title: Factors influencing HPV vaccine delivery by healthcare professionals at public health posts in São Paulo, Brazil.
abstract: OBJECTIVE
  To assess the association between Brazilian healthcare providers' characteristics and their knowledge, perceptions, and practices regarding the HPV vaccine.
  
  
  METHODS
  An observational cross-sectional study was conducted at five public health posts in São Paulo between July 28 and August 8, 2014. Healthcare professionals directly involved in patient care were asked to complete a written survey. Factors associated with routine verification of HPV vaccination status were evaluated using Poisson regression.
  
  
  RESULTS
  Among 200 participants included, 74 (38.5%) reported never and 70 (36.5%) reported always asking about HPV immunization status. Doctors were significantly less likely to report always asking than were community health agents (5/39 [12.8%] vs 32/60 [53.3%]; adjusted prevalence ratio [aPR] 0.25 [95% confidence interval (CI) 0.07-0.91]). Knowledge about the correct dosing schedule was associated with always rather than never verifying vaccination status (aPR 2.46 [95% CI 1.06-5.70]).
  
  
  CONCLUSIONS
  Knowledge and attitude played secondary roles in influencing HPV vaccine verification. Community health agents were crucial for vaccine promotion; continued education and support of this group is essential for the sustained success of HPV immunization efforts in Brazil.
authors.affiliation: Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Daniella
authors.initials: D
authors.lastname: Figueroa-Downing
authors.affiliation: The Cancer Institute of the State of São Paulo, São Paulo, Brazil.
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Baggio
authors.affiliation: Department of Behavioral Science and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Misha L
authors.initials: ML
authors.lastname: Baker
authors.affiliation: Department of Anthropology, Emory College of Arts and Sciences, Emory University, Atlanta, GA, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Dias De Oliveira Chiang
authors.affiliation: The Cancer Institute of the State of São Paulo, São Paulo, Brazil.|Department of Radiology and Oncology, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Luisa L
authors.initials: LL
authors.lastname: Villa
authors.affiliation: Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.|Oncology Foundation of São Paulo, São Paulo, Brazil.
authors.forename: Jose
authors.initials: J
authors.lastname: Eluf Neto
authors.affiliation: Departments of Behavioral Science and Health Education and Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Dabney P
authors.initials: DP
authors.lastname: Evans
authors.affiliation: Departments of Behavioral Science and Health Education and Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.|Cancer Prevention and Control Program, Winship Cancer Institute, Atlanta, GA, USA.|Emory Vaccine Center, Atlanta, GA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bednarczyk
mesh_terms: D000328:Adult; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D017150:Public Sector; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014611:Vaccination / Q000592:standards*
chemical_list: D053918:Papillomavirus Vaccines
keywords: 
  HPV
  ; Brazil; Cervical cancer; Community health agents; National immunization program; Vaccine