Explanation of Health Systematic

Explanation of Health Systematic

Instructions/Descriptions

Explanation of Health Systematic Article Review

One of the overall objectives of the guideline is to articulate the procedures for using the prophylactic HPV vaccine in the prevention of cervical cancer and cervical intraepithelial neoplasia. The other aim of the guideline is to recommend a periodic vaccination program for females between eleven and twelve years.

It recommends catch-up vaccination for females between thirteen and eighteen years. The guideline also aims to recommend informed decision making in vaccinating males aged between 9 and 26.

2. The health question(s) covered by the guideline is (are) specifically described.

The health questions covered in the guidelines include, should late vaccination be recommended for females between the age of 19 and 26 to supplement their missed doses? The RTC suggested that the efficacy of the vaccine decrease by age.

The ACS did not find adequate information for approving or disputing the periodic vaccination of the population at these age gaps (Supplemental Evidence Review, 2016). The other question was, should HPV vaccine be proposed to males between the age of nine and twenty-six years?

The RCT demonstrated that that efficacy of the vaccine, safety and high levels of immunogenicity in males are similar to those in females. ACS also has a question, should the 9-valent HPV vaccine be proposed? The guide does not recommend the use of this vaccine formulation.

3. The population (patients, public, etc.) to whom the guideline is meant to apply

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The guide addresses the population of females between the ages of 9 and 13 and the others between the 19 and 26 years (Saslo et al., 2016). The two populations have different treatments. The other population that the guide focuses on is the vaccination of males between 11 and 12, and also the males from 13 through 26 years.

4. The guideline development group includes individuals from all relevant professional groups.

The development of this guideline includes professions from pediatric care, family care, obstetricians, and gynecologists. These professionals are recognized in need of improving the HPV vaccination guideline to achieve the expected value and consistency in the efforts of immunization as an essential strategy for preventing cancer.

5. The views and preferences of the target population (patients, public, etc.)

The preferences of the public and patients were incorporated in the guideline through control trials. A formal systemic review was conducted to make the recommendations of ACS evidence-based. The experiments were carried out by the manufactures of vaccines to evaluate its efficacy.

6. The target users of the guideline are clearly defined.

The target users of the vaccine were females between 9 and 11 years. Older females were not included because age increases the likelihood of the number of sexual partners and greater exposure to HPV. This would alter the results of the controlled trials.

7. Systematic methods were used to search for evidence.

The systemic method that was used in searching for evidence is randomized controlled trials. They were rolled out by manufacturers of vaccines. Literature reviews were also conducted to explore the available evidence on the outcomes of HPV vaccination (Supplemental Evidence Review, 2016). It involved a PubMed search for 4091 articles, and 338 were found to be relevant for the study.

8. The criteria for selecting the evidence are clearly described

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Criteria for selecting evidence included the use of specific search terms such as HPV vaccine efficacy. Evidence that lacked abstract or was written in another language apart from English were excluded. The evidence was categorized as either important or critical, where all the selected evidence listed.

9. The strengths and limitations of the body of evidence are clearly described.

The body of evidence has strength of well-presented methods of development in tables using suitable methods. However, there is a weakness of documentation that was not provided. It was required to demonstrate that the systemic review of the evidence was carried out.

10. The methods for formulating the recommendations are clearly described

The methodology of formulating the recommendations entailed the process of approval for the update of the HPV vaccine (Saslo et al., 2016). It entailed the examination of the methodology of recommendations and a review of supplemental evidence.

The content was examined by ACS GDG 4 upon where there were approval and development of statements of endorsement. Experts of advisors were engaged in the review of evidence and, finally, approved by the ACS Board of Directors.

11. The health benefits, side effects, and risks have been considered in

formulating the recommendations.

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The formulation of the recommendation has the health benefits of preventing incidences of cancer, morbidity, and mortality in both females and males. The vaccination has non-serious side effects. A risk that is associated with the formulation of this vaccine is that its efficacy reduces as the age advances.

12. There is an explicit link between the recommendations and evidence.

The literature review sufficiently supports the recommendation. The support also comes from new data on the outcome of the population. The evidence reinforces the ACIP recommendations, which qualified the one statement that is linked to late vaccination.

13. The guideline has been externally reviewed by experts prior to its publication.

Teams of experts sufficiently reviewed the guideline before its publication. This was done through the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. A team of expert advisors was engaged in the review of the report that was later approved by a Board of Directors.

