HPV Vaccination In GHANA:

Seizing The Moment For

Elimination Of Cervical Cancer
And Other HPV -related Cancers
Dr. (med) Aisha Ali Issaka
(MBCHB/MPH/MGCS)
29th June, 2025

1
Outline Background: -
Proposed impact on
Prevalence/importan Why the moment is
Ghanaian
ce: World/ Africa/ now?
communities
Ghana

Ghana’s Efforts in Busting myths and

HPV Vaccination-
HPV elimination, misconceptions for a
history
vaccination successful program

Changes in Trends of Impact assessment

Controversies/
vaccination of HPV Vaccination:
updates
protocols World/Africa/ Ghana

2
 In 2019, Human Papillomavirus (HPV)
caused an estimated 620 000 cancer
cases in women and 70 000 cancer cases
in men. (WHO Fact sheet, 03/2024)

HPV infection is the commonest infection

BACKGROUN of the reproductive system and has a well
documented association with genital and
D non genital cancers. The greatest burden
of cancer is cervical cancer.
Hence a foundational pillar for the
elimination of cervical cancer relies on the
elimination of HPV infection.

3
Global burden of cancer
attributable infections
• 2018- 2·2 million infection-attributable
cancer cases
• Helicobacter pylori -810 000 cases
• Human papillomavirus (690 000, 8·0)
• Hepatitis B virus (360 000, 4·1)
• Hepatitis C virus (160 000, 1·7).
• The cancer burden attributed to
human papillomavirus showed the
clearest relationship with country
income level 6·9vrs 16.1 cases per
100 000 (De martel C, et al 2019)
4
GLOBAL BURDEN OF CANCER
• International Agency for Research on Cancer (IARC) - 2020 reports
(36 cancers, 185 countries)
• Worldwide-19.3 million new cancer, 10.0 million cancer deaths
• Incidence: Female breast cancer -(11.7%), lung cancer (11.4%),
colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers
• Mortality: Lung cancer (18%), colorectal (9.4%), liver (8.3%),
stomach (7.7%), and female breast (6.9%) cancers.
• Mortality: Death rates for female breast and cervical cancers,
however, were considerably higher in transitioning versus
transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2
per 100,000, respectively).

5
HPV IN WOMEN-GLOBAL
• Metanalysis of more than a million women in 5 continents
estimated the prevalence in at 11.7%
• Sub-Saharan Africa (24%)
• Latin America and the Caribbean (16%),
• Eastern Europe (14%), and South-East Asia (14%)
• Age-specifc HPV prevalence was highest in young age
groups (<25 years) at 22% then rebound in
age>45years- Africa and the Americas
• Commonest HPV types 16, 18, 31, 52, and 58 (Bruni L. et
al,2010 )
6
 2023 Systematic review and metaanalysis
(44 769 men) -35 countries. The global
pooled prevalence any HPV was 31% (95% CI
27–35) HR-HPV: 21% (18–24)
HPV-16 was the most prevalent HPV genotype
(5%, 95% CI 4–7) then HPV-6 (4%, 3–5).

HPV IN MEN-
Global Highest prevalence in ages: 25 years and 29
years

Sexually active men: important reservoir for

HPV (Bruni L, et al 2023)

7
 Systematic review and meta analysis of 11 studies
comprising 9342 men

Prevalence of any HPV ranging between 19.1% and 100%.

pooled prevalence of any HPV was 78.2% (95% CI 54.2 to
91.6) among HIV-positive and 49.4% (95% CI 30.4 to 68.6)
among HIV-negative men (p=0.0632).
HPV MEN- PCR-based studies, the pooled prevalence of any HPV was

Sub Saharan 84.5% (95% CI 74.2 to 91.2) among HIV-positive and

56.4% (95% CI 49.7 to 62.9) among HIV-negative men
(p<0.0001).
Africa Nine-valent HPV vaccine, Common types: HPV16 and
HPV52, and HPV6 was the most common low-risk HPV
type.

