Linnet Masese, PhD

Masese, Linnet

Nominated From:University of Washington
Research Site:Kenya
Research Area:Infectious Disease
Primary Mentor:Scott McClelland

Research Project

HPV Vaccine Preparedness among Youth in the Coast Region of Kenya in the HIV Cohort Study

Two HPV vaccines are licensed in Kenya, Cervarix and Gardasil. The vaccines are approved for use in females 9-26 years old. Although routine HPV immunization has not been introduced, Kenya was first among 7 African countries selected by GAVI Alliance for a demonstration project to explore options for vaccine delivery. The demonstration project, located in Kitui County (central region), was initiated in March 2013.

With the introduction of free primary education in Kenya, there has been a surge in enrollment of girls in schools. Consequently, introducing the vaccine through schools has been adopted by the demonstration project as a potential vaccine delivery method.
However, HPV vaccine coverage could be greatly reduced if the number of vaccine target-age girls attending school is low. In addition, vaccine coverage on a national scale may be lower than shown in demonstration projects due to the lack of additional resources allocated to such projects. Before the introduction of the HPV vaccine nationwide, baseline information on HPV vaccine preparedness and HPV infection in the vaccine target population (girls 9-13 years) will be invaluable in vaccine scale-up efforts. To inform the development of an effective national HPV vaccination program, we propose a study whose specific aims are:

1. To utilize capture-recapture methodology to assess HPV vaccine preparedness in Mombasa County by determining the proportion of target-age girls who are out of school, and therefore likely to be missed through school-based HPV vaccination programs.

Hypothesis: Due to reasons such as attitude towards education, education cost, early marriage and pregnancy, girls may fail to enroll in school or may not complete primary education. This will hamper vaccine coverage though the school-based delivery system.

2. To determine the prevalence and correlates of HPV infection among girls 9-13 years old in Mombasa County using HPV RNA testing on urine samples and to compare the prevalence between the in-school and out-of-school girls.

Hypothesis: Socio-behavioral factors such as age of coitarche, number of sexual partners, condom use, transactional sex, peer influence, parental bonding, religion, and non-participation in school will be associated with higher likelihood of HPV infection. This is important, as women already infected with the vaccine subtypes would not benefit from vaccination, suggesting the need to vaccinate earlier in the 9-13 year old vaccination window.


Research Significance

Human papillomavirus (HPV) is one of the most common STIs in sexually active adolescents in developing countries. Approximately 90% of the infections are asymptomatic and self-limited, but persistent infection causes cervical dysplasia and carcinoma. The associated morbidity and mortality are significant, especially in areas where screening is not available. Cervical cancer is the most common cause of cancer deaths in women in the developing world. In Kenya, the mortality rate of invasive cervical cancer among women 18-69 years is high (35 per 100,000 women).
We will be recruiting an understudied population. Our data will add to the limited HPV literature among Kenyan adolescents. Also, the adolescents in Mombasa are socio- demographically different from those in Kitui. Assessing vaccine preparedness in the coastal region will allow development of strategies that are better tailored to this population.




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