A Mentored Research Experience in Investigating the Socio-geographic Expansion to Liberia of a Novel Campaign-based Public Health Approach to Cervical Cancer Prevention

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This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 23-038. Women in sub-Saharan Africa bear the greatest burden of cervical cancer in the world, and the reasons are clear: lack of HPV vaccination, screening for pre-cancer, and treatment. In recognition of the global disparities surrounding cervical cancer and that preventive solutions exist, the WHO has adopted a global strategy for cervical cancer elimination. It calls for 90% vaccination coverage, 70% screening coverage, and treatment of 90% of those with cervical disease. Lacking in this strategy, however, is a clear path to implementation. Furthermore, a shortage in the research workforce in areas most affected, such as sub-Saharan Africa, hinders the ability for context-specific evidence to be generated to reduce the disparities. Through parent award U54 CA254571, we have developed in East Africa what we call a campaign-based public health approach to address gaps in the implementation of preventive interventions for cervical cancer control. Our approach features Community Health Worker-led mobilization of eligible community members to attend local Health Fairs at which HPV vaccination and HPV-based cervical cancer screening (via self- collection) are offered, followed by ablative therapy for those found to be HPV-infected by a Mobile Treatment Team at a convenient central site in the community. In Kenya and Uganda, these community-based campaigns have been well-attended and well-accepted. NOT-CA-23-038 is a well-timed opportunity for us to expand our work in East Africa to another resource-limited socio-geographic context — Liberia, in West Africa — while concurrently providing a research practicum for an early-stage low- and middle-income country (LMIC) investigator (ESLI) from Liberia. Accordingly, our specific aims are to: Aim 1: Evaluate the uptake and acceptability of HPV vaccination and cervical cancer screening offered through a campaign-based public health approach to cervical cancer control in Liberia. Aim 2: Determine the factors explaining non-participation in either community-based HPV vaccination among adolescent girls or in cervical cancer screening among women in Liberia. Aim 3: Provide a mentored career development experience for Dr. Cozie Gwaikolo, a Liberian ESLI. To address our aims, we will evaluate a community-based integrated cervical cancer vaccination and screening program (developed in parent grant U54 CA254571), which will be implemented by our Ministry of Health (MOH) partners in Liberia. Evaluation will include assessment of acceptability and follow-up among Health Fair attendees as well as a population-based door-to-door community survey after completion of the campaign, which will determine uptake of the program and reasons for non-participation. Findings from this work may form a blueprint for the ultimate elimination of cervical cancer in the region. Finally, the project is an incomparable opportunity for Dr. Gwaikolo in his quest to become an independent principal investigator.