High rates of penile and cervical cancer in the region-

(Olesen TB et al, 2014)

8
OVERVIEW OF HPV IN GHANA- HPV
INFORMATION CENTRE

cancer male female

Cervical cancer - 18.3%
• March 10, 2023 reports:
Anal cancer 0.46 0.67
10.6million women are at risk of
infection. Cervical cancer cases: Vulva cancer - 0.37
2797 and deaths 1699 Vaginal cancer - 0.12
• Crude incidence rates of cancer Penile cancer 0.13 -
attributable to HPV were: Oropharyngeal cancer 0.30 0.16
Oral cavity cancer 0.86 0.38
Laryngeal cancer 0.8 0.35

9
 Prevalence of 16/18: normal cytology (3.8%), LSIL/CIN1:
24.9%, HSIL/CIN2/CIN3/CIS- 38.6%, Cervical cancer:
59.2%
Other risk factors: smoking (0.2), TFR(3.9), OCP(4.3),
HIV(2.3), sex at 15yo (9.3%/11.8%), median age at
OVERVIEW sexual debute (19.1-19.8yrs/17-18.4yrs)
?Assessment of programs: cervical cancer screening
OF HPV IN program,

GHANA- HPV ?Official national recommendation, year of initiation,

INFORMATIO active invitation to screen, screening ages

N CENTRE ?HPV Vaccination program, year of introduction, HPV

vaccines

(Bruni L et al, 2023)

10
 Prevalence: 10.7%, RF: illiteracy (POR: 13.9,
1.9-100), >3 LTSP (POR: 4.6,1-22.2)
(Domfeh et al, 2008).

A study amongst women living with HIV in a

HPV IN clinical setting, 52% had HPV infection. The
GHANA- commonest HPV genotypes HPV 18, 52, 68-
ASCUS, HPV 52, 18, 45- LSIL, HPV 16, 52,
WLWH 42- HSIL/ Severe dysplasia (Domfeh et al,
2022).
The prevalence of hr-HPV among WLWH
was 44.4%. 25% for hr-HPV group 1
(genotypes 16, 18, 31, 33, 35, 39, 45,51,
52, 56, 58, 69) and 46.8% for multiple HPV
genotypes (Gyane F. A. et al, 2024).
11
HPV DNA IN • Unmatched case control study:
• HPV DNA detected amongst women with
GHANA- cervical and those without cervical
cancer (84.8% vs 45.8%).
cervical • Most common HR-HPV genotypes in
Cervical cancer: 16, 18, 45, 35 and 52
cancer- • Most common HR- HPV without cercival
cancer: 66, 52, 35, 43 and 31
• Non vaccine dominant types: HPV
66b(non cervical cancer) and 35(cervical
cancer)
• Cervical cancer risk was associated with
a positive HPV test (Adjusted OR (AOR):
5.78; 95% CI: 2.92–11.42), infection with
any of the HR-HPV genotypes (AOR: 5.56;
95% CI: 3.27–13.16) or multiple HPV
infections (AOR: 9.57 95% CI 4.06–22.56)
(Nartey Y et al, 2023). 12
HPV IN • Study amongst migrant head
porters in Accra, vulval warts
GHANA 5.0% and vaginal warts 3.3%.
hr-HPV positivity was 33.3%
(95% CI, 21.7–46.7), (Tekpor et
al, 2024)

• Study of prevalence in Oral

Squamous Cell Carcinoma
• HPV DNA was detected in 3 of
the 88 samples, a prevalence of
3.4%. Genotypes detected were
16, 18 and 52. (Dawson et al,
2018)
13
HPV IN • Hospital based study in a DM
center: (mean age, 60.2 ± 12.1
GHANA- DM years),
• High hr-HPV prevlance: 21.7%
(95% CI, 16.1–28.1),
disaggregated as 1.5% (95% CI,
0.3–4.4) each for HPV16 and
HPV18 and 20.7% (95% CI, 15.3–
27.0) for other HPV genotype(s).
• Each unit increase in FBG level
increased the odds of hr-HPV
infection by about 15% (aOR =
1.15; 95% CI, 1.02 − 1.30; p-
value = 0.021). (Atiase et al,
2024)
14
HPV IN • Slightly below 24% tested
positive for hr-HPV
GHANA- • HPV 18 only (n = 2, 1.9%),
NUNS • non-HPV 16/18 genotypes
(others) (n = 22, 21.0%)
• mixed infection with HPV 16
and other genotype(s) (n = 1,
1.0%)]
• Similar prevalence of hr-HPV
amongst nuns and general
population.
• (Effah K. et al, 2023)

15
 WLWH:
CA CERVIX: 52/44%- (6-
84.8% fold higher
risk)

SUMMARY HEAD
OF DM:21.7% PORTERS:33
PREVALENCE %

NUNS: 24%

16
Burden of Cervical Cancer
About 604 000 women worldwide were
diagnosed with cervical cancer and 342,000
women died from the disease (WHO/IARC
NEWS,2022).

