Prevention of Cervical Cancer in Sub-Saharan Africa: The Advantages and Challenges of HPV Vaccination
HPV vaccination campaigns and medical affairs support to provide evidence describing HPV strain prevalence were areas of work I did in Kenya, Tanzania, Uganda, Zambia, and Ethiopia. Rwanda had implemented government-sponsored HPV and Rotavirus vaccination, yet I worked there too as new scientific research emerged. While there are now government-sponsored HPV vaccination programs in Kenya, Tanzania, Uganda, Zambia, and Ethiopia, due in part to the teams and individuals I coordinated and the support of the Global Alliance for Vaccinations and Immunization, there are many obstacles still to reckon with. This review highlights a lot of the challenges our teams faced and my teams and colleagues continue to face in their work in sub-Saharan Africa.
AUTHORS: Eleanor Black * and Robyn Richmond
School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia;
*Correspondence: ellie.black@gmail.com; Tel.: +61-413-037-188, R.Richmond@unsw.edu.au
ABSTRACT: Cervical cancer is a critical public health issue in sub-Saharan Africa (SSA), where it is the second leading cause of cancer among women and the leading cause of female cancer deaths. Incidence and mortality rates are substantially higher than in high-income countries with population-based screening programs, yet implementing screening programs in SSA has so far proven to be challenging due to financial, logistical, and sociocultural factors. Human Papillomavirus (HPV) vaccination is an effective approach for primary prevention of cervical cancer and presents an opportunity to reduce the burden from cervical cancer in SSA. With a number of SSA countries now eligible for Global Alliance for Vaccines and Immunization (GAVI) support for vaccine introduction, it is timely to consider the factors that impede and facilitate implementation of vaccine programs in SSA. This article describes epidemiological features of cervical cancer in SSA and the current status of HPV vaccine implementation in SSA countries. Rwanda’s experience of achieving high vaccination coverage in their national HPV immunization program is used as a case study to explore effective approaches to the design and implementation of HPV vaccination programs in SSA. Key factors in Rwanda’s successful implementation included government ownership and support for the program, school-based delivery, social mobilization, and strategies for reaching out-of-school girls. These findings might usefully be applied to other SSA countries planning for HPV vaccination.