Advancing Cancer Control for Health and Value

The Advancing Cancer Control for Health and Value (ACCHV) project is implemented by The African Population and Health Research Center (APHRC), New York University, Innovation for Poverty Action (IPA), and Kenya Medical Research Institute (KEMRI). The project is working with collaborators from the University of California, Los Angeles (UCLA), the University of Southern California, and Kamuzu University of Health. The project is funded by the US National Institutes of Health/National Cancer Institute (Award No. R37CA272664). It is being implemented in Kenya and Malawi. Both countries have experience delivering the Human Papillomavirus( HPV) vaccine through health facilities and schools, which are the predominant modalities in Africa and worldwide. The project aims to collect and use primary and secondary data from Kenya and Malawi to identify the factors most strongly associated with HPV vaccine uptake and motivation to vaccinate, and explore which interventions may most effectively increase population-level HPV vaccine coverage in these countries.

The African Population and Health Research Center (APHRC) is leading Aim 1 and the knowledge translation aspects of this project. In Aim 1, APHRC is implementing a qualitative design to understand the policy, systems, and community-level context for HPV vaccine delivery. The first approach is to conduct key informant interviews with stakeholders and decision-makers working on cervical cancer prevention and control, and HPV vaccine implementation to understand the context of HPV vaccine delivery. The second approach, which focuses on the policy context, involves reviewing the policy and program implementation documents in Kenya and Malawi to understand how they inform HPV vaccine delivery and the prevention and control of cervical cancer.

Project Goal and Objectives

Goal: This proposed study seeks to identify areas where future interventions may be best targeted to address the specific barriers limiting HPV vaccine coverage in these countries.

Specifically, the project seeks to achieve the following objectives;

• Aim 1: Characterize the context for HPV vaccine delivery at the policy, systems, and community levels through mixed-methods data collection.
• Aim 2: Assess multi-level influences on HPV vaccine uptake, and on parents’ motivation to vaccinate age-eligible girls.
• Aim 3: Explore the potential impact of approaches to increase population-level HPV vaccine coverage among girls using agent-based modeling.

Methodology

This study is a mixed-methods, multi-country research project aimed at identifying barriers to HPV vaccine uptake and evaluating potential intervention strategies in Kenya and Malawi. The study incorporates both qualitative and quantitative approaches to address the research objectives across three aims. The qualitative design (Aim 1) will explore the policy, systems, and community-level context for HPV vaccine delivery by collecting primary and secondary data (key informant interviews with stakeholders and content analysis of policy and program implementation documents. A quantitative, cross-sectional design will assess multi-level factors influencing HPV vaccine uptake and parental motivation to vaccinate (Aim 2). Surveys will be conducted with parents/guardians of girls aged 9–13 in Malawi and 10–13 in Kenya using random-digit dialing. The agent-based modeling (Aim3) is an innovative component that will use computational modeling to simulate the potential impact of different intervention strategies on increasing HPV vaccine coverage, without a specific geographic focus. The model will leverage data from Aims 1 and 2 to explore how modifying multi-level factors—environmental, systemic, community, and parental—could influence population-level vaccination outcomes. While not a perfect representation of reality, this approach offers a powerful means to guide intervention design by estimating the effectiveness of different strategies and identifying high-yield targets for policy making.

Project Period

• Start Date: June 1, 2024
• End Date: May 31, 2029

Background

Cervical cancer remains a leading cause of death for women in low- and middle-income countries (LMICs), claiming over 300,000 lives annually. Persistent infection with high-risk strains of the Human Papillomavirus (HPV), a common sexually transmitted disease, primarily causes cervical cancer. While most HPV infections clear spontaneously, types 16 and 18 can lead to cervical cancer and other, less common cancers. Because HPV is asymptomatic, many people do not detect their infections, which prevents early intervention and allows the disease to progress.

Profound inequity defines the burden of cervical cancer, with the highest incidence and mortality rates in sub-Saharan Africa. Kenya and Malawi exemplify this crisis. The Global Cancer Observatory 2022 report put the number of new cervical cancer cases at 44,726 and 19,846 in Kenya and Malawi, respectively. HPV vaccination offers a safe and effective primary prevention strategy. Administering the vaccine to adolescents before sexual debut can dramatically reduce future cervical cancer incidence. As a result, both Kenya and Malawi launched national HPV vaccination programs for adolescent girls in 2019, targeting girls aged 9–13.

However, low uptake hampers the promise of vaccination. Coverage in both countries remains far below the WHO target of 90%, with rates of 60% in Kenya and 89% in Malawi by 2023. Low routine cervical cancer screening coverage underscores the importance of high vaccination coverage. A critical evidence gap stands as a significant barrier to improving uptake. Researchers have primarily studied HPV vaccination drivers in high-income countries; however, there is a limited understanding of the complex, multi-level factors—ranging from government policies and delivery systems (such as school- or facility-based) to individual knowledge and social norms—that shape vaccine acceptance in high-burden African contexts.

Therefore, this project aims to investigate the determinants of HPV vaccine uptake in Kenya and Malawi. By identifying key barriers and facilitators across different levels, this research will provide the evidence needed to inform effective, context-specific interventions and strengthen national cancer control programs.

Project Team

• Corrina Moucheraud – Principal Investigator (PI), New York University
• Lynette Kamau – Co-principal investigator (Co-PI), APHRC
• Ramatou Ouedraogo – Co-principal investigator (Co-PI), APHRC
• Erick Muge, APHRC – Role
• Cynthia Kairu, APHRC – Role
• Mauline Onyancha, APHRC – Role

Partners

• New York University (NYU)
• Innovation for Poverty Action (IPA)
• Kenya Medical Research Institute (KEMRI)
• University of California, Los Angeles (UCLA)
• University of Southern California
• Kamuzu University of Health

Funder

US National Institutes of Health/National Cancer Institute

Acknowledgement

APHRC acknowledges financial support from the United States (US) National Institutes of Health/National Cancer Institute as part of the “Advancing cancer control for health and value” project (Award No. R37CA272664).