Access and Attitudes to HPV Vaccination amongst Hard-To-Reach Populations in Kenya

Abstract

BackgroundSub-Saharan Africa bears the greatest burden of cervical cancer. Human papillomavirus (HPV) vaccination programmes to prevent the disease will need to reach vulnerable girls who may not be able access health and screening services in the future. We conducted formative research on facilitators and barriers to HPV vaccination and potential acceptability of a future HPV vaccination programme amongst girls living in hard-to-reach populations in Kenya.MethodsStakeholder interviews with Ministry of Health staff explored barriers to and support for the uptake of HPV vaccination. A situation assessment was conducted to assess community services in Maasai nomadic pastoralist communities in Kajiado County and in Korogocho informal settlement in Nairobi city, followed by focus group discussions (n=14) and semi-structured interviews (n=28) with health workers, parents, youth, and community and religious leaders. These covered marriage, knowledge of cervical cancer and HPV, factors that might inhibit or support HPV vaccine uptake and intention to accept HPV vaccine if a programme was in place.ResultsReported challenges to an HPV vaccination programme included school absenteeism and drop-out, early age of sex and marriage, lack of parental support, population mobility and distance from services. Despite little prior knowledge of cervical cancer and HPV, communities were interested in receiving HPV vaccination. Adequate social mobilisation and school-based vaccination, supplemented by out-reach activities, were considered important facilitating factors to achieve high coverage. There was some support for a campaign approach to vaccine delivery.ConclusionsGiven the high level of support for a vaccine against cervical cancer and the experience of reaching pastoralist and slum-dwellers for other immunizations, implementing an HPV vaccine programme should be feasible in such hard-to-reach communities. This may require additional delivery strategies in addition to the standard school-based delivery, with vaccine offered at multiple venues, potentially through a campaign approach.

Association Between Individual and Intimate Partner Factors and Cervical Cancer Screening in Kenya

“…Kenyan national guidelines recommend screening women aged 25 to 49 and women younger than 25 who are at high risk for cervical cancer (6). However, despite the availability of screening options and national efforts to increase screening, use of cervical cancer screening services remains low in Kenya, with the lowest rates among rural women and those belonging to nomadic livestock-herding tribes (7–9). Concurrently, Kenya has experienced an increase in cervical cancer cases, from 2,454 in 2012 to 4,802 (crude incidence rate = 22.4) in 2016.…”

Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries

“…Previous studies have evaluated HPV vaccination acceptability in parents of eligible adolescents and health care providers [5,20–23]. However, to our knowledge, no research study has assessed provider and maternal perceptions of a 2-versus 3-dose HPV vaccination schedule across countries using a standardized questionnaire.…”

Lessons from the first clinical trial of a non-licensed vaccine among Ugandan adolescents: a phase II field trial of the tuberculosis candidate vaccine, MVA85A

“…As reported by other African research sites 21, 32, 33 , we did not have locally applicable ‘normal’ reference ranges for laboratory tests of this adolescent population. Published reference ranges are usually based on Western populations.…”