Multi-level school-based intervention to improve HPV vaccine uptake and completion in South Africa

以学校为基础的多层次干预措施提高南非 HPV 疫苗的接种率和完成率

• 批准号: 10730916
• 负责人: Lisa Michelle Butler
• 金额: $ 33.97万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-07 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10730916
• 关键词: Address; Administrator; Adolescent; Age; Anogenital cancer; Area; Cancer Control; Cancer Etiology; Caring; Charge; Child; Clinical Trials; Communication; Communities; Consult; Decision Making; Dose; Drops; Educational Curriculum; Effectiveness; Eligibility Determination; Enrollment; Ensure; Epidemic; Evaluation; Exposure to; Female; Focus Groups; Gender; Goals; Government; Grant; HIV; Health; Health behavior; Healthcare; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Human Resources; Hybrids; Immunization; Immunization Programs; Income; Individual; Influentials; Institution; Interruption; Intervention; Interview; Link; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measures; Medical; Methods; Misinformation; Nurses; Ownership; Parents; Participant; Phase; Population Heterogeneity; Preparation; Prevention; Questionnaires; Randomized; Randomized, Controlled Trials; Research; Research Personnel; Resource-limited setting; Sampling; School-Age Population; Schools; Sexually Transmitted Diseases; South Africa; South African; Structure; Students; System; Testing; United States; Vaccinated; Vaccines; Voice; Vulnerable Populations; Woman; acceptability and feasibility; boys; cancer prevention; civil society; community engagement; coronavirus disease; design; effectiveness evaluation; elementary school; feasibility trial; fifth grade; girls; health communication; health equity; hybrid type 2 trial; improved; learning materials; malignant oropharynx neoplasm; mortality; programs; recruit; school health; sexual debut; social media; study population; teacher; trial planning; uptake; urban setting; vaccination strategy; vaccine acceptance; vaccine hesitancy; working group; young woman

PROJECT SUMMARY Human Papillomavirus (HPV) is the most common sexually transmitted infection globally, and is causally linked to cervical, anogenital, and oropharyngeal cancers. HPV-associated cancers have a disproportionate impact in low-resource settings and nowhere is this evident than in South Africa, which has a uniquely vulnerable population due to the convergence of the largest HIV epidemic globally, with HPV rates of up to 85% in young women under the age of 25. Cervical cancer is the leading cause of cancer-related mortality among women in South Africa. In 2014, the South African National Department of Health implemented a national, school-based HPV immunization program. Despite a promising start, vaccine coverage and dose completion rates dropped precipitously after 2014, with only 37% of girls receiving their first dose in 2021. Recent declines have been attributed to COVID-related program interruptions, increased medical mistrust, and vaccine hesitancy related to misinformation spread on social media. There are additional critical gaps in care – specifically boys who are ineligible for this program, as well as adolescents outside the public school system. There is an urgent need to identify effective, replicable, and scalable strategies to optimize HPV vaccine uptake and completion in school-age children. The overall objective of the proposed R34 is to refine and evaluate a school-based multi-level communications strategy that addresses intrapersonal, interpersonal, and institutional factors associated with HPV vaccine uptake and completion amongst fifth graders, as part of a pilot feasibility trial. The proposed study is led by investigators from the United States and South Africa in partnership with the Department of Health and elementary schools in an urban setting with high burden of HPV vaccine preventable cancers in KwaZulu Natal, South African. The project builds upon our team’s expertise in HPV prevention, vaccine decision making, health communications, participatory design, and community engagement to pursue the following Specific Aims. (1) To refine components of a school-based multi-level communication strategy to improve HPV vaccine uptake and completion among girls and boys, and (2) To evaluate preliminary effects of the communications strategy and key criteria to advance to a full- scale hybrid type 2 trial. Our systems-focused approach leverages established partnerships with area schools serving diverse populations who are not always effectively served by traditional healthcare channels. We will ensure health equity is at the core of our research integrating the voices of individuals living in low- resource settings to understand and reduce the barriers to HPV vaccine initiation and completion. This proposal is responsive to NCI’s call for cancer prevention and control clinical trials planning grants (PAR-22- 173) both in its active stakeholder engagement, and its focus on engaging a diverse, scientifically appropriate study population.

项目摘要 人乳头瘤病毒（HPV）是全球最常见的性传播感染，是因果 与宫颈，肛门生殖器和口咽癌有关。 HPV相关的癌症的比例不成比例 在低资源环境中的影响，而没有在南非的证据，而南非具有独特 由于全球最大的艾滋病毒流行病的融合，易受伤害的人口，HPV率最高 25岁以下的年轻妇女中有85％。宫颈癌是与癌症相关死亡率的主要原因 在南非的妇女中。 2014年，南非国家卫生部实施了 国家基于学校的HPV免疫计划。尽管有希望开始，疫苗覆盖和剂量 完成率在2014年之后恰好下降，只有37％的女孩在2021年接受了首次剂量。 最近的下降归因于与共同相关的计划中断，医疗不信任的增加以及 与错误信息有关的疫苗犹豫不决在社交媒体上传播。护理中还有其他关键差距 - 特别是没有资格参加该计划的男孩以及公立学校系统以外的青少年。 迫切需要确定有效，可复制和可扩展的策略以优化HPV疫苗 学龄儿童的吸收和完成。提议的R34的总体目标是完善和 评估一种基于学校的多层次通信策略，该策略涉及人际关系，人际关系和 作为飞行员的一部分，与HPV疫苗的吸收和完成相关的机构因​​素 可行性试验。拟议的研究由美国和南非的调查人员领导 与卫生和小学系在城市环境中的合作伙伴关系，HPV高燃烧 南非夸祖鲁·纳塔尔（Kwazulu Natal）的疫苗可预防的癌症。该项目以我们团队的专业知识为基础 HPV预防，疫苗决策，健康通信，参与设计和社区 参与追求以下特定目标。 （1）完善基于学校的多层次的组件 沟通策略以改善男孩和男孩的HPV疫苗的摄取和完成，以及（2） 评估通信策略和关键标准的初步影响，以促进完整的 比例混合2型试验。我们以系统为中心的方法利用与地区建立了合作伙伴关系 为潜水人群提供服务的学校并不总是由传统医疗渠道有效地服务。 我们将确保健康公平是我们研究的核心 资源设置以了解和减少HPV疫苗计划和完成的障碍。这 提案对NCI呼吁进行癌症预防和控制临床试验的呼吁有反应（PAR-22- 173）既有其积极的利益相关者参与，又专注于与潜水员进行科学合适的潜水员 研究人群。