Multilevel Interventions Aimed at Improving HPV Immunization Coverage: A Systematic Review and Meta-Analysis.

Area of Science:

• Public Health
• Preventive Medicine
• Vaccinology

Background:

• Human papillomavirus (HPV)-attributable cancers pose a significant global health challenge.
• Suboptimal HPV vaccination rates worldwide necessitate effective intervention strategies.

Purpose of the Study:

• To evaluate the impact of multilevel interventions on improving HPV vaccination initiation and completion rates.
• To synthesize evidence from randomized controlled trials on HPV vaccination promotion.

Main Methods:

• Systematic literature review and meta-analysis of randomized controlled trials.
• Random-effect meta-analysis using generic inverse variance method.
• Pooled effect estimate calculated as risk ratio (RR) with 95% confidence intervals (CI).

Main Results:

• Multilevel interventions significantly increased HPV vaccination coverage (RR=1.26, 95% CI 1.16-1.38) and initiation (RR=1.14, 95% CI 1.04-1.24).
• Results were robust across sensitivity analyses.
• Interventions showed effects across most comparisons, except for completion rates when targeting four levels.

Conclusions:

• Multilevel interventions are effective in enhancing HPV vaccination rates in high-income countries.
• Future research should focus on resource-limited settings and sustainable, policy-integrated strategies.
• Emphasis on detailed data collection and avoiding self-reported outcomes is recommended.