HOPE Study
The HOPE (HPV One and Two Dose Population Effectiveness) Study is investigating the impact of 1-dose and 2-dose human papillomavirus (HPV) vaccination schedules on the prevalence of HPV in South African adolescent girls. This research aims to evaluate the effectiveness of these vaccination schedules in reducing community-level HPV prevalence within this population.
Purpose
The purpose of the study is to monitor the effectiveness of 1-dose and 2-dose HPV vaccination schedules on community-level HPV prevalence among South African adolescent girls.
Primary Objectives
In South African adolescent girls aged 17–18 years, the study aims to:
- Measure the population effectiveness of the national 2-dose HPV vaccine schedule, administered at age 9, in protecting against infections with sexually transmitted HPV types 16 and 18.
- Assess the population effectiveness of a 1-dose HPV vaccine schedule delivered via a demonstration project to girls in Grade 10 at public schools, in protecting against infections with sexually transmitted HPV types 16 and 18.
Secondary Objectives
- Determine whether HIV infection status affects the protective effectiveness of HPV vaccines.
- Measure the extent of vaccine cross-protection and herd protection following the national 2-dose vaccine schedule administered at age 9.
- Identify sociodemographic and behavioral correlates of uptake and the impact of the national 2-dose program.
Investigators
- Prof Sinead Delany-Moretlwe, Principal Investigator
Media Coverage
- Spotlight, 19 June 2024: HPV vaccination switching to single dose and private schools to get government supply
- Juta Medical Brief, 13 February 2019: Wits RHI launch Africa’s first HPV vaccine impact evaluation project
HOPE Results Abstract
Population impact of South Africa’s HPV vaccination programme on HPV prevalence in adolescent girls: a repeat cross-sectional study
Dorothy A Machalek, Dorothy Nyemba-Machemedze, Danielle Travill, Kathy Petoumenos, Zizipho Mbulawa, Ishana Naidoo, Feni Motshwane, Lesley Bamford, Helen Rees, John Kaldor, Sinead Delany-Moretlwe on behalf of the HOPE study team. IPVC 2024, Edinburgh, UK, 12-15 November 2024
Background: A two-dose bivalent HPV vaccination programme for Grade 4 girls (age ≥9) commenced in South Africa in 2014, achieving 87% learner coverage. We evaluated the programme’s impact on HPV prevalence among adolescent girls.
Methods: Using a repeat survey design, girls aged 17–18 attending health services in four provinces (Free State, Gauteng, Mpumalanga, Northwest) provided a self-collected sample for HPV testing (AnyPlex™II HPV28). The first survey in 2019 estimated HPV prevalence in a pre-vaccine cohort. A survey repeated in 2023 estimated HPV prevalence in a school programme-eligible cohort. The latter included girls who received any doses (vaccinated) and those who missed out. We compared HPV prevalence between the cohorts using generalised linear regression (estimating adjusted prevalence ratios [aPR]), overall, by HIV status, and vaccination status among the vaccine-eligible group based on information obtained from provincial registers.
Results: Overall, 819 girls made up the pre-vaccine cohort (n=248; 30.3% adolescents living with HIV [ALHIV]) and 1,538 made up the vaccine-eligible cohort (n=294; 19.1% ALHIV), including 313 (20.4%) vaccinated girls. HPV16/18 prevalence was 81% lower in the vaccine-eligible cohort than the pre-vaccine cohort (3.2% vs 21.6% respectively; aPR=0.19 [95%CI 0.14–0.27]). Similar results were observed for ALHIV (4.4% vs 29.4% respectively; aPR=0.19 [0.11–0.34]) and among girls in the vaccine-eligible cohort who were vaccinated (1.3% vs 21.6% respectively; aPR=0.08 [0.03–0.21]) and unvaccinated (3.6% vs 21.6% respectively; aPR=0.20 [0.15–0.29]). HPV31/45 prevalence was also 54% lower (5.7% vs 16.5% respectively; aPR=0.46 [0.35–0.59]). No reductions in prevalence were noted for other HPV groups.
Discussion: Nine years into South Africa’s programme, we observed significant population-level reductions in vaccine-preventable HPV16/18 types among adolescent girls, with similar impacts in ALHIV and herd effects in unvaccinated girls. There was also evidence of cross-protection against HPV31/45. These data provide important evidence of population impacts in a setting with a high HIV burden.
Latest Update
December 2024
For more about HOPE Study please email rhicomms@wrhi.ac.za
