Ethnic/racial barriers to cervical cancer prevention with the HPV vaccine

1546 Background: High risk types of the human papilloma virus (HPV) are necessary though not sufficient causes of the vast majority of cervical cancers. Black women have the highest prevalence of HPV (20.6%, 95% CI, 19.8–21.5%), followed by Latinas (14.1%, 95% CI, 13.9, 14.4%). Black women have the highest rates of mortality from cervical cancer, followed by Latinas. Recent population-based data reveal low uptake of the HPV vaccine (∼25%), particularly among Black women and Latinas. Objectives: The aim of this systematic review is to describe the supports and barriers to HPV vaccine inoculation among Black and Hispanic U.S. women. Methods: We conducted a systematic literature review of studies with more than one observation point or a comparison group that were published over the past 10 years, using a standardized extraction protocol. Inter-rater reliability rates were high (> 0.98). Of 64 English-language articles from peer-reviewed journals, we selected 16 for review. Results: We found barriers at the policy, provider, and patient levels. Barriers at the policy level include access to health care, cost, insurance coverage, vaccine availability, limited knowledge of the HPV vaccine, and media coverage that stigmatizes inoculation. At the provider level, knowledge about HPV incidence and transmission as well as physician recommendation are important factors that influence parental and patient acceptability of the HPV vaccine. Providers report difficulty in discussing STIs with parents, preadolescents, and adolescents. Providers are hesitant to store a vaccine that will be less widely used. Office-based procedures present structural impediments to dissemination of the vaccine. At the patient level, barriers include limited awareness of the vaccine, socioeconomic status, perception of risk based on sexual history, fear of vaccine safety, socio-cultural, economic, and religious factors. Conclusions: Policy, provider, and patient-focused intervention approaches to increasing dissemination of the HPV vaccine are proposed to increase uptake among Black women and Latinas. No significant financial relationships to disclose.