Ghana: It is the second most common cause

of cancer and deaths in women (Ghana
Burden Of Cancer, 2018)

About 10.6million Ghanaian women in the

reproductive ages are at risk of developing
cervical cancer.

17
 The link between HPV and cervical
cancer is well established

Virtually all cases of cervical cancer

HPV AND linked to HPV infection

CERVICAL 15 HPV DNA TYPES CLASSIFIED AS

CANCER HIGH RISK

16,18,31,33,35, 39, 45, 51, 52, 56,

58,59, 68, 73, 82

70% associated with 16,18

18
WHO

19
20
WHO- 90/70/90 FOR
CERVICAL CANCER
BY THE YEAR 2030
• Vaccination: 90% of girls fully vaccinated
with the HPV vaccine by the age of 15
years;
• Screening: 70% of women screened using
a high-performance test by the age of 35
years, and again by the age of 45 years;
• Treatment: 90% of women with precancer
treated and 90% of women with invasive
cancer managed.
• WHO,2022

21
WHAT IS HUMAN
PAPILLOMA VIRUS (HPV)

• DNA Viruses- Papillomaviridae family

• Small, non enveloped
• 2 main structural elements: L1 and L2
• Infect only human
• Over 200 types
• Causes various diseases of the skin and linings
of internal organs (mucosa)

22
HOW DOES IT
INFECT HUMANS
• Breaks in the skin or lining, causes the virus to
be attached to the cells of the skin
• The virus genes and proteins becomes a part of
the skin or mucosa cell growth and when the
skin is shed the virions are released then infect
other cells again, then the cycle continues.
• Most HPV infections resolve after 1 year
• Carcinogenic HPV that persists for more than
12 months may cause precancerous or
cancerous lesions
• Latency period/viral reactivation

23
WHAT • Cutaneous/ skin lesions
• Plantar warts- HPV 1,2,4
• Anus and genital tract
lesions

DISEASES • Common warts- HPV

• Penis
• Scrotum
1,2,4
DOES HPV • Flat warts- HPV 3,10 • Perineum
CAUSE • Butcher’s warts- HPV
7,2
• Anal canal
• Vaginal introitus
• Vulva
• Other organ linings • Cervix
(HPV 16, 6, 11)
• (cancer of all the
• Cancer of the throat above, HPV 16-
• Lesions on the vocal highest risk of
cords progression to cancer)

24
HPV AND • NON-GENITAL WARTS
• Transmission is closed
• GENITAL WARTS
• 1-10% prevalence
WARTS personal contact • Peak prevalence: 17-
• 10% occurs in children 33 years
• 12-16 years peak • Peak incidence: 20-
incidence 24 years
• 3.5% in adults • 90% caused by HPV
6,11
• Pediatric genital
warts are assoc with
HPV 1, 2

25
HPV Vaccination History

26
WHO • Developed by WHO Strategic
Advisory Group of Experts (SAGE)-
POSITION ON April 2022
• Prophylactic HPV vaccination
HPV strategy to accelerate elimination
VACCINATION of cervical cancer as a public health
problem
S • Implementation of this strategy
could prevent 60 million cervical
cancer cases and 45 million deaths
over the next 100 years.
• licensure of new HPV vaccines and
evidence on vaccine
immunogenicity and effectiveness
with reduced dose schedules
• Replaces the 2017 position 27
YEAR ACTIVITY Immunization
history
1983- Dr. Richard Shope/ Dr Discovery of HPV as a cause of
Harald zur Hausen cerival cancer
1991- Dr. Jian Zhou, Dr. Ian Frazer-
VLPs
Dr John Schiller- HPV Vaccine
2001-2002 Laura Konstsky- efficacy of • Immunization is the most successful
monovalent vaccine HPV 16
method in preventing and controlling
2006 Gardasil HPV 6,11,16,18- FDA
Approved immunization for girls infectious diseases, which has helped
2009 Cervarix HPV 16, 18 Approved saving millions of lives worldwide.
2014 Gardasil 9: HPV 6,11,16,18-
31,33,45,52,58- Approved • As of February 28, 2025, 148 WHO
member states have incorporated the
2016 Shift of dose regimen: 2 doses
at least 6 months apart ages
HPV vaccine into their national
11/12, 3 doses older than 15 immunization programs.
years
2018 Gardasil 9 approved for females • Weighted average coverage of the first
and males ages 27 to 45 years
2019 Over 100 countries on HPV
dose is 61.6%
vaccination program • Full dose of HPV: 47.6%.
2020 HPV 9 approved for other cancer
prevention • Only 11% of the 132 countries who
2030 WHO hopes to eliminate cervical
cancer
reported coverage achieved 90%
coverage. (Han J. et al, 2025)
28
DIFFERE
NT HPV
VACCINE
S

