HPV Vaccination in Young Girls from Developing Countries: What Are the Barriers for Its Implementation? A Systematic Review

Abstract

Cervical cancer is the second most common cancer in women living in developing countries that account high HPV incidence and mortality rates. Vaccinating girls between 9 and 14 years old is supposed to be the most cost-effective public health approach against cervical cancer. This systematic review aims to assess the application and coverage of the HPV vaccine in developing countries and identify the main challenges for the introduction of the vaccine in these settings. Eligible studies were selected according to the defined inclusion and exclusion criteria. To determine the quality of the studies was employed the STROBE checklist. This review included seven studies, encompassing the analysis of 19 countries and 112,116 girls aged from 9 to 18 years old. The coverage of HPV vaccination ranged from 13.8% to 107.4%, with most of the programs having more than 60% of coverage, which reflects a high percentage of vaccinated girls. The main challenges were lack of knowledge and worries about the vaccine, insufficient financial resources and staff workers, lack of community involvement and dissemination of important information about HPV. In developing countries that implemented the HPV vaccine, high coverage rates were achieved, despite sociocultural, economic and political challenges. In the future, studies that analyze the coverage rates after the elimination of the barriers and the repercussions on the mortality rates should be conducted, so that more developing countries have the opportunity to efficiently implement the vaccine.