IMPROVE-HPV

The challenge

An estimated 700,000 cervical cancer cases occur each year, leading to around 372,000 deaths. The burden of cervical cancer, which affects the lower uterus, is greatest in sub-Saharan Africa, where the incidence of the disease is twice as high as in Asia and four times as high as in North America.

The majority of cases of cervical cancer result from persistent infection with high-risk human papillomavirus (HPV). Eliminating cervical cancer as a public health problem will be heavily dependent on the use of HPV vaccines. These are being rolled out globally, with introductions being accelerated by a 2022 WHO recommendation endorsing a single dose of vaccine to girls and boys aged 20 years or younger.

However, vaccinecoverage remains suboptimal in many countries due to delivery challenges for a novel target group (pre-adolescent and adolescent girls and, in some countries, also boys) and low take-up, often related to concerns or misunderstandings about the vaccine.

The project

The IMPROVE-HPV project aims to increase HPV vaccine uptake in Nigeria and Tanzania. Tanzania has already introduced HPV vaccination and has moved from a two-dose to a single-dose schedule, while Nigeria introduced a single-dose HPV vaccine for the first time. 

Tanzania has also been piloting the use of a ‘gender-neutral’ HPV vaccination strategy – administration of the vaccine to both girls and boys. HPV infections can also have detrimental effects in men, causing around 60,000 cancers a year. In addition, vaccination of boys could reduce the levels of HPV in circulation in the population, providing additional ‘herd immunity’ to girls. It could also lead to fewer concerns about vaccination, given that administering the vaccine solely to girls is a source of vaccine hesitancy. 

The IMPROVE-HPV project is taking advantage of these national plans to organise clinical studies and consultations to gather evidence on HPV vaccination to support policymaking on vaccine use. 

The project is examining a range of HPV vaccine-delivery/provision scenarios, including the use of the two-dose schedule in girls, the introduction or switch to the single-dose approach, and a gender-neutral approach. It is conducting studies to compare vaccine effectiveness and uptake of different approaches in the two countries. 

The project is also exploring the perceptions of health workers and community members regarding different delivery strategies, including two- versus one-dose schedules and girls-only versus gender-neutral strategies. 

Impact

The IMPROVE-HPV project will generate valuable evidence on ways to enhance HPV vaccination uptake. It will:

• Demonstrate whether one- or two-dose schedules are associated with significantly higher vaccine uptake.
• Reveal whether gender-neutral strategies lead to enhanced take-up of vaccination in females.
• Shed light on other factors affecting the acceptability of HPV vaccine delivery schedules.  

Evidence generated by the IMPROVE-HPV project will enable policymakers to optimise the design of HPV vaccine programmes, to increase uptake and ensure that more women are protected against HPV infection and the development of potentially deadly cervical cancer.