29
 Ghana’s
Efforts in HPV
Elimination-

30
 EVOLUTION OF
HPV VACCINATION
PROGRAM IN
GHANA

31
GAVI PILOT OF HPV VACCINATION
• 5 year program- 2013 to 2018
• Enjoyed political support from the first lady, gender
ministry, health ministry, community leaders,
• Very successful, 33,000 girls were vaccinated in 4
districts in the greater Accra and Northern regions both
in school and out of school girls
• Lessons learnt could be used to guide current
implementation strategy

32
33
 NATIONAL
CANCER
POLICY- HPV
VACCINATIO
N

34
Barriers

35
BARRIERS TO HPV VACCINATION
• KNOWLEDGE GAP
• Low levels of knowledge amongst healthcare providers.
• Lack of knowledge amongst general population about risk factors for
cervical cancer, symptoms, HPV and HPV vaccine. Most vulnerable
women to cervical cancer have no formal education, unemployed,
less likely to live in urban communities (Nartey Y et al, 2023).

• Misconceptions
• Vaccine will encourage early sexual debute, cause men to be
infertile,
• (Osei Evans et al , 2023)

36
Barriers- Belief systems and
stigmatization
• HPV infection regarded as an STI and cervical cancer as an STD
• Beliefs about the causes of cervical cancer, which include the
choices of cloths and criminal abortions.
• Beliefs on cervical cancer prevention; early education of the girl
child on vagina hygiene and avoidance of highly processed food
products.
• Beliefs on cervical cancer treatment; participants believed that
cervical cancer is one of the diseases not well managed in
hospitals in Ghana.
• Mistrusts for vaccines has been well spread across social media

37
BARRIERS: COST
• Average out of pocket cost: 65-70$, hence restricted
access to only few health centers.
• High cost of introducing new vaccines into the EPI, cost
for HPV estimated at more than $11 million despite its
cost effectiveness
• Ghana transitioning from GAVI support- struggled with
childhood immunization reported reduced coverage,
acute shortage of routine vaccines
• ? Sustainability issues: GAVI co-financing, donor support
subject to availability of funds, sustained political will
38
ENABLING FACTORS
• High acceptability of HPV vaccines in the general population and key
stakeholders
• Successful pilot: use of school based delivery, community outreaches,
communication strategies to improve the level of awareness amongst the
public
• MOH has memory: demonstrated rapid mobilization and effective
coordination amongst multiple sectors during the covax facility
• State led covid-19 awareness and vaccination strategy could be employed
• EPI has a well established infrastructure and framework for the distribution
of vaccines and EPI linkages with outreaches and community education
• Merging of reproductive cancers on a single platform such as the national
cancer program: non communicable disease

39
Why the moment is now?

40
IMPLEMENTATION
PHASE

41
 The two
presidents
: Ghana
and GAVI

42
APPROVAL
OF HPV
VACCINE
IN GHANA-
UNICEF

43
HPV VACCINES IN GHANA
• Initial doses shipped: 441,860
• Total doses: 2.5million doses
• 5- day national immunization campaign- September,
2025
• After campaign, vaccines will be free for girls turning
aged 9 years
• Vaccine approved: quadrivalent: Gardasil
• (UNICEF 2025)

