Prevention of human papillomavirus (HPV) infection and HPV-related diseases: Barriers to HPV vaccine coverage among university women in the U.S., and Initial steps in integrating cervical cytology testing into primary care in the Republic of Georgia

Worldwide, cervical cancer is second only to breast cancer in incidence. Screening for pre-cancerous abnormalities can reduce cervical cancer incidence and mortality, though this is not uniformly used worldwide. Recently, a vaccine against human papillomavirus (HPV), a necessary cause of cervical cancer, was approved for preventive use in the United States.;This research was undertaken to address cervical cancer prevention in two geographic areas: (1) to examine HPV vaccine knowledge, attitudes, practices and barriers among a U.S. female undergraduate student population and (2) to evaluate cervical testing results from a sample of women with vaginal symptoms and physician's barriers to cervical screening in the Republic of Georgia.;A cross-sectional survey of 588 female undergraduate students at a Northeastern U.S. public university showed 56% initiated the HPV vaccine series with 79% of initiators completing the three-dose series. However, only 38% of African-American women initiated vaccination. Major vaccination barriers included vaccine safety concerns, lack of physician recommendation and parental hindrances. Women who received the vaccine indicated they were less likely to alter behaviors (e.g. increase sexual activity, decrease cervical screening) than women who did not receive the vaccine. Further research is needed to understand racial differences in vaccination practices and perceptions of vaccine safety.;Of 233 symptomatic women receiving Pap smear testing at a clinic in Tbilisi, Georgia, 19% had cytological abnormality. Abnormalities were more common in older women and those with a higher number of total pregnancies or induced abortions. With one in five symptomatic women having cervical abnormalities, women need appropriate education about cervical cancer testing when symptoms are present.;Of 253 physicians surveyed in two Georgian polyclinics, 58% did not perceive Pap smear testing as a job responsibility, including 37% of obstetrician-gynecologists. Physicians younger than 55 years were more likely to perform Pap smears than older physicians (55% versus 17%). Most physicians were willing to receive HPV and cervical cancer education, and indicated they would increase Pap smear testing following education. Thus, opportunities to educate Georgian physicians about Pap smear tests should be pursued, with additional research to understand other high-order barriers after knowledge and basic skills are developed.