Project Grant R37CA272664

IDENTIFYING MODIFIABLE MULTI-LEVEL FACTORS ASSOCIATED WITH HPV VACCINE UPTAKE IN KENYA AND MALAWI - PROJECT SUMMARY/ABSTRACT CERVICAL CANCER BURDEN FALLS DISPROPORTIONATELY ON WOMEN IN LOW- AND MIDDLE-INCOME COUNTRIES. ACHIEVING CERVICAL CANCER ELIMINATION IN THESE HIGH-BURDEN SETTINGS WILL REQUIRE HIGH COVERAGE OF HPV VACCINATION. TO THIS END, MANY AFRICAN COUNTRIES HAVE INTRODUCED THE HPV VACCINE IN NATIONAL PROGRAMS THAT OFFER THE VACCINE FOR FREE TO PREADOLESCENT GIRLS. HOWEVER, UPTAKE IN THE REGION IS LOW AND CORRELATES OF UPTAKE ARE UNDER-STUDIED. THIS PROJECT AIMS TO (A) COLLECT PRIMARY (QUALITATIVE AND QUANTITATIVE) AND SECONDARY (QUANTITATIVE) DATA IN KENYA AND MALAWI ABOUT FACTORS HYPOTHESIZED TO AFFECT HPV VACCINE UPTAKE AT THE ENVIRONMENTAL/POLICY, SYSTEMS, COMMUNITY, AND INDIVIDUAL LEVELS; AND USE THESE DATA IN (B) MULTI-LEVEL MODELING TO IDENTIFY WHAT IS MOST STRONGLY ASSOCIATED WITH HPV VACCINE UPTAKE AND MOTIVATION TO VACCINATE, AND (C) AGENT-BASED MODELS TO EXPLORE WHAT INTERVENTIONS MAY BE MOST EFFECTIVE AT INCREASING POPULATION-LEVEL COVERAGE OF HPV VACCINE IN THESE COUNTRIES. KENYA AND MALAWI WERE SELECTED FOR THIS STUDY DUE TO THEIR HIGH CERVICAL CANCER BURDEN, AND EXPERIENCE WITH DIFFERENT VACCINE DELIVERY SETTINGS IN THEIR NATIONAL HPV VACCINATION PROGRAMS: KENYA OFFERS THE VACCINE AT HEALTH FACILITIES, WHILE MALAWI HAS USED SCHOOL-BASED CAMPAIGNS PLUS HEALTH FACILITY-BASED DELIVERY. THE ANALYSES WILL THEREFORE OFFER "CASE STUDIES" FOR OTHER COUNTRIES USING OR CONSIDERING THESE DIFFERENT APPROACHES. TO OUR KNOWLEDGE, THIS WOULD BE THE FIRST STUDY TO SURVEY A LARGE SAMPLE OF RANDOMLY-SELECTED AFRICAN PARENTS (N=3000 IN EACH COUNTRY) ABOUT THE FACTORS ASSOCIATED WITH THEIR DAUGHTER'S HPV VACCINATION STATUS; AND THE FIRST TO SYSTEMATICALLY COLLECT AND ANALYZE DATA ON MULTI-LEVEL FACTORS ASSOCIATED WITH HPV VACCINATION AND MOTIVATION, E.G. THE POLICY SPACE, THE HEALTH SYSTEM AND VACCINE DELIVERY CONTEXT, AND SOCIAL COMMUNITIES. THE PROJECT WILL LEVERAGE RESEARCH PARTNERSHIPS BETWEEN NYU AND: APHRC (AN AFRICAN RESEARCH AND POLICY INSTITUTE), IPA (WHICH HAS EXTENSIVE EXPERIENCE COLLECTING DATA IN LOW-RESOURCE SETTINGS), UCLA (HPV VACCINATION AND MULTI-LEVEL RESEARCH EXPERTISE), AND USC (SPECIFICALLY AROUND SIMULATION MODELING FOR HEALTH OUTCOMES). THERE IS ALSO LOCAL EXPERTISE FROM BOTH KENYA AND MALAWI, AND A TEAM OF EXPERTS ON ALL FACETS OF THE STUDY. MULTI-LEVEL ANALYSES THAT INCLUDE NEW PRIMARY AND SECONDARY DATA ABOUT CORRELATES OF HPV VACCINE UPTAKE ARE NECESSARY IN ORDER TO DEVELOP TARGETED, COMPREHENSIVE, CONTEXT-SPECIFIC STRATEGIES THAT WILL INCREASE HPV VACCINATION, IMPROVE HEALTH OUTCOMES AND ULTIMATELY ACHIEVE CERVICAL CANCER ELIMINATION. AS CERVICAL CANCER IS A MAJOR CAUSE OF MORBIDITY AND MORTALITY IN MANY COUNTRIES, AND AS VACCINATION UPTAKE IS AN INCREASING CHALLENGE WORLDWIDE ESPECIALLY IN DIVERSE POPULATIONS, THIS STUDY MAY INFORM PRACTICE AND POLICY IN OTHER SETTINGS.