Implementing a mother-daughter programme in Cameroon

Introduction

In Cameroon, a pilot based on an integrated approach combining primary and secondary prevention of cervical cancer, through a mother-daughter programme, was leveraged to increase the uptake of both HPV vaccine and screening in rural communities. Based on first insights from this programme, integrated delivery of  primary and secondary prevention, seems to increase parents’ confidence in vaccinating their daughters and both generations can learn about benefit from prevention of HPV.

Background

Since the introduction of routine HPV vaccination in Cameroon in 2019 by the Ministry of Health (MOH), hundreds of thousands of doses of HPV vaccines have expired due to high levels of vaccine hesitancy and misinformation in the population. The MOH called on all national stakeholders to assist in promoting and administering vaccines. The Cameroon Baptist Convention Health Services (CBCHS) was the first to introduce HPV vaccination in Cameroon in 2010 through a donation programme. One of the major lessons learned from the initial rollout was  that when HPV vaccination is offered in conjunction with cervical cancer screening, acceptability is increased in Cameroon,. In 2022, through a grant from TogetHER for Health, CBCHS piloted the mother-daughter approach in two rural communities.

Action

The project started with the training of selected community members on the basics of cervical cancer prevention, about the impact of HPV, including cervical cancer screening, and HPV vaccination. These community members were empowered to sensitise and mobilise women and their daughters for the project. During the campaigns, the daughters received the HPV vaccine following parental consent, while the mothers were screened with HPV DNA testing as primary screening test. If HPV positive, women were triaged with VIA. Those with VIA-positive lesions were provided treatment with thermal ablation (TA) or Large Loop Excision of the Transformation Zone (LLETZ) depending on the characteristics of the lesion.

Results

A total of 613 women were screened for HPV and 33.6% were positive. Of the 91.3% that were triaged to VIA, 8% were positive and received treatment. Out of the 143 women less than 30 screened with VIA only, 7.7% were positive and all were treated. A total of 1892 girls aged nine to 14 were vaccinated. This indicates that three girls were vaccinated for every one woman screened.

Conclusion

The main reflection and lesson learned from the mother-daughter delivery model was that when the HPV vaccine is presented as a standalone service, the population is hesitant, but when it is combined with cervical cancer screening, it is highly accepted. For HPV vaccination to be successful in Cameroon, integrated approaches show an higher acceptability from communities, particularly when vaccination is combined with cervical cancer screening. That is when women are being screened for cervical cancer, their children are being vaccinated at the same time. With this strategy, HPV vaccination is progressing in Cameroon.