Grant: Operating Grant

In Canada, human papillomavirus (HPV) is responsible for roughly 3000 new cervical, vaginal, vulvar, penile, anal and head/neck cancers each year. The burden of HPV-related diseases is higher in regions with higher poverty and lower education, and among immigrants and men-who-have-sex-with-men (MSM). Recently, school-based HPV vaccination programs for girls were implemented across Canada at an annual cost of more than $100 million. However, failure to vaccinate girls most at risk of infection and disease (e.g., lower SES, immigrants) could mitigate the anticipated population level benefits of HPV vaccination and accentuate existing health inequalities. Furthermore, other groups such as boys, MSM and older females are not currently included in HPV vaccination programs, producing inequalities. Very few modeling studies have attempted to identify optimal HPV vaccination and screening strategies in terms of cost-effectiveness, and none in terms of reduction in inequalities. To fill this important gap in knowledge, our multidisciplinary team will use state-of-the-art transmission-dynamic modelling techniques combined with high-quality data to answer the following key questions: 1) What is the population-level effectiveness and cost-effectiveness of current HPV vaccination programs? 2) What is the impact of these programs on inequalities? 3) What are the most effective and cost-effective vaccination and screening strategies to reduce HPV-related burden of disease and inequalities? The proposed research will make important methodological contributions as transmission-dynamic models have yet to examine issues related to inequalities following immunization. More importantly, our analysis directly addresses the needs of policy-makers for evidence on equity, in addition to effectiveness and cost-effectiveness. Ultimately, our results will be translated into customized messages to help policymakers optimize HPV vaccination and screening programs, and reduce inequalities.