A Human Rights Approach to Understanding Provider Knowledge and Attitudes toward the Human Papillomavirus Vaccine in São Paulo, Brazil Open Access
Kruse, Meredith (2016)
Abstract
Background: In March 2014, the Brazilian Ministry of Health instituted a nationwide vaccination program that offers females a two-dose series of the quadrivalent HPV vaccine at no cost through Sistema Único de Saúde (Unified Health System or SUS). The vaccine, now fully integrated into the immunization calendar, is available to females through schools and SUS and excludes all males and females above the age of 13 from participation. However, Brazil's constitution dictates a right to health for the entire population.
Objective: To address to what extent human rights considerations influence the sexual and reproductive health care of all males and females over the age of 13 in Mauá, Brazil, specifically in terms of access to the HPV vaccine.
Methods: From May to August 2015, we conducted a cross-sectional study among health care providers in eight public health clinics located in the city of Mauá, a suburb of São Paulo, Brazil. Frequency analysis was conducted across the three main subject areas: knowledge, attitudes and access. Comparisons focused on response variance based on occupation.
Results: A total of 154 surveys were analyzed. Correct knowledge was relatively high among all providers, though there were some knowledge gaps. A majority reported it is medically effective to vaccinate females over the age of 13 (115/150 [77%]), females over the age of 13 should be vaccinated (126/150 [84%]), and they would vaccinate a female over the age of 13 (123/150 [82%]). Similar responses were reported for male vaccinations. A majority reported that Brazilians do not have equal access to health (120 [80%]) and the population exclusions of the HPV vaccination program limit an individual's right to health (108 [72%]).
Conclusions: Limiting access to the HPV vaccine infringes upon an individuals' right to health. The current economic and political climate in Brazil presents challenges to expand the vaccination program; however, it is Brazil's responsibility to anticipate what steps can be taken to assuage these barriers. The domestic production of the vaccine, additional education campaigns, and increased access will enable individuals to make their own decisions about their sexual and reproductive health and evoke their right to health.
Table of Contents
Chapter I: Introduction ........................................................1
Global Cancer Burden...........................................................1
Cervical Cancer Burden in Brazil ...........................................1
Human Papillomavirus (HPV)................................................2
HPV Prevention....................................................................4
HPV Vaccine Program Implementation in Brazil .....................5
Sistema Único de Saúde (Unified Health System or SUS) ..........7
Mauá, Brazil .........................................................................8
Current HPV Vaccine Program Outcomes in Brazil..................10
Human Rights Impact...........................................................12
Objectives and Aims.............................................................13
Chapter II: Literature Review ................................................16
HPV Trends - Who? Target Population...................................16
Cost-Effectiveness................................................................18
Social Acceptability..............................................................19
HPV Trends -Where? Vaccine Location...................................21
HPV trends - When? Vaccination Schedule ............................24
HPV Trends - Why? Provider Knowledge and Beliefs...............26
United States Providers ........................................................26
Global Providers ..................................................................28
Right to Health ....................................................................30
Literature Gaps ....................................................................33
Chapter III: Methodology......................................................36
Population ..........................................................................36
Participant Recruitment .......................................................36
Instrument..........................................................................38
Procedures..........................................................................38
Data Entry and Management................................................40
Data Analysis .....................................................................40
Limitations ........................................................................41
Chapter IV: Results.............................................................43
Provider HPV Knowledge ....................................................44
Attitudes toward Eligibility..................................................46
Right to Health ..................................................................49
Chapter V: Discussion ........................................................52
Policy Recommendations....................................................54
Finances............................................................................55
Knowledge.........................................................................57
Access ...............................................................................58
References .........................................................................60
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