Attitudes, Practices, and Beliefs About Human Papillomavirus Vaccine Among Young Adult African-American Women: Implications for Effective Implementation

Cervical cancer is both a preventable and treatable disease. Racial and ethnic minorities and those of low-socioeconomic status tend to experience the greatest morbidity and mortality due to cervical cancer. Vaccination against the human papillomavirus (HPV) has been shown to prevent cervical cancer and genital warts, and subsequently reduce the number of women requiring follow-up and treatment of abnormal Pap Tests. There is relatively little published evidence to assess acceptance and utilization of the HPV vaccine among minority and low socioeconomic groups. The purpose of this study was to generate knowledge and inform policy considerations to reduce cervical cancer incidence and mortality by use of the HPV vaccine among African-American women, aged 18-26. A qualitative descriptive study design sought to characterize the barriers to, and potential facilitators of HPV vaccine introduction to young adult African-American women, aged 18-26, while recommending strategies for implementation. The study comprised a mix of both primary and secondary data collection and analysis methods. Interviews were conducted with stakeholders demonstrating expertise in cervical cancer prevention and an assessment of the literature on vaccines, diffusion of innovation, and policy adoption was conducted to inform policy alternatives to promote receipt of the vaccine among the target group. Several overarching themes emerged to suggest factors that might deter or promote use of the vaccine including: mistrust of government, access to vaccination, attitudes about health, varying opinions regarding HPV vaccine guidelines, social determinants contributing to cervical cancer disparities, and a comprehensive strategy for introducing vaccination among others. Strategic recommendations to support implementation of HPV vaccination catch-up programs, specifically designed for African-American women, aged 18-26, include addressing gaps in knowledge thru expansion of a cervical cancer prevention social marketing educational campaign to Historically Black Colleges and Universities (HBCU's) and enhancing access by evaluating how best to integrate HPV immunization and cervical cancer screening delivery. These findings confirm that introduction of HPV vaccination to African-American women will require an incremental and targeted approach, and can be used by public health officials and policy-makers as they strive to improve the overall quality and delivery of cervical cancer prevention services

Community-based surveillance advances the Global Health Security Agenda in Ghana.

Ghana Health Service (GHS) has strengthened community-based surveillance (CBS) to facilitate early detection and rapid reporting of health events of all origins. Since June 2017, GHS has employed an event-based surveillance approach at the community level in a phased manner. CBS coverage has broadened from 2 to 30 districts across Ghana. Through this effort, capacity was built across all administrative levels in these districts to detect, report, triage, and verify signals, and to perform risk assessment and investigate events. Data were collected and analyzed during an evaluation of initial 2-district implementation in March 2018 and during expanded 30-district implementation in March 2019. Between September 2018 and March 2019, 317 health events were detected through CBS. These events included vaccine-preventable disease cases, acute hemorrhagic conjunctivitis outbreaks, clusters of unexpected animal deaths, and foodborne illness clusters. Eighty-nine percent of the 317 events were reported to district-level public health staff within 24 hours of detection at the community level, and 87% of all detected events were responded to within 48 hours of detection. CBS detected 26% of all suspected vaccine-preventable disease cases that were reported from implementing districts through routine disease surveillance. GHS strengthened CBS in Ghana to function as an early warning system for health events of all origins, advancing the Global Health Security Agenda

Strengthening laboratory surveillance of viral pathogens: Experiences and lessons learned building next-generation sequencing capacity in Ghana

Objective: To demonstrate the feasibility of applying next-generation sequencing (NGS) in medium-resource reference laboratories in Africa to enhance global disease surveillance. Methods: A training program was developed to support implementation of NGS at Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana. The program was divided into two training stages, first at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA, followed by on-site training at NMIMR for a larger cohort of scientists. Results: Self-assessment scores for topics covered during the NGS training program were higher post-training relative to pre-training. During the NGS Training II session at NMIMR, six enterovirus isolates from acute flaccid paralysis cases in Ghana were successfully sequenced by trainees, including two echovirus 6, two echovirus 11 and one echovirus 13. Another genome was an uncommon type (EV-B84), which has not been reported in Africa since its initial discovery from a Côte d’Ivoire specimen in 2003. Conclusions: The success at NMIMR provides an example of how to approach transferring of NGS methods to international laboratories. There is great opportunity for collaboration between institutes that have genomics expertise to ensure effectiveness and long-term success of global NGS capacity building programs. Keywords: Next-generation sequencing, Molecular surveillance, West Africa, Enteroviru