Human Papillomavirus (HPV) Vaccination in Ghana: Exploring Ways to Improve HPV Vaccination Practices and Inform Policy

Background: Low-resource countries like Ghana face a significant burden from HPV-related cancers, accounting for 84% of global cases and 88% of deaths. In Ghana, cervical cancer incidence and mortality rates are alarmingly high, at 32.9 and 23.0 per 100,000 women, respectively, which is almost three times the global average. HPV vaccination is a key preventive measure, and between 2013 and 2018, the Gavi global vaccine partnership piloted a vaccination project in preparation for nationwide implementation. However, Ghana currently lacks a publicly funded HPV vaccination program, limiting access to private options and exacerbating inequities. Most HPV vaccination research in Ghana focused on vaccine knowledge and acceptance, with insufficient attention given to strategies for promoting equitable access to vaccination. This gap of strategic ways to improve HPV vaccination highlights the need for more comprehensive research to improve practice and inform policy the forthcoming national program. Aim: The overarching aim of this paper-based dissertation project was to explore ways to improve HPV vaccination in Ghana and to generate evidence to inform policy on a national HPV vaccination program. This dissertation consists of two related studies. Study 1 focused on identifying, describing, and synthesizing existing evidence regarding HPV education strategies in low- and middle-income countries, specifically tailored to be applicable in Sub-Sahara Africa, including Ghana. Study 2 examined the challenges and inequities in a privately funded HPV vaccination program to obtain lessons to inform practice and policy. Methods: Study 1 used the scoping review methodological framework by Arksey and O’Malley advanced by Levac et al. Four electronic health sciences databases were searched for relevant reports published between January 2006 and January 2021. Study 2 used the qualitative case study research design guided by the intersectionality theory, and involved interviews with vaccinators, policy/program leaders, and HPV vaccine recipients in a hospital-based privately-funded vaccine program. Results: In Study 1, a search yielded 1,757 reports, with 48 from low- and middle-income countries. Of these, 39 were interventional studies, primarily targeting females. Most educational strategies aimed to enhance HPV knowledge and were delivered by health professionals through various methods, including in-person sessions, text materials, media, theater, and online formats. Study 2 identified significant challenges in the privately-funded HPV vaccination program, including a lack of guiding policies, reliance on sexual history for eligibility, and insufficient education for providers and recipients. Findings revealed that the privately-funded program is largely inaccessible to underprivileged individuals, influenced by gender, socioeconomic status, and conservative sociocultural norms hindering discussions about sexual health. Conclusions: The privately-funded HPV vaccination program is inaccessible to underprivileged individuals and faces structural challenges. Without a guiding policy, its quality and efficiency are limited. Standardized guidelines are needed to support evidence-based practices and promote advocacy to stimulate political interest in policy-making. Additionally, these findings underscore the need for a comprehensive, publicly funded program that addresses both access and education, incorporating culturally sensitive strategies to overcome socio-cultural barriers and ensure equitable coverage.