Authors: Ghangha Jamin G. MPH, Sangwe Clovis N. MD, MSc, MPH, PhD(c), Njedock Nelson S. MD, Internist, Michael Budzi, MD, MPH.

Introduction

According to the World Health Organization (WHO), cervical cancer is the fourth most common cancer among women worldwide, despite being preventable and curable1. Cervical cancer is caused by human papillomaviruses (HPV) transmitted through sexual contact, with HPV 16 and 18 being the most oncogenic types. As a result, cervical cancer has been targeted for elimination by 20301. To achieve elimination by 2030, WHO has set three targets for countries: a) 90% of girls should be fully vaccinated by the age of 15; b) 70% of women should be screened by the age of 35, and again by the age of 45; and c) 90% of women with pre-cancer should be treated and 90% of women with invasive cancer should be treated2.

Over the years, vaccination has proven to be the most cost-effective method of disease management. This article discusses strategies for achieving target (a), which is to reach adolescent girls before the age of 15 with the effective HPV vaccine, in rural and enclaved communities in Cameroon.

Proposed strategies

One of the strategies proposed, based on success stories in promoting adherence to treatment for infectious diseases such as HIV, is to create a platform for young adolescents who have been vaccinated to act as ambassadors and champions for HPV. Evidence shows that youth health champions often have a genuine passion for promoting health and well-being. Their authenticity and enthusiasm can motivate their peers to get vaccinated against cervical cancer. When young people see their peers actively living healthy lifestyles and advocating for positive change, it can create a ripple effect and encourage others to follow in their footsteps3.  Providing unique platforms such as secondary school tours, youth camps and other gatherings that bring young people together can be the perfect avenues for these champions and ambassadors to educate young people about the importance of getting vaccinated. It is important to note that the effectiveness of HPV champions can be enhanced if they receive adequate support, guidance and resources from community organisations, government and international NGOs.

Recognizing that communication to increase HPV vaccination uptake among rural communities takes different forms, the use of context-specific information, education and communication (IEC) materials is critical. Borrowing from Arthur Brisbane’s adage that “a picture is worth a thousand words”, IEC materials for HPV vaccine awareness should be more pictorial with relatively short messages that the target audience can understand to facilitate decision-making about vaccine uptake and community ownership of the vaccination process, especially in rural areas where literacy levels are low. Powerful images should be used to demonstrate the effectiveness of the vaccine and how it prevents cervical cancer.

Another strategy that could improve HPV vaccination uptake among adolescents in rural communities is to use the health activities of civil society organizations, which have a high level of acceptance in rural and enclaved communities. Rural Doctors, a community-based CSO with a focus on health system strengthening through immunization, is well accepted in rural communities in the South West, North West, Littoral, and Centre regions of Cameroon. Plans are underway to use their community presence to promote HPV vaccination activities among adolescents in rural communities.

An integrated approach called the Community Oriented Primary Care (COPC) model can also increase HPV vaccination coverage in rural areas. This integrated approach prioritizes community health needs through a needs assessment with community engagement to involve parents, adolescents, health care providers, and relevant stakeholders. By addressing community-specific barriers and providing education and support, the COPC model can help to increase HPV vaccine uptake and improve p Conclusion

Targeting adolescents, parents and other stakeholders to increase HPV vaccine uptake in rural and enclaved communities is a priority. Some of the strategies highlighted in this article may be ongoing, but it is important to scale up such strategies to have a national impact and the protection against HPV-related diseases.

References

  1. Cervical Cancer Initiative. (2021). Available online at: https://www.who.int/initiatives/cervical-cancer-elimination-initiative (accessed May 30, 2021).
  2. World Health Organisation. HPV and Cervical Cancer. (2020). Available online at: https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer (accessed May 30, 2021).
  3. National Collaborating Centre for Determinants of Health. (2015). Engaging youth in community-based participatory research for health promotion: A module. Retrieved from https://www.nccdh.ca/resources/entry/engaging-youth-in-community-based-participatory-research-for-health-promot