Human Papillomavirus Vaccine Integrated Service Implementation Research in Cameroon

Introduction Cervical cancer is a leading cause of cancer among women in Cameroon. Vaccinating very young adolescent girls and boys is the most effective long-term strategy to reduce its risk. Despite the introduction of the human papillomavirus (HPV) vaccine in Cameroon in 2020, the vaccination program has faced substantial challenges, including widespread vaccine hesitancy and low awareness of the vaccine. As a result, an initial approach focusing on school-based vaccination was shifted to routine, health facility-based distribution. Integrating HPV vaccinations into existing health platforms that reach very young adolescents and their caregivers presents an opportunity to improve the effectiveness, acceptability, and feasibility of routine, community-based HPV vaccination in Cameroon. Implementation research is needed to evaluate the effectiveness of such integrated service delivery approaches, contributing to more effective HPV vaccine programs in Cameroon and other, similar settings.

Objectives The aim of this research project is to evaluate the effectiveness, feasibility, acceptability, and potential for scalability of integrating HPV vaccination into an existing supply- and demand-side sexual and reproductive health and rights (SRHR) intervention to increase HPV vaccine coverage among girls and boys aged 9-13 years in the North and far North regions of Cameroon. The intervention will aim to deliver HPV vaccination through integration with demand- and supply-side program interventions in addition to an existing program implemented by Population Services International-Cameroon (PSI-C) and Association Camerounaise pour le Marketing Social (ACMS): Programme d'Accès aux Services de Santé de la Reproduction (PASSR).

Specific objectives

1. To describe the barriers and facilitators affecting the implementation of HPV vaccination services for VYA girls (aged 9-13) in the North and Far North Regions of Cameroon, and to assess how these impact access and uptake of HPV vaccination.
2. To evaluate the effectiveness of integrating HPV vaccination interventions into existing supply- and demand-side SRHR programs on uptake of HPV vaccination.
3. To evaluate the effectiveness of integrating HPV vaccination interventions into existing supply- and demand-side SRHR programs on uptake of other VYA health service utilization.
4. To assess acceptability, feasibility, cost, equity, and potential for maintenance and scale of HPV vaccination for adolescent girls integrated into an SRHR intervention.
5. To provide evidence for policy integration of HPV vaccine in the adolescent sexual and reproductive health package at the MOH

Methods The study will be conducted in 4 intervention PASSR health districts (HDs) and 4 'standard of care' comparison HDs in the North and Far North regions of Cameroon. It will use a hybrid model of effectiveness and implementation research, with research conducted from approval until December 2025 (with the potential for ongoing data analysis, manuscript preparation, and dissemination through conferences and publications after this end date). Phase 1, the rapid formative and design phase, research activities will include interviews with key informants and secondary analysis of service statistics and program monitoring data. Key informant interview data will contribute to the development of the implementation model, which will also be informed by programmatic co-design workshops. The second phase (implementation) will include a quasi-experimental effectiveness study comparing HPV vaccine administration to girls and boys aged 9-13 years in the intervention and comparison areas, as well as implementation research activities to assess uptake, reach, implementation, activity-based costing and readiness for integration and scale-up. In addition, phase 2 will include analyses of acceptability, feasibility, and satisfaction, using data from key informant interviews; and quantitative exit interviews, focus group discussions, and qualitative in-depth interviews with girls, boys, and caregivers and health professionals. A mixed methodology, integrating quantitative and qualitative research methods, will be used.