title: Knowledge and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: a systematic review.
abstract: OBJECTIVE
  We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination.
  
  
  METHODS
  We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990-2011 were extracted from the World Health Organization database.
  
  
  RESULTS
  The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above.
  
  
  CONCLUSIONS
  There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support.
authors.affiliation: Pathfinder International, Watertown, Massachusetts, United States of America.
authors.forename: Stacey
authors.initials: S
authors.lastname: Perlman
authors.affiliation: Northeastern University, Boston, Massachusetts, United States of America.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Wamai
authors.affiliation: Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Bain
authors.affiliation: Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
authors.forename: Thomas
authors.initials: T
authors.lastname: Welty
authors.affiliation: Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
authors.forename: Edith
authors.initials: E
authors.lastname: Welty
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
authors.forename: Javier Gordon
authors.initials: JG
authors.lastname: Ogembo
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000276:immunology; D055088:Early Detection of Cancer; D015981:Epidemiologic Factors; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000276:immunology*; D010342:Patient Acceptance of Health Care; D062486:Public Health Surveillance; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D053918:Papillomavirus Vaccines