Background/Purpose: Women with systemic lupus erythematosus are at an increased risk of infections from the human papillomavirus (HPV) and subsequently HPV-mediated malignancies and genital warts. The HPV vaccine is an effective preventative strategy for these complications; however, the HPV vaccination rate has not been well described in a racially and ethnically diverse patient population in the United States.Furthermore, the attitudes, knowledge, and beliefs of patients towards HPV vaccination has not been described in women with SLE.

Methods: We performed a cross-sectional study in which we enrolled consecutive women with a diagnosis of SLE by 2019 ACR criteria. Eligible women were aged 21-45 years of age without a prior history of cervical cancer or hysterectomy. The Centers for Disease Control (CDC) recommends vaccination up to ages 45 for patients that are high risk for HPV infections. We collected demographics, clinical characteristics, constructs of the Health Belief Model (HBM) (susceptibility, severity, perceived barriers, benefits, cues to action, and self-efficacy). Patients answered questions according to the 5-point Likert Scale (1 – Strongly Agree to 5- Strongly Disagree). Answers were reversely coded when necessary and means with standard deviations were generated. Higher means showed an increased perception of an individual construct (i.e. a higher mean for barriers indicates women had perceived barriers for why they did not obtain the HPV vaccine, whereas a higher mean for severity indicates beliefs that there are less consequences from HPV infection). Our primary outcome was self-reported HPV vaccination, as there is currently no approved laboratory study to confirm vaccination status.

Results: We enrolled 75 women. The mean age was 33. Most patients were either black (27%) or Hispanic (44%). Our results showed that only 27% of patients had received HPV vaccination, whereas the remaining 73% either had not received the vaccine or were unsure. There were no associations between HPV vaccination and demographic variables (including race, ethnicity, marital status, insurance, education, and smoking status). With respect to HBM constructs where a value of 3 is neutral, women with SLE had increased perceived barriers (mean 4.0, SD 0.83) and decreased perceived severity (mean 3.25, SD 0.90). Women did not have an increase in the perceived susceptibility (mean 2.4, SD 0.63), benefits (mean 1.9, SD 0.81), self-efficacy (mean 1.96, SD 0.66), and cues to action (mean 1.9, SD 0.43). There were no statistically significant differences in the HBM constructs between vaccinated and non-vaccinated women.

Conclusion: Women with SLE that should consider HPV vaccination by the CDC guidelines are vaccinated at a low rate of 27%. Our HBM model shows that women had increased perceiver barriers to vaccination and had decreased perceived severity about HPV infection. This model suggests that strategies to target the constructs can be used to increase screening in this vulnerable patient population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/human-papillomavirus-vaccine-uptakes-in-ethnically-diverse-women-living-with-systemic-lupus-erythematosus/