Claudia Hanson

A missed opportunity: faith leaders and the HPV vaccination effort in Addis Ababa, Ethiopia

Cervical cancer causes morbidity and mortality among women worldwide, particularly in low- and middle-income countries (LMICs). Human Papillomavirus (HPV) vaccine is crucial for cervical cancer prevention, yet the vaccination rates remain suboptimal in Ethiopia. Studies identified cultural and religious factors as key barriers. While evidence suggests that faith leaders can effectively promote public health interventions, their potential role in HPV vaccination efforts has largely been overlooked and remains inadequately understood. This study aimed to explore the perspectives of faith leaders in Addis Ababa to identify factors influencing HPV vaccination among girls. This study employed qualitative methods, using in-depth interviews with purposively selected faith leaders. The faith leaders employed by the Inter-Religious Counsel of Ethiopia (IRCE) were excluded. A total of 13 faith leaders participated in the interviews. The 5C framework informed the data collection tool, and data analysis was conducted using inductive reflexive thematic analysis (RTA). Faith leaders are navigating between modern medicine and their religious beliefs, face distrust of Western vaccine aid intentions and local HPV vaccine providers, and receive fragmented or inconsistent information. These challenges make it difficult for them to act as champions for the vaccination, but with clear, well-organized information, there is an opportunity to involve them more effectively. Faith leaders face several challenges that limit their role in promoting HPV vaccination. This study recommends providing clear, culturally relevant materials and communication strategies to support faith leaders and their communities. With these tools, faith leaders have the opportunity to engage and become effective advocates for the elimination of cervical cancer.

Building HPV vaccine confidence through codesigned interventions with and for healthcare workers in Nigeria: protocol for a pilot cluster randomised controlled trial

Introduction The human papillomavirus (HPV) vaccine can effectively prevent cervical cancer, yet HPV vaccine uptake is particularly low in some low-income settings, due to supply and vaccine confidence barriers. HPV vaccine confidence has also been found to be lacking among healthcare workers in some countries, including Nigeria. Nigeria has a long history of low vaccine confidence in some parts of the country. HPV vaccine rumours and concerns have been observed throughout the country, including among healthcare workers. Interventions that specifically address healthcare workers’ vaccine confidence are limited, since vaccine confidence is often assumed among this group. The aim of our pilot cluster randomised control trial (cRCT) is to evaluate the feasibility of conducting a trial that evaluates codesigned interventions to improve HPV vaccine confidence in healthcare workers and the acceptability and feasibility of delivering this intervention. Methods and analysis This is a 3-arm pilot cRCT, using a mixed-methods approach to assess the feasibility of the trial design, alongside the feasibility and acceptability of intervention delivery in two states in Nigeria (Jigawa and Oyo). We will implement two interventions: one with a focus on digital delivery, and one with an HPV champion present at a health facility. Both will be compared with a control arm, providing standard information on HPV vaccine only. Overall, 12 trial clusters (six in Jigawa and six in Oyo), defined as government primary healthcare facilities, will be randomised using a 1:1:1 ratio, stratified by state. All healthcare workers within these facilities will be eligible to take part in the intervention and evaluation. The primary outcome of interest will be intervention uptake, as a measure of subsequent trial feasibility given concerns around contamination in control clusters. This will be assessed through an endline healthcare worker survey. Intervention feasibility and acceptability will be assessed through quantitative intervention monitoring and qualitative interviews with healthcare workers. Ethics and dissemination We received approval from Jigawa State Ethics Committee (ref: JGHREC/2023/151), Jigawa Ministry of Health (ref: MOH/PH/PHRAT/MN/23/003), Oyo State Research Ethics Review Committee (ref: AD/13/479/362A), The University of Ibandan and University College Hospital Research Ethics Committee (UI/UCH Ethics Committee) (ref: UI/EC/23/308) and from the Swedish National Ethics Review Board (2023-04772-01-471058). Data will be presented in manuscript form and submitted to relevant conferences for dissemination. Registration details The pilot trial has been registered with ISRCTN—the UK’s Clinical Study Registry, registration number ISRCTN37847119 .