||1R56CA272664-01 Interpret this number
||University Of California Los Angeles
||Identifying Modifiable Multi-Level Factors Associated with HPV Vaccine Uptake in Kenya and Malawi
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 vaccination status, 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 the use of different vaccine delivery settings
in their national HPV vaccination programs: Kenya offers the vaccine at health facilities, while Malawi relies
primarily on school-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, e.g. the policy
space, the health system and vaccine delivery context, and social communities.
The project will leverage existing research partnerships between UCLA and: AFIDEP (an African research and
policy institute), Innovations for Poverty Action (which has extensive experience collecting data in low-resource
settings), and University of Southern California (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
vaccine uptake, improve health outcomes and ultimately achieve cervical cancer elimination. As cervical cancer
is a major challenge in many low-income countries, and as vaccination uptake is an increasing challenge
worldwide especially in diverse populations, this study may inform practice and policy in other settings.