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

ABSTRACT/SUMMARY The human papillomavirus (HPV) vaccine is a WHO-endorsed, evidence-based tool that can prevent up to 90% of cervical cancer cases by preventing HPV infection when administered prior to exposure to HPV and it is recommended for girls ages 9-14. However, HPV vaccine coverage is low in low- and middle- income

countries (LMICS) where risk of dying from cervical cancer is high, especially in Zambia (site of parent grant; UO1CA275033). REACH aims to increase access to and uptake of the vaccine using implementation science methods. However, implementation science is a field developed in the U.S. and only recently has started to

recognize the importance of explicitly recognizing equity in the implementation process. Transposing approaches from high income countries risks failure when misunderstanding contexts, relying on leadership and expertise from HICs, and maintaining colonization practices This supplement project, responding to the

call for Administrative Supplements for NCI Global Oncology Mentored Research (NOT-CA-24-028), is a methods study aiming to explicitly investigate how equity and decolonization practices can be embedded in capacity building practices and implementation process. This is a methods-focused study aiming to strengthen

Dr. Asante's knowledge and skills on implementation science with a focus on team collaboration. To achieve these goals, we will adapt an evidence-based matrix mentoring model for global collaboration, including self, senior, scientific, staff mentors and sponsors. We conceptualize equity as a process aimed at reducing

disparities and its root causes, including social, structural, and political determinants. Centering equity in implementation entails building trusting relationships, dismantling power structures, and investing in strategies that advance equity. We will use methods of reflexivity based on Alexander et al's. model to enhance personal

and team awareness of their own positionality. The model proposes that three reflexivity practices (reflexivity in, on, and underlying action) are tied to five actions from the Ottawa Charter: a) building healthy public policy, (b) creating supportive environments, (c) strengthening community actions, (d) developing personal skills, and

(e) reorienting health services. Based on this model, Dr. Asante will: (1) Center equity in the REACH team using Alexanders' three types of reflexivity, and (2) Center equity in the development of the implementation strategies. The project will produce a needed outline of methods for the field of implementation science on how to explicitly outline reflexivity and center equity during the implementation

mapping process. This supplement will also strengthen Dr. Asante's skills in global research leadership as an implementation scientist, supporting her to reach her mid-term goal to MPI an R01 in implementing color cancer screening in Zambia, further enabling her to reach her long-term goal of launching her own independent

research in CRC prevention.