Clinic services price list Bibliography available upon request “Exploring issues around Knowledge of the Human Papillomavirus, cervical cancer, perception of risk, and vaccine acceptance among women in Alexandra township, South Africa”  Shelley A. Franics, DrPH, MPH, CHES; Joan Liverpool, EdD, CHES; Jenny A. Nelson, MPH; Roland H. Thorpe, PhD, MS; Soji Shogun, MBBS, FACHE; Nokuthula Mofammere Abstract Specific Aims Results – Specific Aim #3 Describe the socio-demographic context of clinic attendees; Assess knowledge of Human Papillomavirus (HPV) and cervical cancer; Assess the participants’ perception of risk for HPV and cervical cancer risk as well as their child’s risk Background: Developing countries account for 85% of the nearly 500,000 yearly cases of cervical cancer worldwide with approximately 250,000 deaths occurring in Sub-Saharan Africa, South Asia, and Latin America. In South Africa, cervical cancer is the 3rd leading cause of death among women. Although cervical cancer can be prevented with regular Pap screening, access to preventive screenings may be nearly non-existent in resource poor settings that have limited public health infrastructure and where women may lack basic health education. The World Health Organization estimates that even once in a life time screening, performed by women in their 30s or 40s, could reduce the risk of cervical cancer by 25-30%.  Purpose: to assess women’s knowledge about STDs, cancer risk, vaccine acceptance, and maternal-child communication about STDs and cervical cancer.   Methods: Eighty-eight women ,ages 18-44 with at least one child who presented  at an antenatal clinic in township in Johannesburg were recruited to complete  a brief questionnaire.  Using both descriptive and multivariate statistics, we assessed knowledge of cervical cancer, HPV, and the vaccine; assessed maternal-child communication about sex and STDs, assessed willingness to vaccinate child; and identified barriers to assessing medical care and the vaccine.  Results: The majority of participants were unfamiliar with HPV and cervical cancer, were concerned about their child’s and their own risk for HPV, faced numerous barriers to accessing screening, and were willing to vaccinate their child. Discussion/conclusion: Women in developing countries need increased access to screening and education about cervical cancer and HPV prevention.   Specific aim #3: Assess participants’ perception of risk for HPV and cervical cancer 1/3 of women feel they are at low risk for HPV ½ of women feel their risk for cervical cancer is about the same as other women 75% of women are somewhat/very concerned that they will get HPV Prevention Messages 68% had seen/heard cervical cancer messages 23% had seen /heard HPV messages Most had seen/heard messages from clinicians, media, books/magazines Methods Results – Specific Aim #1-2 Specific aim #1: Describe the socio-demographic context of clinic attendees Study recruitment Study was based outside of Johannesburg, South Africa in Alexandra township Up to 75 women attending a private clinic in One local part-time research assistant assisted with study recruitment/survey administration Study inclusion criteria: Be female Be between the ages of 18 and 44 years old Have at least one child Provide consent to participate in the study Phase 1 - Quantitative phase Eligible participants completed a brief 15-20 minute survey Survey assessed the following areas: Demographic characteristics Cervical cancer knowledge, screening, and risk HPV knowledge, screening, and risk Vaccine knowledge and acceptance HPV prevention messages and services Maternal-child communication Phase 2 – Qualitative phase Recruited approximately 30 participants who completed survey Women must have completed Phase 1 and consented to participate in focus groups Recruited 10-12 traditional healers Total of 4 focus groups held Groups held in the community at the clinic Participants were compensated for participation in Phase1 and Phase 2 IRB approval granted by Case Western Reserve University and Witwatersrand University Data analysis Given the exploratory nature of the study, descriptive and univariate analyses was used to explore relationships among variables Data cleaning and analyses was performed by study staff. All analyses performed using SAS 16.0 and Stata 9.0 Summary Women are unfamiliar with HPV, cervical cancer, and the vaccines Women are concerned about their risk for HPV Women lacked access to screening Education on issues related to cervical cancer and HPV is needed for women and providers Employment status 48% of women employed Background Marital status 59% of women single, never married Limitations and Strengths Significance Cervical cancer 2nd most common cancer worldwide The World Health Organization found that women in developing countries accounted for 85% of 500,000 yearly cases with 250,000 annual deaths; most occurring in Sub-Saharan Africa, South Asia, and Latin America HPV is the major risk factor. Six types of HPV account for 85% of cases worldwide Four of the most common types include HPV 6, 11, 16, 18 HPV 6, 11 are associated with genital warts while HPV 16, 18 are associated with 70-80% of cervical cancer Cervical Cancer in Developing World & South Africa #1 cause of cancer related deaths; attributed to over 3400 deaths of South African women Will affect 1 in 26 South African women Strong association between HIV and HPV Women with limited access to routine PAP tests are at risk Pap tests and early detection are the KEY to prevention Key findings from empirical research on HPV, cervical cancer, and vaccine acceptability in Sub-Sahara Africa Adult women had limited knowledge of HPV and cervical cancer Women had limited access to care Women with limited access to routine PAP tests at risk included availability/accessibility of trained clinicians and modern labs Countries lacked cervical cancer prevention programs There is growing interest in vaccine uptake; however, numerous challenges exist Gaps in the literature In developing countries: There are a limited number of empirical studies assessing HPV and cervical related issues Previous studies found women had limited understanding/knowledge of HPV and cervical cancer related issues Lack of studies assessing maternal/parental attitudes Demographics’ of Children 53% have a daughter Mean age of daughter - 5.7 yrs (SD=4.5) Mean age of son - 6.99 yrs (SD=5.8) Limitations Descriptive study Generalizable to clinic population only Small sample size Strengths Explored an understudied area Provides a better understanding of issues around knowledge and attitudes about HPV, cervical cancer, and vaccine acceptance Assesses traditional healers attitudes, beliefs ,and knowledge Used mixed analytical methods Assessed participant religiosity Specific aim #2: Assess knowledge of HPV and cervical cancer 39% have not heard of cervical cancer 71% have not heard of the HPV virus Ever Had Pap Exam 56% had never had a PAP When did you have your most recent PAP? Clinic services price list Public Health Implications Findings have consequences for both health education and health policy Women and providers need information on HPV and cervical cancer Need to utilize media in awareness campaigns Need to increase availability of screening and vaccine (at prices they can afford) Barriers to Getting a PAP Cost Lacked medical aid/assistance Fear, “it’s painful” “Took the womb out” “I don’t know much about it” Acknowledgments The South Africa Women’s Health study is supported by an investigator initiated award from Merck Pharmaceuticals, Inc. The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official views of Merck Inc. Bibliography available upon request