Boosting HPV Vaccine Uptake Among Adolescent Girls and Young Women Living with HIV

Each year, over 300,000 women die from cervical cancer, with 90% of these cases and deaths occurring in sub-Saharan Africa—a region already facing a heavy burden of HIV. Women living with HIV are six times more likely to die from cervical cancer compared to their HIV-negative peers. This stark disparity underscores a pressing need for targeted interventions.

Fortunately, there is good news. The human papillomavirus (HPV) vaccine offers strong protection against the types of HPV most commonly linked to cervical cancer. The vaccine has the potential to prevent more than 90% of HPV-related cancers, making it one of the most effective tools in cancer prevention. However, vaccine uptake remains low. Only 14-30% of eligible adolescent girls receive the first dose, and fewer than 50% receive the second dose, mainly due to lack of awareness of the vaccine’s benefits and availability.

To begin to address this gap, Dr. Anita Kabarambi, Brown School PhD student and ICHAD’s Research Associate, conducted a pilot randomized control study to test the preliminary impact of a health education intervention on HPV vaccination uptake among 100 adolescent girls and young women (10-24 years) living with HIV in Uganda. Participants in the intervention condition received educational sessions on HPV and cervical cancer, take-home brochures, and informational posters displayed at their respective ART health clinics. Participants in the control condition received only the informational posters displayed at their health clinics.

Findings published in AIDS and Behavior revealed a low vaccine uptake rate, with only 31% of the participants having received the HPV vaccine at baseline. At 6-months follow-up, participants who received the intervention showed a 50-percentage point increase in vaccine uptake, as the number of unvaccinated girls dropped from 34 to 9, while the control condition showed no change. These preliminary findings demonstrate that targeted health education interventions can significantly improve HPV vaccine uptake among adolescent girls.

Kabarambi

“It is essential to design interventions that meet girls and young women where they already are—like at ART clinics. These are safe, familiar spaces that ensure privacy and continuity of care. School-based models risk unintended disclosure of HIV status when more than one vaccine dose is required. ART clinics can offer a confidential, efficient, and inclusive solution for HPV vaccine delivery,” said Dr. Kabarambi.

This work was supported by funding from ICHAD’s D43 ACHIEVE Training Program. For her ACHIEVE project, Dr. Kabarambi worked under the mentorship of Drs. Fred Ssewamala, Jean Hunleth and Michelle Silver at WashU, and Nixon Niyonzima at the Uganda Cancer Institute. Prior to joining the PhD program at WashU, Dr. Kabarambi served as the Research Director for ICHAD’s field office in Uganda. Her research interests include adolescent health, implementation science, HPV vaccine uptake, HIV prevention and treatment outcomes.