Investigator(s)
| Co-Investigator(s) |
Ela Singh Rathaur WHO Nepal Ela Singh Rathaur 
|
| WHO Technical Officer |
Dr. Madan Kumar Upadhyaya Family Welfare Division, MoHP Dr. Madan Kumar Upadhyaya
|
| Co-Investigator(s) |
Balwinder Singh Chawla World health organization Balwinder Singh Chawla
|
| Co-Investigator(s) |
Rahul Singh Pradhan World health organization Rahul Singh Pradhan
|
| Co-Investigator(s) |
Ela Singh Rathaur World health organization Ela Singh Rathaur
|
Title(s) and abstract
| Scientific title | Post Campaign Coverage Study of Human Papilloma Virus Vaccination 2025 in Nepal- A mixed method study |
| Public title | Post Campaign Coverage Study of Human Papilloma Virus Vaccination 2025 in Nepal- A mixed method study |
| Background | Cervical cancer is one of the leading causes of cancer-related deaths among women in Nepal, with more than 2,000 new cases and over 1,300 deaths reported in 2022. To address this public health threat, the Ministry of Health and Population (MoHP), with technical support from WHO, UNICEF, and Gavi, launched a nationwide HPV vaccination campaign on 4 February 2025. This combined effort targeted approximately 1.69 million girls including Grade 6 schoolgirls (age 10 out of schoolgirls (OOS)) for routine immunization and Grades 7–10 (ages 11–14 OOS) to capture multi age cohort delivered through school-based sessions, health facility vaccination and community outreach sessions. Accurate data on HPV vaccine coverage and its determinants are critical for informed policy and equitable programme implementation. Since administrative data may be incomplete and overlook behavioural and social influences, WHO recommends Post-Campaign Coverage Survey (PCCS) to validated evidence on coverage, equity, and accountability. Use of the WHO BeSD framework will help identify key barriers and motivators, guiding targeted actions to support Nepal’s progress toward cervical cancel elimination. |
| Objectives | • To estimate the coverage of the HPV vaccine among eligible adolescent girls during the nationwide HPV vaccination campaign conducted in Nepal in February–March 2025, disaggregated by province, school-going (Grades 6–10) and out-of-school girls aged 10–14 years. • To assess barriers and enablers to immunization in the national HPV vaccination campaign using Behavioural and Social Drivers of Vaccination (BeSD) framework, with a focus on awareness of the national HPV vaccination campaign among the adolescent girls/mothers/caretakers of the eligible girls. • To examine the association between programme-related factors (e.g., availability of vaccination cards, exposure to IEC materials), selected social and demographic factors, and the immunization status of other children aged 12–35 months within the household, in relation to the immunization status among eligible adolescent girls during the HPV vaccination campaign. • To assess awareness of cervical cancer screening among the mothers of the eligible girls. |
| Study Methods | The study will use a cross-sectional, mixed-methods design, integrating a quantitative household survey with qualitative in-depth and key informant interviews. The quantitative component will employ a two-stage probability-proportional-to-size (PPS) cluster sampling across eight strata—the seven provinces and Kathmandu Valley as a separate stratum. In the first stage, 1,368 wards (clusters) will be selected using 2021 Census data on girls aged 10–14 years. In the second stage, each ward will be divided into blocks of 29–150 households, from which one block will be randomly chosen. From each block, 29 households will be systematically sampled, resulting in an estimated 9,560 completed interviews from roughly 39,000 household visits. Data collection will be conducted by 15 provincial teams, comprising 95 enumerators and 15 supervisors, over 46 days following a week-long participatory training in Kathmandu that includes mock interviews and pretesting. Digital data collection will be done using tablets with the KoBo Toolbox CAPI system, enabling real-time monitoring and quality control. The qualitative component will involve interviews with mothers of vaccinated and unvaccinated girls, as well as vaccinators and health workers, to explore behavioural, social, and contextual factors influencing vaccine uptake and campaign performance. Data will be cleaned and analysed using SPSS, applying sampling weights to adjust for unequal selection probabilities and non-response. HPV vaccination coverage will be estimated following WHO’s Vaccination Coverage Quality Indicators (VCQI). Ethical approval will be obtained from the Nepal Health Research Council (NHRC) and SEARO ERC. |
| Expected outcomes and use of results | The study is expected to generate reliable and representative estimates of HPV vaccination coverage at both national and provincial levels, providing a comprehensive understanding of immunisation performance across different contexts. In addition to quantifying coverage, the research will yield valuable insights into the behavioural and social drivers influencing vaccine uptake among eligible populations. By exploring these determinants, the study will identify key barriers and enabling factors that affect acceptance and accessibility of the HPV vaccine. Furthermore, the analysis will highlight existing programme gaps and operational challenges within the vaccination delivery system. Based on these findings, the study will formulate evidence-based recommendations to strengthen the integration of HPV vaccination into the routine immunisation programme. These results will support policymakers, programme managers, and partners in developing targeted strategies to improve vaccine uptake, enhance equity, and sustain high coverage across all provinces |
| Keywords | HPV vaccination; Post-Campaign Coverage Survey (PCCS; Adolescent girls; Behavioural and Social Drivers (BeSD); Vaccination coverage; Nepal |
Research Details
| Student research | No |
| Start Date | 15-Jan-2026 |
| End Date | 30-Jun-2026 |
| Key Implementing Institution | Family Welfare Division, Department of Health services |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Immunization/Vaccine Preventable Disease |
| Involves human subjects | No |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Under Review |