Anna Kågesten

Anna Kågesten

Assistant Professor | Docent
Telephone: +46852482826
Visiting address: Widerströmska huset Tomtebodavägen 18 A, plan 3, 17165 Solna
Postal address: K9 Global folkhälsa, K9 GPH Ekström Kågesten, 171 77 Stockholm
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About me

  • Associate Professor in Global Health with focus on Sexual and Reproductive Health and Rights (SRHR) and Adolescent Health. Teamleder within the Global and Sexual Health research group at the Department of Global Public Health, Karolinska Institutet. 15+ years research and technical experience in advacing SRHR globally with focus on adolescents and young people.

    Previous professional experience as a research consultant to several international organizations including the World Health Organization (WHO). I also have experience working with SRHR within the Swedish health-care system and improving the quality of sexuality education in Swedish schools.


    Education
    PhD from the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health (2017)
    Master of Public Health (MPH) in epidemiology and global health from the Johns Hopkins Bloomberg School of Public Health (2012).
    Bachelor of Public Health from the University of Gothenburg (2007).

    Academic honours, awards and prizes
    Phi Beta Kappa, Johns Hopkins Bloomberg School of Public Health (2017)
    Delta Omega Public Health Honor Society, Johns Hopkins Bloomberg School of Public Health (2017)
    Caroline Cochrane Award for Population and Reproductive Health (2015)
    Daphne Purves Award, Graduate Women International (2014)
    Fellowship in Family Planning, Johns Hopkins Bloomberg School of Public Health (2013, 2014, 2016)
    International Peace Scholar, P.E.O International (2011, 2012)
    Fulbright Grant, Fulbright Commission Sweden (2011)

Research

  • My research focuses on the intersection between social and structural determinants of health, such as gender inequality and empowerment, with sexual and reproductive health and rights (SRHR). The overall aim of my research is to promote SRHR among young people and vulnerablized populations, by generating evidence to inform policy and optimize interventions that are accessible, acceptable and sustainable within resource-limited contexts. I am particularly interested in 1) understanding the complexities, disparities and drivers of gender norms, violence and its link with SRHR among young people in resource-limited contexts; 2) optimizing implementation and evaluation of interventions to promote sexual health and wellbeing among younger as well as older adolescents; 3) improving measurement and monitoring of SRHR and other sensitive topics that are critical to advance health and wellbeing.

    I use quantitative and qualitative methods to explore a broad range of topics related to SRHR, such as determinants of teenage pregnancy in low-income settings, norms and values related to gender and sexuality, sexual- and gender-based violence, HIV prevention, fertility intentions,   sexual wellbeing, sexual risk-taking and early sexual debut, and interventions to improve adolescent SRHR. Most of my research is located in low- and lower-middle income countries and I have been part of several multi-county studies spanning sub-Saharan Africa, South and South-East Asia, South America, North America and Western Europe.

    I have a PhD from the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health with a focus on adolescent reproductive health and epidemiology (2017), and a Master in Public Health from the same institution (2012).

    Areas of expertise include:

    • Sexual and reproductive health and rights
    • Adolescent health
    • Teenage pregnancy
    • Very young adolescents (10-14 years)
    • Sexual and gender-based violence
    • Social and gender norms
    • Epidemiology
    • Mixed-methods research
    • Implementation research
    • Systematic and scoping reviews

    I am co-chair of the Global Action for Measurement of Adolescent Health (GAMA) Advisory Group, led by the WHO in collaboration with the UN H6+ partnership agencies (UNAIDS, UNESCO, UNFPA, UNICEF, UN Women, the World Bank Group, and the World Food Programme). Additionally, I am an expert member of the WHO Sexual Health and Well-Being Advisory Group (SWAG). 


    Current main projects and collaborations:


    ENding HIV transmission to infants by Generating Evidence to optimize prevention and care for pregnant and postpartum Adolescent Girls and young women with HIV (ENGAGE): I am the PI for this 5-year project which seeks to optimize prevention of vertical HIV transmission care for pregnant and postpartum adolescent girls and young women in Tanzania. In collaboration with our co-investigators at Management Development for Health in Tanzania, we will use data from a large registry-based cohort of pregnant and postpartum girls and young women with HIV, and combine this with evidence reviews and qualitative interviews to better understand the needs of most-at-risk AGYW. Findings will be used to co-design and test an intervention package that can be easily implemented in routine healthcare to optimize prevention of vertical HIV transmission services (VR funded 2023-2027). 

    GLOBE-HPV: multi-country study funded by the Gates Foundation, aiming to estimate the burden of HPV as well as barriers to prevention/treatment among girls and women countries without national HPV vaccination programs. I am the KI lead investigator for this study which is led by the the International Vaccine Institute in collaboration with London School of Hygiene and Tropical Medicine and collaborators in eight countries (Bangladesh, Nepal, and Pakistan, the Democratic Republic of the Congo, Ghana, Sierra Leone, Tanzania, and Zambia). KI is leading the qualitative sub-studies to further understand how gender-related dynamics create barriers to HPV prevention, screening, and treatment services. Read more about the project here: https://news.ki.se/funding-for-global-study-on-hpv-burden-among-girls-and-women

    BUDDY study: Collaboration with the Desmond Tutu Health Foundation on a project to assess the impact of the COVID-19 crisis on gender-based violence among young people living with and without HIV in South Africa. This includes a PhD project to evaluate the effect of a school-based primary prevention intervention to prevent gender-based violence during times of public health crises (VR funded 2020-2022, extended).