44
NEXT STEPS

45
HPV • A lack of guiding policy/framework for the
HPV vaccination program

Vaccination • An emphasis on sexual history, cervical

screening, and HPV DNA test in determining

Pilot- Have vaccination eligibility by vaccinators

• A lack of formal provider and recipient HPV
we education programs
• Many vaccinators advocated for a universal
addressed HPV program, reluctance of some
policy/program leaders to prioritize HPV due
these issues! to their focus on acute health concerns.
• A vaccination program without a policy can
be limited in quality and efficiency, as there
will be no accountability and sustainability
measures.
• We recommend the need to develop
standardized guidelines to support evidence-
based HPV vaccination practice. (E Marfo et
al, 2024)
46
Supply and • Is the quantity enough
• Is the system available to reach public

logistics girls, not in school who are the most

vulnerable
• Is the system sustainable
• Our academic and research institutions:
technical support and advice
• NITAG, Vaccine institute
• NGOs, CSOs: IPVS, SOGOG, PSG,
SOFPOG
• MOH/MOF/GES/GENDER/

47
COMMUNICATI • Community engagement to spread the
knowledge of HPV and create demand
for the vaccine
ON • Communication tools to illustrate the

STRATEGIES link between HPV and cervical cancer

• Culturally sensitive messages to our
religious groups and families.
• Clear messages communication the
prevention of cervical cancer and the
elimination of HPV infection is key.
• Clear communication about current
national policy on single dose vaccine:
issues with efficacy, quality,
immunogenicity vrs cost
• HPV protection for both boys and girls
wholistic message

48
INTEGRATED • School based delivery : teacher training
is key, use of schoolteachers and head
teachers in rural areas
APPROACH IS • Community health nurses and
Community health and planning
KEY services (CHPS)-Community based and
outreach delivery
• Dedicated efforts by CSOs to target out
of school girls
• The ‘State’ or MOH to take the front row
in this campaign
• Professional societies and the general
public
• Utilization of existing EPI centers
• Cold chain supply well establish in all
districts in Ghana

49
Bringing the • Systematic review and meta-analysis of
HPV in men concluded

boys and men • “Almost one in three men worldwide are

infected with at least one genital HPV
type and around one in five men are
on board infected with one or more HR-HPV types.
Our findings show that HPV prevalence is
high in men over the age of 15 years and
support that sexually active men,
regardless of age, are an important
reservoir of HPV genital infection.” (Bruni
L et al, 2023)
• Men play a significant role in the health
behaviours of some Ghanaian women.
Cervical cancer education interventions
targeting Ghanaian men are needed to
correct misconceptions and increase
spousal support for cervical cancer
screening. (Williams and Amoateng,
2012)

50
ADVOCACY • Building awareness, educating
communities

STRATEGIES • Mobilizing local champions and support

of CSO/NGO/ In country partners
• Increasing acceptance, optimizing
uptake and coverage of the program
• Multi-media delivery platforms: TV,
Radio, social media, internet, billboards,
public address systems in markets,
community durbars
• Targeting women groups, religious
groups

51
IPVS- GHANA 2ND
National
Symposium-
One Less Worry

52
 National HPV vaccination was found to
be cost effective in all scenarios for
vaccination amongst 9 year old girls
alongside a one time catch up campaign
amongst 10-14 year olds with a bivalent
vaccine.
PROPOSED
IMPACT ON Despite high costs of about 11.2m to
GHANAIAN 15.4m depending on the doses and
type of vaccine
COMMUNITIE
S
About 11-15% of total estimated
immunization costs

53
CONTROVERSIE
S AND
UPDATES

54
Is single • Varying degrees of agreement
with respect to the type of
dose as vaccine and the time period of
immunogenicity. Differences
effective as 2 bother on protection against
or 3 doses infection rates, pre-cancer and
cancer
• Benard et al, 2023: population
level effectiveness of singlel dose
HPV Vaccine: one dose of routine
vaccination could avert most of
cervical cancer provided the
duration of protection is 20-30
years
• IARC News, 2025: 15 years
protection after single dose 55
Is single dose as
effective as 2 or 3 doses
• RCT- KENYA: Single dose of either bivalent or
nonavalent vaccines found to be 97.5% and
98.8% effective at 18months follow up
• RCT TANZANIA: Amongst 9-14 year old who
were vaccinated, non inferior immune response
for HPV 16/18 after 2 years following
vaccination
• COSTA RICA: 82.1% vrs 83/80.2% protection
after 11 years vaccination for single dose and
2/3 doses respectively
• INDIAN COHORT study (IARC): 10 years follow
up of single dose quadrivalent vaccine vrs 2/3
doses, no significant differences in incidence of
HPV infection.

