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

> **NIH NIH U01** · WASHINGTON UNIVERSITY · 2024 · $659,269

## Abstract

ABSTRACT/SUMMARY
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. The human papillomavirus (HPV) vaccine
is a WHO-endorsed, evidence-based tool that can prevent 90% of cervical cancers, and is recommended for
girls ages 9-14. However, HPV vaccine coverage is low (16%) in low- and middle- income countries (LMICs),
and our team's on-the-ground experience suggests HPV vaccination is even lower in Zambia, particularly
among girls with HIV, who are most at risk of poor cancer outcomes. Currently, HPV vaccination is
delivered via school-based campaigns, which are viewed as efficient for broad coverage but also exclude the
most vulnerable children—those out-of-school or who irregularly attend (e.g., orphans, poor). Adolescents
living with HIV (ALHIV) are more likely to have these additional vulnerabilities. In addition, WHO recommends
ALHIV receive a 3rd dose of the HPV vaccine, which is not given in traditional 2-dose school-based campaigns.
To ensure that ALHIV have access to the WHO-recommended 3-doses, we propose to integrate HPV
vaccination 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., stigma, misinformation,
staffing, supply chain), integrating HPV vaccination requires a multilevel approach, stakeholder
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 HPV vaccine uptake; 2) Use Implementation Mapping to translate stakeholder feedback and findings
from Aim 1 into a package of implementation strategies to integrate HPV vaccine into HIV clinics; 3) Conduct a
Hybrid Type 3 effectiveness-implementation trial to evaluate the package of multilevel implementation
strategies for integrating HPV vaccine into HIV clinics. Our research team has significant expertise in HIV,
HPV, cancer prevention, implementation science, and LMIC research. Wehave strong institutional backing,
including$325,000 over the course of the study;strong support, technical expertise, and resources (e.g.,
vaccines) from the Zambian Ministry of Health; and political will for scale-up. If successful, this
stakeholder-based implementation model could be t...

## Key facts

- **NIH application ID:** 10911963
- **Project number:** 5U01CA275033-03
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Jean Marie Hunleth
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $659,269
- **Award type:** 5
- **Project period:** 2022-09-06 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10911963

## Citation

> US National Institutes of Health, RePORTER application 10911963, Leveraging HIV infrastructure to implement cervical cancer prevention: A study to integrate HPV vaccination in adolescent HIV clinics in Zambia (5U01CA275033-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10911963. Licensed CC0.

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