Leveraging HIV infrastructure to implement cervical cancer prevention: A study to integrate HPV vaccination in adolescent HIV clinics in Zambia

Washington University, Saint Louis MO

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Abstract

Cervical cancer is the leading cause of cancer death in Zambia, where HIV prevalence is also high (11.3%). HIV heightens the risk of developing and dying from cervical cancer. Primary cervical cancer prevention can prevent many cases of cervical cancers. However, use of these primary prevention tools is low in low- and middle- income countries (LMICs), particularly among girls with HIV, who are most at risk of poor cancer outcomes. To ensure that ALHIV have access to evidence-based primary cervical cancer prevention tools, we propose to support strengthening of primary cervical cancer prevention integrate into routine care in adolescent HIV clinics. Adolescent HIV clinics in Zambia have regular contact with ALHIV and are trusted sources of health information for the community. Given the known challenges of providing cervical cancer prevention in LMICs, including Zambia (e.g., resources, staffing, supply chain), integrating primary cervical cancer prevention requires a multilevel approach, Ministry of Health engagement, and diversified implementation strategies. To achieve success, we will co-design a package of implementation strategies using a previously successful implementation research approach developed for cervical cancer prevention in LMICs: the Integrative Systems Praxis for Implementation Research (INSPIRE). INSPIRE is a novel, formal, and comprehensive framework to develop, implement, and evaluate implementation science efforts. Following key elements of INSPIRE, our specific aims are to: 1) Identify the unique multilevel contextual factors (barriers and facilitators) across HIV settings (rural, urban, peri-urban) that influence primary prevention; 2) Use Implementation Mapping to translate findings from Aim 1 and Ministry of Health priorities into a package of implementation strategies to integrate into HIV clinics; 3) Conduct a feasibility trial to evaluate the package of multilevel implementation strategies for primary prevention into HIV clinics. Our research team has significant expertise in HIV and cancer prevention, and strong institutional support including $325,000 over the course of the study; strong support, technical expertise, and resources from the Zambian Ministry of Health; and political will for scale-up. If successful, this implementation model could be transported to HIV clinics across Zambia and serve as a model to address cancer prevention priorities for those with HIV in other LMICs.