56
Is single dose as
effective as 2 or 3 doses
• Systematic reviews:
• Single dose of quadrivalent and nonavalent vaccine
was just as efficient at preventing HPV16 and18
infections, further research required to evaluate
single dose bivalent vaccine( Bao et al, 2024)
• More than 50% of included studies concluded that
one dose vaccine offered similar vaccine
effectiveness
• Few studies indicated Ab protection at 4-8 years
and immune memory is not as high as 2 or 3 doses
• 3 studies out of the 23 mentioned that 1 dose
vaccine did not significantly reduce infection or
precancer compared to unvaccinated groups: more
studies required for definitive conclusion (Setiawan
D et al, 2024)

57
CONCLUSION • HPV is prevalent in the Ghanaian population
and has a strong association with cervical
cancer and premalignant lesions of the
cervix.
• There is high acceptability of vaccination
amongst the Ghanaian population
• Ghana has received HPV vaccines, and at
implementation phase of HPV vaccination
• Ghana has well established framework for
mobilization and distribution of vaccines
• Integrated approach is key to successful
uptake and vaccination program
• Single dose vaccine is as effective as double
dose vaccine at least for a minimum of 15
years
• The climate is ripe for HPV implementation
and elimination. Lets collaborate across all
sectors in public and private spaces in
Ghana
58
THANK YOU

59
REFERENCES

60
REFERENCES
• https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-
cancer
• de Martel C, Georges D, Bray F, Ferlay J, Clifford GM. Global burden of cancer
attributable to infections in 2018: a worldwide incidence analysis. Lancet Glob
Health. 2020 Feb;8(2):e180-e190. doi: 10.1016/S2214-109X(19)30488-7. Epub
2019 Dec 17. PMID: 31862245.
• Lewis, R. M., Laprise, J. F., Gargano, J. W., Unger, E. R., Querec, T. D., Chesson, H.
W., Brisson, M., & Markowitz, L. E. (2021). Estimated prevalence and incidence of
disease-associated HPV types among 15–59-year-olds in the United States.
Sexually Transmitted Diseases, 48(4), 273.
https://doi.org/10.1097/OLQ.0000000000001356
• Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, de Sanjosé S. Cervical
human papillomavirus prevalence in 5 continents: meta-analysis of 1 million
women with normal cytological findings. J Infect Dis. 2010 Dec 15;202(12):1789-
99. doi: 10.1086/657321. Epub 2010 Nov 10. PMID: 21067372.

61
REFRENCES CONT’D
• Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global
Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide
for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi:
10.3322/caac.21660. Epub 2021 Feb 4. PMID: 33538338.
• Olesen TB, Munk C, Christensen J, Andersen KK, Kjaer SK. Human papillomavirus
prevalence among men in sub-Saharan Africa: a systematic review and meta-
analysis. Sex Transm Infect. 2014 Sep;90(6):455-62. doi: 10.1136/sextrans-2013-
051456. Epub 2014 May 7. PMID: 24812407.
• Frazer IH. The HPV Vaccine Story. ACS Pharmacol Transl Sci. 2019 May 29;2(3):210-
212. doi: 10.1021/acsptsci.9b00032. PMID: 32259056; PMCID: PMC7089001.
• Akhatova A, Azizan A, Atageldiyeva K, Ashimkhanova A, Marat A, Iztleuov Y,
Suleimenova A, Shamkeeva S, Aimagambetova G. Prophylactic Human
Papillomavirus Vaccination: From the Origin to the Current State. Vaccines (Basel).
2022 Nov 11;10(11):1912. doi: 10.3390/vaccines10111912. PMID: 36423008;
PMCID: PMC9696339.

