ABSTRACT Cervical cancer is a major cause of morbidity and mortality in many sub-Saharan countries, including Nigeria. Expanding human papillomavirus (HPV) vaccination for young girls/women, ages 9-26 years (primary prevention) and HPV self-collection for cervical cancer screening for older women, ages 30-49 (secondary prevention) are both critical to achieving WHO and Nigerian goals for reducing the cervical cancer burden. The Nigerian government now recommends HPV vaccination and self-collection, yet uptake is poor. As such, context-specific, targeted and culturally relevant implementation strategies are needed. We focus on HPV vaccination among girls and self-collection among women because of the substantial burden of cervical cancer. Mother-daughter relationships in Nigeria can be leveraged to increase HPV vaccination uptake among young girls and HPV self-collection among mothers. Mothers (or similar female caregivers) profoundly influence decisions and preferences about young girls’ vaccine uptake in the Nigerian cultural context. At the same time, maternal choices about HPV self-collection can be reinforced in discussions with their daughters. In the proposed study, Actions for Collaborative Community-Engaged Strategies for HPV (ACCESS-HPV), we will use participatory crowdsourcing methods to drive HPV prevention among mother-daughter dyads. Crowdsourcing open calls will allow us to identify locally relevant messages and dissemination techniques to increase uptake of HPV prevention. Then, participatory learning communities will build capacity for community- led implementation of selected strategies. Informed by social learning theory and the PEN-3 cultural model, our multi-disciplinary research team proposes the following specific aims: (1) to develop a new combined campaign to increase HPV vaccination for young girls (ages 9-26) and HPV self-collection for mothers (ages 30-49) using crowdsourcing open calls and participatory learning communities; (2) to determine the effectiveness of a final combined campaign on uptake of HPV vaccination among young girls/women and HPV self-collection among their mothers using a stepped-wedge randomized controlled trial; (3) to estimate the impact and cost-effectiveness of the crowdsourced campaign. Our primary outcome will be vaccine uptake (ascertained by clinic records of vaccine uptake) among young girls and HPV self-collection (ascertained by laboratory receipt of specimens) among their mothers. The strong support of the Nigerian Institute for Medical Research (NIMR) alongside national HPV programs creates a rich research infrastructure and increases the likelihood of successful implementation. Our multi-disciplinary research team has experience organizing implementation research focused on crowdsourcing and community participation in Nigeria. This study will enhance our understanding of HPV prevention in resource-constrained settings. This grant application directly responds to strategic priorities of the United States government, the National Institutes of Health, the National Cancer Institute, and NOT-CA-20-025.

PUBLIC HEALTH RELEVANCE Although there is a substantial burden of cervical cancer among Nigerian women, there are significant gaps in implementing both primary and secondary HPV prevention strategies. The study will engage young girls and their mothers to increase uptake of essential HPV prevention services. The findings from this study will be relevant to other resource-constrained settings that are expanding HPV vaccination and screening programs.