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

项目摘要 人乳头瘤病毒（HPV）是全球最常见的性传播感染， 与宫颈癌肛门生殖器癌和口咽癌有关HPV相关的癌症有不成比例的 在低资源环境中的影响，这一点在南非最为明显，南非有着独特的 由于全球最大的艾滋病毒流行病的汇合， 在25岁以下的年轻女性中占85%。宫颈癌是癌症相关死亡的主要原因 在南非的女性中。2014年，南非国家卫生部实施了一项 全国学校HPV疫苗接种计划尽管有一个有希望的开始，疫苗覆盖率和剂量 完成率在2014年后急剧下降，只有37%的女孩在2021年接受了第一次注射。 最近的下降归因于与COVID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。在护理方面还有其他关键差距- 特别是没有资格参加该方案的男孩，以及公立学校系统外的青少年。 迫切需要确定有效，可复制和可扩展的策略来优化HPV疫苗 学龄儿童的接受和完成。拟议的R34的总体目标是改进和 评估以学校为基础的多层次沟通策略，解决人际、人际和 与五年级学生HPV疫苗接种和完成相关的制度因素，作为试点的一部分 可行性试验。这项拟议中的研究由来自美国和南非的研究人员领导， 在HPV高负担的城市环境中与卫生部和小学建立伙伴关系 南非夸祖鲁纳塔尔的疫苗可预防的癌症。该项目建立在我们团队的专业知识， HPV预防、疫苗决策、健康传播、参与式设计和社区 致力于实现以下具体目标。(1)完善校本多层次 提高女孩和男孩HPV疫苗接种率和完成率的宣传战略，以及（2） 评估传播战略的初步效果和推进全面传播的关键标准， 大规模杂种2型试验。我们以系统为中心的方法充分利用与 学校服务于传统医疗保健渠道并不总是有效服务的不同人群。 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，以了解和减少HPV疫苗启动和完成的障碍。这 该提案是响应NCI对癌症预防和控制临床试验规划赠款的呼吁（PAR-22- 173)无论是积极的利益相关者参与，还是专注于参与多样化的，科学上适当的 研究人群。

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.