Bridging Gaps in HPV Vaccination (2026-2027)

Please note that this is a joint Duke-DKU team that will include faculty and students from both institutions. Applicants should be excited to work collaboratively across institutions and should expect to coordinate meetings across time zones.

Background

Cervical cancer is one of the most preventable cancers, yet it remains a leading cause of death among women worldwide. The burden is disproportionately high in low- and middle-income countries (LMICs), where incidence is nearly twice, and mortality nearly three times, that of high-income regions. Asia accounts for a large share of global cervical cancer cases and deaths, while Sub-Saharan Africa experiences among the world’s highest incidence and mortality rates.

The World Health Organization has set a global goal: 90 percent of girls should be fully vaccinated against human papillomavirus (HPV) by age 15 by the year 2030. Despite progress, HPV vaccination coverage in many LMICs remains far below target. In 2024, HPV vaccination coverage among girls by age 15 was just 28 percent in Africa, 9 percent in the Western Pacific and 4 percent in Southeast Asia.

Barriers to HPV vaccination vary widely across cultural, policy and health system contexts. For example, fear of infertility deters uptake in parts of Sub-Saharan Africa, while in Indonesia resistance in some religious schools poses a major challenge. Identifying context-specific barriers is essential for designing effective interventions and accelerating the global strategy for cervical cancer elimination.

Project Description

This project will investigate HPV vaccination implementation in four LMICs — China, Indonesia, Kenya and Uganda — to identify coverage gaps, understand country-specific facilitators and barriers and propose tailored strategies for improvement.

The work will proceed across three major components:

Study settings and context
Each country has introduced HPV vaccination through its national immunization program, yet coverage varies significantly. The team will examine one to two provinces or cities per country, selected for socioeconomic representativeness, to conduct in-depth case studies. This work builds on more than a decade of ongoing HPV-related research by the project’s faculty in Asia and Africa.

Conceptual framework
The team will adapt implementation science frameworks — including RE-AIM, the Consolidated Framework for Implementation Research (CFIR) and the WHO Behavioral and Social Drivers of Vaccination (BeSD) tools — to evaluate reach, adoption, implementation and contextual drivers of HPV vaccine uptake.

Mixed-methods research
The team will combine policy analysis, immunization registry data analysis and key informant interviews with decision-makers in finance, education and health, as well as providers at vaccination sites. Quantitative data will come from national and global immunization datasets (e.g., WHO, VIEW-hub) and local health authorities. Qualitative interviews will provide insight into attitudes, structural barriers and operational challenges within each country’s vaccination program.

Together, these approaches will produce a detailed landscape of HPV vaccination implementation, barriers and opportunities for targeted strategies across diverse settings.

Anticipated Outputs

Four policy briefs with country-specific recommendations to strengthen HPV vaccination
A hybrid dissemination workshop with key stakeholders from all four countries
One to two academic manuscripts for peer-reviewed publication
Student-led presentations at international conferences

Student Opportunities

The team will include about 4 graduate or professional students and 8 undergraduate students from fields such as public health, epidemiology, global health, sociology, psychology, anthropology, nursing, medicine, economics, statistics and data science.

Students will:

Conduct literature reviews, policy analyses and immunization data analysis
Support cross-country comparative research
Participate in qualitative data collection, including interviewing key informants
Clean and analyze quantitative and qualitative data
Prepare country reports, policy briefs, posters and manuscripts
Present findings at workshops and academic conferences

Students will gain experience in mixed-methods global health research, implementation science frameworks, stakeholder engagement, cross-cultural communication, academic writing and evidence translation. Graduate and professional students will have opportunities to serve as project managers or lead sub-teams and may co-author publications.

Timing

Summer 2026 – Summer 2027

Summer 2026 (optional):

Master’s students obtain IRB approval, coordinate with local partners and conduct contextual analysis
Produce early findings that inform fall research design

Fall 2026:

Refine study designs
Obtain additional IRB approvals as needed
Conduct data collection and stakeholder interviews
Faculty and staff may lead parts of fieldwork that conflict with coursework

Spring 2027:

Clean and analyze data
Draft country reports and co-author manuscripts or policy briefs
Present findings at a stakeholder workshop
Prepare dissemination plans and next-phase proposals

Summer 2027 (optional):

Finalize analyses, outputs and publications
Consolidate lessons learned and plan follow-up research on HPV vaccination

Crediting

Academic credit available for fall and spring semesters