independent title, abstract & full text screening. 3. After consultation, 3 rd researcher voted to decide on disagreements 4. Rationale for excluded articles were noted in excel document

11 METHODS Screening & Methodological Quality Check Total of 718 peer-reviewed articles identified, 205 removed as duplicates; (remaining 513); 366 excluded after title & abstract screening. 147 articles assessed for full text screening, 13 articles remained & underwent methodological quality assess; 9 longitudinal & 4 crosssectional studies. Articles were screened and methodological quality checked using modified Newcastle Ottawa Scale. Risk of bias of articles was considered low. Pooled/subgroup meta-analysis were conducted on 13 articles using key variables

12 RESULT PRISMA FLOW DIAGRAM

13 RESULT Vaccination Uptake Random effects model showed a pooled estimate of vaccination uptake of 55.9% (95% CI: to ) Articles had vaccination uptake ranging from 12% - 88% Ethnicity not reported in articles, so not used as variable for group meta-analysis

14 RESULT

15 RESULT Subgroup Analysis: Significant Findings Individuals < 18 years; in funded, school-based HPV vaccination programs were 4.92 times more likely (95% CI: 4.15 to 5.82) to be immunized compared to individuals >18 years, paying out-of-pocket; community-based programs. MSM are less likely to be immunized than other participants No identifier for ethnic background of participants in all the studies.

16 PUBLIC HEALTH IMPLICATION Need for HPV National vaccine registry to supplement provincial databases for better tracking of HPV vaccination uptake in Canada. No evidence to suggest a targeted HPV vaccination program for populations with higher burden of HPV infection and cervical cancer in Canada (e.g MSM, women of Aboriginal origin).

17 SELECTED REFERENCES Ahken, S., Fleming, N., Dumont, T., & Black, A. (2015). HPV awareness in higher-risk young women: The need for a targeted HPV catch-up vaccination program. Journal of Obstetrics and Gynaecology Canada: JOGC = Journal D'obste trique Et Gynećologie Du Canada: JOGC, 37(2), Ogilvie, G., Naus, M., Money, D., Dobson, S., Miller, D., Krajden, M.,... Coldman, A. (2015). Reduction in cervical intraepithelial neoplasia in young women in British Columbia after introduction of the HPV vaccine: An ecological analysis. International Journal of Cancer, 137(8), Moores, A., Phillips, J., O Byrne, P., & MacPherson, P. (2015). Anal cancer screening knowledge, attitudes, and experiences among men who have sex with men in Ottawa, Ontario. The Canadian Journal of Human Sexuality, 24(3), Burchell, AN., Rodrigues, A.,Moravan, V., Tellier, PP.,Hanley, J & Franco, ED. (2014). Determinants of Prevalent Human Papillomavirus in Recently Formed Heterosexual Partnerships: A Dyadic-Level Analysis J Infect Dis. (2014) 210 (6): Mcclure, Macswain, Morrison, & Sanford. (2015). Human papillomavirus vaccine uptake in boys and girls in a school-based vaccine delivery program in Prince Edward Island, Canada. Vaccine, 33(15), Musto, R., Siever, J., Johnston, J., Seidel, J., Rose, M., & McNeil, D. (2013). Social equity in Human Papillomavirus vaccination: A natural experiment in Calgary Canada. BMC Public Health, 13, 640. Lim, W., Sears, K., Smith, L., Liu, G., & Lévesque, L. (2014). Evidence of effective delivery of the human papillomavirus (HPV) vaccine through a publicly funded, school-based program: The Ontario Grade 8 HPV Vaccine Cohort Study. BMC Public Health,14, Liu, X., Bell, C., Simmonds, K., Russell, M., & Svenson, L. (2016). HPV Vaccine utilization, Alberta 2008/ /14 School year. BMC Infectious Diseases, 16(1), 15. Smith, L., Brassard, P., Kwong, J., Deeks, S., Ellis, A., & Lévesque, L. (2011). Factors associated with initiation and completion of the quadrivalent human papillomavirus vaccine series in an ontario cohort of grade 8 girls. BMC Public Health,11, 645. Whelan, Noella W., Steenbeek, Audrey, Martin-Misener, Ruth, Scott, Jeffrey, Smith, Bruce, & D Angelo-Scott, Holly. (2014). Engaging parents and schools improves uptake of the human papillomavirus (HPV) vaccine: Examining the role of the public health nurse. Vaccine, 32(36), Krawczyk, A., Perez, S., King, L., Vivion, M., Dubé, E., & Rosberger, Z. (2015). Parents Decision-Making about the Human Papillomavirus Vaccine for Their Daughters: I. Quantitative Results. Human vaccines & immunotherapeutics 11(2): Ogilvie, G., Anderson, M., Marra, F., McNeil, S., Pielak, K., Dawar, M.,... Wright, L. (2010). A Population-Based Evaluation of a Publicly Funded, School-Based HPV Vaccine Program in British Columbia, Canada: Parental Factors Associated with HPV Vaccine Receipt (Evaluation of BC HPV Vaccine Program). PLoS Medicine, 7(5), E Wilson, Sarah E., Harris, Tara, Sethi, Pam, Fediurek, Jill, Macdonald, Liane, & Deeks, Shelley L. (2013). Coverage from Ontario, Canada's school-based HPV vaccine program: The first three years. Vaccine, 31(5),

18 THANK YOU