Improving methods for measuring the coverage and equity of Human Papillomavirus (HPV) vaccination in Gavi Priority Countries

Project Period

November 2024 - September 2026

About the HPV-Impact project
The HPV-Impact Project is a multi-country consortium and research initiative led by the African Population and Health Research Center (APHRC) aimed at improving how countries measure HPV vaccine coverage among adolescent girls. The project is being implemented in selected Gavi priority countries, including Rwanda, Senegal, and Liberia. These countries are at different population HPV vaccine coverage levels and diverse HPV vaccine delivery systems. This research catalytic investment is co-funded by the Vaccine Alliance (Gavi) and the Gates Foundation.
Background
Human Papillomavirus and why its prevention matters?
Human Papillomavirus (HPV) is a common viral infection, primarily spread through sexual contact and often without any symptoms. Most HPV infections may clear on their own, although infections with some HPV strains, specifically HPV 16 and 18, are known to persist and cause cervical cancer in women and other cancers, though rarely, in men. Cervical cancer alone kills more than 300,000 women annually, largely in lower and middle-income countries. Because most HPV infections show no symptoms, people often don’t seek screening or early treatment for pre-cancerous conditions, allowing the virus to persist and potentially cause long-term complications. This makes prevention the most effective way to reduce the risk of infection and its complications. HPV infection can be prevented through the administration of a safe and effective HPV vaccine. While the vaccine is beneficial to both adolescent girls and boys before they become sexually active, the most benefit is among the girls, and it is for this reason that the vaccination programs target girls.

What is the problem?
Many countries’ immunization programs provide the HPV vaccine through different channels such as school-based delivery, health centres, community outreaches, and special campaigns, among others. As a result, HPV vaccination data are captured in multiple systems, and this makes it difficult to accurately understand the country’s performance in terms of coverage and equity. Because of this, monitoring countries’ progress towards the World Health Organization (WHO) global target to vaccinate 90% of girls against HPV by age 15 by 2030 is uneven and difficult to compare across the board. Administrative data are often plagued with quality concerns such as incompleteness, accuracy, lack of adequate disaggregation, and timeliness. Due to these limitations, it is challenging to rely on these data to understand coverage and equity within the program. This leaves the costly and complex household coverage surveys as the reliable approach for estimating HPV vaccination coverage. Moreover, unresolved methodological and cost challenges continue to plague the household survey methods.
To address the challenge of accurate measurement of vaccination coverage at the county level, Gavi and the Gates Foundation have partnered to provide a solid evidence base for the global measurement plan for the HPV vaccine program using Rwanda, Senegal, and Liberia as case studies.

Project Goal and Objectives
Goal: The main goal of this project is to improve the measurement of HPV vaccination coverage and equity in selected Gavi priority countries in Africa. The household survey approach will be used as the gold standard while testing the utility of using administrative data and alternative methodologies, including the costs involved.

Specifically, the project seeks to achieve the following objectives;

  • To conduct methods research to help define the optimal methodology for HPV vaccine coverage surveys,
  • To estimate household survey-derived, population-level HPV vaccination coverage rates for countries using standard survey methodology,
  • To assess equity in immunization by identifying sociodemographic characteristics of vaccinated and unvaccinated girls, and understand the behavioral and social drivers of HPV vaccination uptake among adolescent girls and their caregivers,
  • To assess the validity of administrative coverage estimates by comparing these to survey coverage estimates,
  • To generate evidence on the appropriateness of alternative, innovative data collection approaches for measuring HPV vaccine coverage and indicators that may be less expensive and/or more rapid than a full vaccine coverage cluster survey.

Methodology
The study employs a multi-method evaluation approach using data from several sources to answer the respective evaluation objectives. A specific evaluation objective might draw on data from more than one approach or data source. We are conducting literature reviews, secondary data analysis of DHSI2 data, qualitative interviews (focus group discussions and cognitive testing), household surveys, and school-based surveys.
Ultimately, we expect that findings from this project will inform improvements in the measurement for HPV vaccination coverage, and this will inform improvements in programming for equitable vaccine uptake and efficiency.

Project Period

  • Start Date: November 2024 to
  • End Date: September 2026

Members of the Consortium
The research HPV-Impact consortium is led by the African Population and Health Research Center (APHRC) and working in partnership with the ICF Macro, the University of California, San Francisco, John Hopkins University, the University of Rwanda, and the University of Liberia. In addition to delivering on the specific objectives, this undertaking also aims to build local capacity to conduct future assessments with minimal external support. We will achieve this through mentorship, joint webinars on specific topics, hands-on training on identified topics, and joint analysis and writing up of results. Other in-country collaborators include National statistics offices, Ministries of Health, and national laboratories.

Partners and funders

Partners

Project Partners Logos

Photos of the Inception Meeting held in Nairobi (9th-11th December 2024):

HPV Inception Meeting: Photo Consent Form:
Photo Consent Form- Nairobi Inception Meeting

Links to any publication/reports