Human papillomavirus, or HPV, is a common virus that can lead to several different cancers, including cervical cancer. The HPV vaccine, approved in 2006, has been crucial in the prevention of cervical cancer over the past 15 years. When administered to the recommended age groups—primarily ages 11 and 12—HPV vaccination has proven to safely and effectively protect individuals from contracting HPV, decreasing their risk of developing cervical cancer and other cancers.

Melissa Stockwell, MD, MPH

Despite the gains made in cervical cancer prevention thanks to the HPV vaccine, vaccine hesitancy still persists among the greater population. In areas across the globe where cervical cancer is on the rise, there is a pressing need to educate the public about how HPV vaccination is a safe and effective way to reduce their risk for cancer. In the larger region of Sub-Saharan Africa, for one, cervical cancer mortality rates are the highest in the world.

To address this global challenge, researchers at the Herbert Irving Comprehensive Cancer Center (HICCC) and Columbia University Vagelos College of Physicians and Surgeons are piloting a text messaging platform to remind individuals about HPV vaccine appointments and raise awareness about the importance of the vaccine as a cancer preventive measure. The project focuses on adolescents and families in Uganda, a country where cervical cancer is the leading cancer among women.

“There is a very strong link between HPV infection and cervical cancer, and we have an incredibly effective vaccine for HPV that can help prevent individuals from getting cancer. The challenge in Uganda is that many families are not coming in for their HPV vaccine or completing the two dosages required,” says Melissa Stockwell, MD, MPH, division chief of Child and Adolescent Heath in the Department of Pediatrics and member of the HICCC’s Cancer Population Science research program. “We know that we can have a large impact on cervical cancer in Uganda if we are able to get more adolescents completing the HPV vaccine dosages."

The team of researchers, in collaboration with  partners in the Department of Pediatrics and Child Health at Makerere University in Kampala, Uganda, are building on previous work by the Stockwell lab that demonstrated the effectiveness and success of text messaging vaccination reminders for HPV and other vaccines. Her team published the first studies that used text message vaccine reminders for adolescent and pediatric populations, and have since shown that text message reminders yield HPV vaccine completion rates up to 74.1% within 12 months. They also found that the texts acted not only as a reminder for the needed doses but also as a way to provide educational information about the vaccine.

The researchers intend to replicate a similar platform in Uganda, a particularly promising project given Uganda’s prevalent use of handheld devices.

According to data by the World Bank, there are an estimated 6.8 billion cell phone users worldwide, and this figure is only expected to increase in coming years. While less developed countries, like those in Africa, trail behind the U.S. and China in terms of the greatest total number of mobile cellular subscriptions, Uganda in particular has a growing rate of people who are connected via mobile devices. The World Bank reports nearly 90% of urban households in Uganda have a cell phone.

The new study in Uganda is currently underway at three health centers overseen by the Kampala Capital City Authority as well as their associated schools, an adolescent clinic, and community immunization posts located in surrounding villages. Dr. Stockwell and her team will be conducting interviews with families, clinicians, nurses, and administrative staff to explore text message reminder educational content, wording, tone, and preferred timing. They will then pilot the new system within a targeted group of parents and adolescents and conduct a randomized control trial at all Uganda partner sites to assess the impact of text message reminders on HPV vaccination.

Dr. Stockwell’s research has pioneered the use and understanding of digital technology to promote HPV vaccinations. Her work in translational interventions to improve vaccinations emphasizes health technology and health literacy, focusing primarily on underserved children and adolescents. At Columbia University, she is instrumental in the ongoing campus-wide rollout of the COVID-19 vaccine and in promoting vaccine literacy and awareness across the university and partner institutions.

“This project, if successful, will provide an important foundation not only for the potential use of HPV vaccine reminders in Uganda," says Dr. Stockwell, "but also for the potential use of text message reminders for other childhood/adolescent vaccinations in Uganda, the larger Sub-Saharan African region, and in other low- and middle-income countries.”

-Melanie A. Farmer