Prevention of Cervical Cancer in Sub-Saharan Africa: The Advantages and Challenges of HPV Vaccination.

Eleanor Black,Robyn Richmond

doi:10.3390/vaccines6030061

Abstract

Cervical cancer is a critical public health issue in sub-Saharan Africa (SSA), where it is the second leading cause of cancer among women and the leading cause of female cancer deaths. Incidence and mortality rates are substantially higher than in high-income countries with population-based screening programs, yet implementing screening programs in SSA has so far proven to be challenging due to financial, logistical, and sociocultural factors. Human Papillomavirus (HPV) vaccination is an effective approach for primary prevention of cervical cancer and presents an opportunity to reduce the burden from cervical cancer in SSA. With a number of SSA countries now eligible for Global Alliance for Vaccines and Immunization (GAVI) support for vaccine introduction, it is timely to consider the factors that impede and facilitate implementation of vaccine programs in SSA. This article describes epidemiological features of cervical cancer in SSA and the current status of HPV vaccine implementation in SSA countries. Rwanda’s experience of achieving high vaccination coverage in their national HPV immunization program is used as a case study to explore effective approaches to the design and implementation of HPV vaccination programs in SSA. Key factors in Rwanda’s successful implementation included government ownership and support for the program, school-based delivery, social mobilization, and strategies for reaching out-of-school girls. These findings might usefully be applied to other SSA countries planning for HPV vaccination.

Highlights

Cervical cancer is a major cause of morbidity and mortality in sub-Saharan Africa (SSA), where the burden from noncommunicable diseases is increasing due in large part to improved control of communicable diseases and an ageing population [1]
We describe the significant burden from cervical cancer in SSA and the role for Human Papillomavirus (HPV) vaccination
We summarize the current status of pilot and national HPV

Summary

Introduction

Cervical cancer is a major cause of morbidity and mortality in sub-Saharan Africa (SSA), where the burden from noncommunicable diseases is increasing due in large part to improved control of communicable diseases and an ageing population [1]. Incidence and mortality rates for cervical cancer are extremely high in SSA [2], reflecting disparities in the effectiveness of prevention and control strategies in high-income versus low- and middle-income countries (LMICs). While high-income countries have been able to implement and sustain population-based screening programs with high population coverage, screening has been less effective in SSA due to financial, logistical, and sociocultural barriers [3]. The introduction of the Human Papillomavirus (HPV) vaccine has allowed for effective primary prevention of cervical cancer and has already demonstrated important impacts on reducing incidence in high-income countries [3,4]. We summarize the current status of pilot and national HPV vaccination programs in SSA countries, and the challenges to successful implementation. Factors that have facilitated some countries, such as Rwanda, to overcome these challenges and achieve high

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