ABSTRACT
Cervical cancer is a major cause of morbidity and mortality in many sub-Saharan countries, including Nigeria.
Expanding human papillomavirus (HPV) vaccination for young girls/women, ages 9-26 years (primary
prevention) and HPV self-collection for cervical cancer screening for older women, ages 30-49 (secondary
prevention) are both critical to achieving WHO and Nigerian goals for reducing the cervical cancer burden. The
Nigerian government now recommends HPV vaccination and self-collection, yet uptake is poor. As such,
context-specific, targeted and culturally relevant implementation strategies are needed. We focus on HPV
vaccination among girls and self-collection among women because of the substantial burden of cervical
cancer. Mother-daughter relationships in Nigeria can be leveraged to increase HPV vaccination uptake among
young girls and HPV self-collection among mothers. Mothers (or similar female caregivers) profoundly
influence decisions and preferences about young girls’ vaccine uptake in the Nigerian cultural context. At the
same time, maternal choices about HPV self-collection can be reinforced in discussions with their daughters. In
the proposed study, Actions for Collaborative Community-Engaged Strategies for HPV (ACCESS-HPV), we will
use participatory crowdsourcing methods to drive HPV prevention among mother-daughter dyads.
Crowdsourcing open calls will allow us to identify locally relevant messages and dissemination techniques to
increase uptake of HPV prevention. Then, participatory learning communities will build capacity for community-
led implementation of selected strategies. Informed by social learning theory and the PEN-3 cultural model, our
multi-disciplinary research team proposes the following specific aims: (1) to develop a new combined
campaign to increase HPV vaccination for young girls (ages 9-26) and HPV self-collection for mothers (ages
30-49) using crowdsourcing open calls and participatory learning communities; (2) to determine the
effectiveness of a final combined campaign on uptake of HPV vaccination among young girls/women and HPV
self-collection among their mothers using a stepped-wedge randomized controlled trial; (3) to estimate the
impact and cost-effectiveness of the crowdsourced campaign. Our primary outcome will be vaccine uptake
(ascertained by clinic records of vaccine uptake) among young girls and HPV self-collection (ascertained by
laboratory receipt of specimens) among their mothers. The strong support of the Nigerian Institute for Medical
Research (NIMR) alongside national HPV programs creates a rich research infrastructure and increases the
likelihood of successful implementation. Our multi-disciplinary research team has experience organizing
implementation research focused on crowdsourcing and community participation in Nigeria. This study will
enhance our understanding of HPV prevention in resource-constrained settings. This grant application directly
responds to strategic priorities of the United States government, the National Institutes of Health, the National
Cancer Institute, and NOT-CA-20-025.