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.

项目概要 人乳头瘤病毒 (HPV) 是全球最常见的性传播感染，并且与 与宫颈癌、肛门生殖器癌和口咽癌相关的 HPV 相关癌症的比例不成比例。 南非对资源匮乏地区的影响最为明显，南非拥有独特的 由于全球最大规模的艾滋病毒流行，HPV 感染率高达 85% 为 25 岁以下的年轻女性。宫颈癌是癌症相关死亡的主要原因 2014 年，南非国家卫生部实施了一项针对南非妇女的政策。 全国性、以学校为基础的 HPV 免疫计划尽管起步良好，但疫苗覆盖范围和剂量仍然有限。 2014 年之后，完成率急剧下降，只有 37% 的女孩在 2021 年接受了第一剂疫苗。 最近的下降归因于与新冠病毒相关的计划中断、医疗不信任的增加以及 与社交媒体上传播的错误信息有关的疫苗犹豫还有护理方面的其他关键差距 - 特别是没有资格参加该计划的男孩，以及公立学校系统之外的青少年。 迫切需要确定有效、可复制和可扩展的策略来优化 HPV 疫苗 学龄儿童的吸收和完成 拟议 R34 的总体目标是完善和完成。 评估基于学校的多层次沟通策略，该策略涉及个人内部、人际交往和 作为试点的一部分，与五年级学生接种和完成 HPV 疫苗相关的制度因素 拟议的研究由来自美国和南非的研究人员领导。 在 HPV 负担较高的城市环境中与卫生部和小学建立伙伴关系 该项目建立在我们团队在南非夸祖鲁纳塔尔省的疫苗可预防癌症的专业知识之上。 HPV 预防、疫苗决策、健康传播、参与式设计和社区 （一）细化校本多层次内容 改善女孩和男孩 HPV 疫苗接种和完成的沟通策略，以及 (2) 评估传播策略的初步效果和关键标准，以推进全面传播 我们以系统为中心的方法利用了与地区建立的合作伙伴关系。 为不同人群提供服务的学校，这些人群并不总是能通过传统医疗保健渠道得到有效服务。 我们将确保健康公平是我们研究的核心，整合生活在低收入国家的个人的声音 资源设置，以了解并减少 HPV 疫苗启动和完成的障碍。 该提案是响应 NCI 的癌症预防和控制临床试验规划拨款 (PAR-22- 173）既体现在其积极的利益相关者参与，也体现在关注多元化、科学上适当的 研究人群。