14. A procedure for updating the guideline is provided.

The procedure for updating the recommendation includes the use of a bivalent (2vHPV) vaccine for females. It involves the guidance of 4vHPV that can be given to males aged 9 and 26 years. The recommendations are based on a review of data on the efficacy of the vaccine.

15. The recommendations are specific and unambiguous

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The recommendations are specific because ACIP identifies the problem that needs to be remedy (cancer and genital warts). It specifies the category of the population that needs to be vaccinated. It is the category of women between 9 through 26 years as well as males aged in the same age group.

16. The different options for management of the condition or health issue are

The recommendation outlines the first option as immunization of females between the age of eleven and twelve years and a catch-up for the ones aged thirteen to twenty-six with quadrivalent HPV. The second option is the use of the bivalent vaccine (2vHPV) and 4vHPV to males aged nine up to 26 years (Supplemental Evidence Review, 2016).

The third recommendation is –valent vaccine (9vHPV) that is based on clinical trials and their efficacies. The recommendation also focuses on a special population like gays and children that are previously exposed to sexual abuse.

17. Key recommendations are easily identifiable.

The guideline recommends that HPV vaccination to females aged 19 through 26 to make the population derive partial benefits since its effectiveness decrease with older age (Saslo et al., 2016). Just like females, males between the ages of 9 through 26 should be vaccinated to protect them from HPV and the associated cancers such as oropharyngeal cancer.

ACIP recommendation on 9-valent HPV suggests that it has comparable safety, efficacy, and immunogenicity with the quadrivalent vaccine.

18. The guideline describes facilitators and barriers to its application.

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The guideline recommends that HPV vaccination to females aged 19 through 26 to make the population derive partial benefits since its effectiveness decrease with older age (Saslo et al., 2016). Just like females, males between the ages of 9 through 26 should be vaccinated to protect them from HPV and the associated cancers such as oropharyngeal cancer.

ACIP recommendation on 9-valent HPV suggests that it has comparable safety, efficacy, and immunogenicity with the quadrivalent vaccine.

19. The guideline provides advice and/or tools

The proposed guideline for implementation of the recommendations is prioritizing on nationwide vaccination. The health care teams in the nation should collaborate with the care systems to improve the education and awareness of the providers. This strategy is expected to increase the system-wide practices that can increase the rate of the vaccine. The focus should be on health systems for both the federal and local governments.

20. The potential resource implications of applying the recommendations

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The potential resource implications for the recommendations are based on the cooperation of the state and federal governments (Saslo et al., 2016). The guideline places the burden of implementation resources on these two institutions through funding vaccine programs. The resources should be channeled to the healthcare systems to increase the scope of HPV vaccination.

21. The guideline presents monitoring and/or auditing criteria.

The monitoring guidelines that are outlined include the evaluation of data to inform future changes. The other outlined strategy is increasing in the screening of women for HPV. The result will be a reduction in tens of thousands of cervical, vulvar, and vaginal cancer cases in females as well as the pre-cancers that are associated with morbidity.

22. The views of the funding body have not influenced the content of the guideline.

The guideline was funded by the American Cancer Society, which is again supported by the CDC and Public Health Fund. These financiers aim to promote public health through various strategies, among them being funding scholars and institutions for independent research (Saslo et al., 2016). Therefore, the development of this guideline is not influenced by the funding agencies.

23. Competing interests of guideline development group members have been recorded

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The guideline declares conflicts of interest for transparency. Two of the authors declared being investigators of the financiers while the rest have no conflicts of interest. All the researchers were required to disclose their financial and non-financial relationships, including intellectual, practice-related, and personal interests that could be perceived as conflicts of interest.

The chairperson of ACS was given the authority to guarantee that there was a balance of opinion in decision making. This was a strategy of ensuring that the recommendation guidelines were independent.

References

Saslo, D, Andrew, S. K, Manassaram-Baptispte, Loomer, L, Lam, E. K, Fisher-Borne, M, Smith, A. R, & Fontham, H. T. E. (2016). Human papillomavirus vaccination guideline update: American Cancer Society guideline endorsement. 66(5): 375–385. doi:10.3322/caac.21355

Supplemental Evidence Review. (2016). HPV vaccination guideline update: American Cancer Society guideline endorsement.

Explanation of Health Systematic Article Review

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