Since the approval and introduction of human papillomavirus (HPV) vaccines in 2006, the burden of new cervical cancer cases has steadily grown in low- and middle-income countries (LMIC). A 2016 study estimated that only 1% of women receiving the HPV vaccine worldwide were from LMICs and that as of 2020, the majority of the 604,000 new cervical cancer cases in the world occurred in LMICs. At this time, the Nepal Ministry of Health and Population (MOHP), Family Welfare Division is planning to apply to GAVI in September 2022 to initiate the introduction of HPV into the national immunization plan. It is anticipated that in mid-to-late 2023 HPV introduction will start in 8 to 12 districts and then move to national coverage.
In Nepal, cervical cancer is the most frequently diagnosed cancer among women and contributes to the highest number of cancer-related mortalities in the country. Limited data are available regarding women’s utilization of cervical cancer screening in Nepal, however one study suggests that only 15% of women surveyed had been screened. The Nepal government has prioritized cervical cancer screening as a free-of-cost priority program; however, multiple socio-cultural and economic factors affect screening including lack of knowledge about cervical cancer both within the healthcare professions and general population, social taboos regarding discussion of sexual and reproductive health, and limited laboratory facilities.
The proposed study is designed to adapt/develop a context-driven strategy to decrease risks of HPV infection and cervical cancer in Nepal through an integrated vaccination and cervical cancer screening campaign. The program will implement a cross-generational approach to encourage vaccination of young girls and screening of their mothers, aunts, grandmothers and other women in the communities. The key objectives are: 1) Assess policy and programmatic, health system, and community factors that affect intention to uptake HPV vaccines for girls ages 9 to 14 and use of cervical cancer screening services among women 30 to 60 years old. 2) Utilize data to adapt/develop: i) a healthcare provider training program in relation to HPV vaccine and cervical cancer screening; and, ii) a cross-generational comprehensive social mobilization and communication strategy to support HPV vaccine uptake and cervical cancer screening. 3) Implement and conduct a randomized control trial of the healthcare provider and community interventions during the initial roll out of HPV vaccines in selected districts. 4) Engage with policy makers, program managers, health care providers and community members (parents/adolescents) through scientific and community advisory boards (SAB/CABs) and a post-project dissemination workshop