Determinantes da saúde e a cobertura da vacina contra o Papilomavírus Humano

Abstract

Human papillomavirus (HPV) infection is the most prevalent sexually transmitted disease worldwide and the necessary cause for the development of cervical cancer. The HPV vaccine is therefore extremely important for preventing the disease. Although provided free of charge by the Unified Health System since 2014, vaccination coverage (VC) is below the expected target, due to factors intrinsic to individuals, such as misinformation and fear of events supposedly attributable to vaccination or immunization (ESAVI) that it can cause. Furthermore, VC can also be influenced by factors inherent to the environment, especially the social environment. To analyze the association between health determinants (individual and environmental) and human papillomavirus vaccine coverage. This is a study consisting of a systematic review and an ecological study, carried out with data from the state of Minas Gerais, Brazil, for girls and boys aged nine to 14 years old from 2014 to 2023. Data on the HPV vaccine were taken from the National Immunization Program Information System (SI-PNI). The HPV vaccine was the dependent variable of this thesis. As independent variables, the sociodemographic variables of the municipalities, made available by the public domain website of the Minas Gerais Social Responsibility Index, of the João Pinheiro Foundation, were adopted: number of families with an income of up to half the minimum wage; percentage of the poor population of Cad-Único; proportion of the population served by the family health strategy; and urbanization rate. For the analyses, the Prais-Winsten autoregressive model, panel regression, and spatial statistical analysis were adopted, supported by the Stata version 16.0 and Geoda version 1.20.0.8 software. The highest prevalence of HPV vaccines (≥50% to <90%) in the municipalities of the state of Minas Gerais, Brazil, showed low VC (≥50% to <90%) for both the first and second doses. The results demonstrated that ESAVI, socioeconomic factors and factors inherent to the social environment, such as the rate of violence, may be determinants of HPV VC. Education and awareness strategies, group/school vaccination and informative reminders stood out as useful for increasing HPV VC. The results demonstrated, supported by data from Minas Gerais, Brazil, that there is a potential association between health determinants (individual and environmental) and VC against human papillomavirus. The various methodologies used in this thesis were essential for understanding this association. The analysis of socioecological determinants associated with VC may be useful for establishing an action plan to improve VC indicators during different life cycles, especially for such specific audiences as the HPV vaccine (children and adolescents). The fundamental importance of nursing professionals for the success of vaccination is reinforced, since they play a significant social role, given that they know users closely, their social context, their lifestyle habits and their health problems, and can contribute to the promotion of appropriate and effective interventions in the context of vaccination.