Cervical cancer prevention in Kenya: Introduction of the HPV vaccines

In Kenya, HPV vaccination is not part of the national immunization scheme. The 2 types of HPV-vaccines are however approved and allowed to use in the country. Dr Hillary Mabeya, National Advisor on Adolescent Vaccination at the Ministry of Health (Kenya), received a grant of 9000 HPV vaccines from the GARDASIL Access Program in order to pilot HPV vaccination. The pilot program started in May 2012 and ended in March 2013. Primary school girls (standard 4 to 9, i.e. approximately 9 to 14 years of age) enrolled in 10 randomly selected public schools were the first target group, but in a second phase the program was opened for young girls from the whole community; 2500 girls of the 3000 girls who received the first dose were fully vaccinated at the end of the program. While vaccination occurred at Moi University Hospital, promotion of the HPV-vaccine was school based: health providers informed teachers who on their turn were asked to inform the girls and parents about the upcoming HPV vaccination opportunity.

Through interviewing mothers of eligible girls before and after the vaccination program, and by organizing focus group discussions with key stakeholders when the program was finished, we studied and evaluated the introduction of the HPV vaccines in Kenya. The objectives were:

To measure the acceptability, intention and behavior towards HPV vaccination in Kenya;
To define the impact of referents’ opinions, and the impact of personal, socio-cultural and structural factors on the decision regarding HPV vaccination of young girls;
To generate achievable recommendations on how to design, implement and promote HPV vaccination in Kenya.

Baseline and follow-up data were collected in March 2012 and May 2013, respectively. Of the 287 women interviewed in 2012, 89.2% (256/287) agreed to be interviewed again the next year. In addition, focus group discussions were organized with fathers (3), teachers (4) and nurses (1) (May 2013).

While acceptance was very high (88%) at baseline, only 31% had eventually vaccinated their daughter, and 51% reported that they had wanted to vaccinate but had missed the opportunity. Results show that among this latter group, 55% had not received information regarding the whereabouts of the program. Among those who had actively decided not to vaccinate (18%), 42% mentioned fear of side effects as barrier while 31% said the partner opposed to vaccinating the daughter against cervical cancer.

The qualitative data revealed that participants had poor knowledge regarding cervical cancer and felt rather uncomfortable sharing information about it, hence the lack of awareness about the vaccination program. Teachers also missed support of health care providers to address the questions of the parents as well as their own doubts. In general, HPV vaccination was not considered important given that cervical cancer was perceived as a consequence of a modern lifestyle with which the participants did not feel related. Finally, distrust towards (new) vaccines also hampered uptake: some thought it was an experiment while others had lost faith in vaccines during previous vaccination experiences. Suspicion did however fade away after a couple of months, once the community was convinced about the safety of the vaccine. Health care promoters of future programs will need to enter in dialogue with the community, as opposed to just provide information, to increase awareness and actively tackle misbeliefs and rumors.