Health Disparities
Human papillomavirus vaccination access in adolescents and young adults with and without a disability: A systematic review Melina Albanese* Melina Albanese Jayati Khattar Kathryn Barrett Hasmik Beglaryan Hilary Brown
Individuals with disabilities have lower receipt of several preventive healthcare services, including vaccination. Human papillomavirus (HPV) is a leading cause of cervical cancer and is almost entirely preventable through vaccination. We conducted a synthesis of literature on access to HPV vaccination by disability status among adolescents and young adults (AYA). We followed systematic review methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, Embase, PsycInfo, CINAHL, and Web of Science Core Collection were searched from database inception to July 9, 2024, using keywords and subject headings for the concepts “disability” and “HPV vaccination.” We included peer-reviewed observational studies published in English comparing HPV vaccination in AYA with and without a disability. Quality was assessed using the Effective Public Health Practice Project tool. A narrative synthesis of the findings was performed. Of 1164 unique records identified, 8 met our inclusion criteria. Studies were mostly cross-sectional surveys (n=4) from the United States (n=3) and examined receipt of 1 or more doses of any HPV vaccine (n=5) or a full series (n=3) among AYA with physical (n=2), sensory (n=1), and developmental (n=3) disabilities, or a composite measure of disability (n=6). Overall, 50% of studies were rated as “weak” quality, 37.5% as “moderate”, and 12.5% as “strong.” Selection bias and failure to adjust for confounding were common reasons for downgrading study quality. Overall, studies found lower access to HPV vaccination in AYA with neurodevelopmental and neurological disabilities but not other disabilities. Findings reflect the need for future studies with population-based designs, validated measures, and good control for confounding. Current literature suggests AYA with neurodevelopmental and neurological disabilities could benefit from public health and clinical strategies to improve HPV vaccination access.