62
REFRENCES
• Amelor, Dodzi & Donkoh, Emmanuel & Asmah, R. &
Nortey, Priscilla & Oppong, Samuel & Wiredu, Edwin.
(2022). Human papillomavirus (HPV) genotypes and
associated cervical disease in an anti-retroviral setting in
Accra, Ghana. 10.21203/rs.3.rs-1386454/v2.
• Dawson RNT, Nartey NO, Kwamin F, et al. Human
papillomavirus DNA prevalence and type distribution in
oral squamous cell carcinoma in Ghana. Translational
Research in Oral Oncology. 2018;3.
doi:10.1177/2057178X18787127
•
63
REFRENCES
• Williams MS, Amoateng P. Knowledge and beliefs about
cervical cancer screening among men in Kumasi, Ghana.
Ghana Med J. 2012 Sep;46(3):147-51. PMID: 23661828;
PMCID: PMC3645156.
• Nartey Y, Amo-Antwi K, Osei-Ntiamoah B, et al. Knowledge of
Human Papillomavirus, Risk Factors and Screening for Cervical
Cancer Among Women in Ghana. Cancer Control. 2025;32.
doi:10.1177/10732748251323765
• Atiase, Y., Effah, K., Mawusi Wormenor, C. et al. Prevalence of
high-risk human papillomavirus infection among women with
diabetes mellitus in Accra, Ghana. BMC Women's Health 24,
260 (2024). https://doi.org/10.1186/s12905-024-03078-z
64
REFRENCES
• Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D,
Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC Information Centre
on HPV and Cancer (HPV Information Centre). Human
Papillomavirus and Related Diseases in Ghana. Summary Report
10 March 2023. [Date accessed: 26 June 2025]

• Osei, Evans & Oti-Boadi, Ezekiel & Stella, Appiah & Bakkari,
Mohammed & Menka, Manuela & Awuah, Dorothy & Kontoh,
Samuel & Menlah, Awube & Garti, Isabella & Boateng, Susana.
(2023). Acceptance of HPV vaccination in boys among mothers
from selected churches in Accra, Ghana. BMC Public Health. 23.
10.1186/s12889-023-16028-5.
65
REFRENCES
• https://www.unicef.org/ghana/press-releases/ghana-receives-its-first-shipment-human-papil
lomavirus-hpv-vaccine
• Asakitogum, D. A., L. Aziato, et al. (2023). "Ghanaian women beliefs on the causes,
prevention and treatment of cervical cancer: A qualitative Study." International Journal of
Africa Nursing Sciences 18: 100538.
• International Vaccine Access Center (IVAC), HPV Vaccine Progress and Next Steps for
Advocacy in Ghana: Findings from Key Informants, IVAC at the Johns Hopkins Bloomberg
School of Public Health, Baltimore, June 2023.
• Coleman, Maame & Levison, Judy & Sangi-Haghpeykar, Haleh. (2011). HPV vaccine
acceptability in Ghana, West Africa. Vaccine. 29. 3945-50. 10.1016/j.vaccine.2011.03.093.
• Bénard, É., M. Drolet, et al. (2023). "Potential population-level effectiveness of one-dose
HPV vaccination in low-income and middle-income countries: a mathematical modelling
analysis." The Lancet Public Health 8(10): e788-e799.
• Gupta, S., Basu, S., & Banerjee, R. (2024). Efficacy of single-dose HPV vaccine over no
vaccination and standard multiple dose regimen: a systematic review and meta-analysis of
available evidence. The Evidence, 2(2). https://doi.org/10.61505/evidence.2024.2.2.71

66
REFRENCES
• Elisabeth Vodicka, Justice Nonvignon, Kwadwo Odei Antwi-Agyei, John
Bawa, Andrew Clark, Clint Pecenka, D. Scott LaMontagne, The projected
cost-effectiveness and budget impact of HPV vaccine introduction in
Ghana, Vaccine, Volume 40, Supplement 1,2022,Pages A85-A93,ISSN
0264-410X.
• Setiawan D, Nurulita NA, Khoirunnisa SM, Postma MJ. The clinical
effectiveness of one-dose vaccination with an HPV vaccine: A meta-
analysis of 902,368 vaccinated women. PLoS One. 2024 Jan
5;19(1):e0290808. doi: 10.1371/journal.pone.0290808. PMID:
38180991; PMCID: PMC10769028.
• Bao, W., He, X., Huang, Y., Liu, R., & Li, Z. (2024). The Clinical
Effectiveness of Single-Dose Human Papillomavirus
Vaccination. Vaccines, 12(9), 956.
https://doi.org/10.3390/vaccines12090956
67