# Human papillomavirus vaccine uptake in ethnically diverse women living with systemic lupus erythematosus

## TL;DR

This study finds that HPV vaccine uptake is low among ethnically diverse women with lupus, with older age and language barriers being key factors.

## Contribution

The study identifies specific factors affecting HPV vaccination rates in women with systemic lupus erythematosus.

## Key findings

- Only 27% of women with SLE reported receiving the HPV vaccine.
- Older age and Spanish language were associated with lower vaccination rates.
- Perceived barriers and cues to action significantly influenced vaccination status.

## Abstract

Women with systemic lupus erythematosus (SLE) are at an increased risk of infection from the human papillomavirus (HPV) and subsequently HPV-mediated malignancies and genital warts. The HPV vaccine is a highly effective intervention in preventing HPV infection and is recommended in SLE patients. We determined HPV vaccination rates and factors associated with decreased vaccination uptake in women living with SLE.

We conducted a cross-sectional study in which we enrolled women with SLE (aged 21–45) for whom the HPV vaccine is recommended for by the US Food and Drug Administration (FDA). The primary outcome was self-reported HPV vaccination as recommended by the Advisory Committee on Immunization Practices (ACIP). We collected demographics, clinical characteristics, knowledge on HPV and vaccines, and items for constructs of the Health Belief Model (HBM) and determined associations between these covariates and HPV vaccination status.

We enrolled 75 women with SLE. Median age was 33 (IQR 27–40) and 20 (27%) had received HPV vaccination. Older women and Spanish-speaking patients were less likely to have received the HPV vaccine. When examining HBM constructs an increase in ‘perceived barriers’ (e.g. not knowing where to get the vaccine) was associated with no vaccination (r = −0.41, p < 0.01). Increased report of ‘cues to action’ (e.g. My doctors told me lupus increases risk for cervical cancer) was associated with increased HPV vaccination (r = 0.30, p < 0.01). After multivariable adjustment of significant covariates, age remained at significantly decreased odds for HPV vaccination (OR 0.82, 95% CI 0.73–0.93).

We found low HPV vaccine uptake among racial and ethnically diverse women with SLE. Older age, Spanish language, increased perceived barriers, and increased cues to action were significantly correlated with HPV vaccination. This data highlights potential strategies for providers to use to improve HPV vaccination in this patient population.