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.
Highlights
Sub-Saharan has the highest rates of cervical cancer globally[1]
Despite little prior knowledge of cervical cancer and human papillomavirus (HPV), communities were interested in receiving HPV vaccination
Given 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
Summary
Sub-Saharan has the highest rates of cervical cancer globally[1]. Successful delivery of human papillomavirus (HPV) vaccination to prevent the disease has been pilot tested in several subSaharan African countries including Uganda and Tanzania, where over 80% of eligible primary school girls received three doses of the vaccine[2,3]. Without targeted and focused interventions for hard-to-reach populations, it is likely that many individuals who suffer the highest burden of cervical cancer and who have least access to cervical screening programmes will fail to receive the benefits of HPV vaccination. These hard-to-reach populations are likely to comprise girls who never go to school, who drop out of primary school early, or who are frequently absent from school. This includes many girls living in informal settlements (slums) in large cities.
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