Modeling the cost-effectiveness of different HPV vaccination strategies in Kenya

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Reference Number: 
GMVMod002
Description: 

Background:

Human Papilloma Virus (HPV) is a sexually transmitted infection that is associated with multiple cancers and genital warts. Two main strains (16 & 18) are associated with a high-risk of developing cervical cancer later in life. HPV is extremely common worldwide amongst sexually active individuals, and studies indicate that the situation is similar in Kenya (de Vuyst et al 2003). Although knowledge of HPV is limited, work indicates that there would be a strong support for vaccination of girls (Becker-Dreps et al 2010). The result of a recent pilot implementation studies in Kitui, delivering HPV vaccine to girls at schools, was that the vaccine was deemed unaffordable, mostly due to the high delivery costs. Key questions are therefore if the vaccine could be administered by other routes (e.g. EPI).

The project aims to:

In consultation with the Kenya National Vaccines and Immunization Programme (NVIP),

  1. Develop or adapt an age and risk-structured dynamic model for HPV transmission in Kenya.
  2. Explore a range of vaccination strategies for prevention of key cancers.
  3. Consider the health-economic implications of HPV vaccination.
  4. Consider the potential interactions between HPV and HIV.

Methods/Study design:

 Data will be collated on both prevalence of HPV and associated cancers, as well as information on sexual behaviour. Models will then be developed to capture the spread of HPV strains by replicating the patterns of sexual mixing (Jit et al 2008). These models will allow for the calculation of the epidemiology and health-economic evaluation of different vaccination programs targeted at different age-groups and genders (Fesenfeld 2013).

The outputs will be:

  1. Advice to NVIP on strategy options for immunisation.
  2. Recommendation on surveillance data requirement for Kenya
  3. Develop in-country skills in predictive modelling of infectious disease

Role of /links with National / Local Public-Health Organisation:

(including access to data, sources of samples, role in defining question and potential impact on policy)

  • These ideas arose from discussions with the Director of the National Vaccine and Immunization Programme – see meeting notes
  • Given the biggest costs of HPV is likely to be delivery, we can respond to questions of whether alternative routes of vaccination is cost-effective and how to prioritise ages and genders.

References:

  1. Becker-Dreps, S., Otieno, W.A., Brewer, N.T., Agot, K., Smith, J.S. (2010) HPV vaccine acceptability among Kenyan women. Vaccine 28 4864-4867
  2. Fesenfeld, M., Hutubessy, R. & Jit, M. (2013) Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: A systematic review. Vaccine 31 3786-3804
  3. Jit, M., Choi, Y.H., Edmunds, W.J. (2008) Economic evaluation of human papillomavirus vaccination in the United Kingdom. BMJ 337:a769
  4. de Vuyst, H et al (2003) Distribution of Human Papillomavirus in a Family Planning Population in Nairobi, Kenya. Sex. Trans. Diseases 30 137-142
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