    HPV-END-IT: I am a co-investigator on this project which seeks to address HPV vaccine hesitancy by co-designing a digital health intervention with and for socioeconomically disadvantaged adolescents and parents/guardians in Sweden (FORTE funded 2024-2027)

    Selected other projects

    Research project in Argentina focusing self-managed community-based abortion in collaboration with CEDES and CREP in Argentina, World Health Organisation in Geneva, and RIVM in the Netherlands (PI: Amanda Cleeve, VR funded)

    Explore4Action, evaluation of the comprehensive sexuality education programme Setara in Indonesia together with Rutgers International (Gates foundation funded)

    Norms and values related to gender & SRHR in four sub-Saharan African countries together with World Values Survey and Expertbyrån för biståndsanalys

    Prevention of sexual and gender-based violence among adolescents in Kenya, Malawi and South Sudan

    Sexual wellbeing and consent among young people in Ecuador and Uganda, collaboration with Plan International and Rutgers International: https://plan-international.org/publications/young-people-sexual-wellbeing-consent/

    Women's economic empowerment India, collaboration with the World Values Survey, University of California San Diego and Gates Foundation

    WelTel PMTCT randomised controlled trial in western Kenya

    SRHR knowledge, attitudes and behaviours among newly-arrived migrants in Stockholm

Teaching

    • Course leader, Synthesizing and Applying Evidence, 6 credits, KI - starting fall 2026 as part of the new 2-year Master of Global Health program
    • Course leader, International Adolescent Health, 6 credits, Johns Hopkins Bloomberg School of Public health
    • Course leader, Human Rights and International Organizations in a Global Health Perspective, 7.5 credits, KI
    • Course development, Planning and design of public health interventions, 7.5 credits, Stockholm University in collaboration with KI
    • Lecturer at graduate and undergraduate levels on topics related to SRHR, gender norms and health, adolescent health and SRHR, human rights, systematic reviews, peer-reviewing, etc.
    • Supervision for several doctoral students (3 as main supervisor, 2 as co-supervisor) and master students

Selected publications

Articles

All other publications

Grants

  • Swedish Research Council for Health Working Life and Welfare
    1 January 2024 - 31 December 2026
    The human papillomavirus (HPV) is responsible for most cervical and anogenital cancers. The HPV vaccine can effectively reduce invasive cervical cancer
    however, HPV vaccine uptake is low in certain groups due to hesitancy and refusal, which undermines the success of the vaccine. In Sweden, HPV vaccine hesitancy has mainly been observed among parents and adolescents in socioeconomically disadvantaged communities with large immigrant populations.The purpose of this project is therefore to co-design and assess the feasibility and preliminary effects of digital health intervention tools to reduce HPV vaccine hesitancy and increase uptake of this vaccine in socioeconomically disadvantaged communities in Stockholm, Sweden. Several research questions shall assess whether a co-designed digital health intervention has the potential to improve HPV uptake, awareness and confidence.The project involves three sub-studies implemented by an interdisciplinary team.  Study 1 will involve a formative stage whereby adolescents, parents/guardians and school nurses situated in socially disadvantaged areas in Stockholm will be interviewed to understand their perspectives and concerns related to the HPV vaccine. Thereafter, study 2 will use knowledge gained from study 1 to inform the co-design phase where adolescent boys/girls and their parents/guardians are invited to develop and provide feedback on content and prototypes for digital health interventions. Finally, study 3 will involve pilot-testing of the intervention for feasibility, acceptability and preliminary effect, using a cluster-randomized design.This project is highly feasible as it builds on the study team’s previous research, which show that immigrant communities in Sweden experience poorer health outcomes as well as vaccine hesitancy. Because 1 in 5 Swedes have a migrant background this study is relevant to Swedish society. An appropriate and accessible digital health intervention has the potential to prevent cervical cancer, saving lives and reducing future burdens on an overstretched Swedish healthcare system. The results from this project will be generalizable to similar contexts in Sweden and possibily beyond.
  • Swedish Research Council
    1 January 2023 - 31 December 2025
    Reports warn of serious pandemic harm on adolescent girls´ and young womens´ (AGYW, 13-24 yrs) lives including on their reproductive health in Africa. The specific aims of this project are to: 1) evaluate the impact of COVID-19 societal restrictions including school closures on unintended pregnancy and contraceptive use among AGYW, and estimate the long-term societal cost of these restrictions in Uganda (Study 1)
    2) explore AGYWs’ and other key stakeholders’ understanding of risk factors and underlying reasons for unintended pregnancies and low contraceptive use in the wake of the pandemic and beyond (Study 2)
    3) co-design a resilient intervention package aiming to reduce unintended pregnancies and improve contraceptive use among AGYW (Study 3)
    and 4) implement and test the intervention package using a cluster-randomized design. Data will be drawn from a large population cohort (rural/urban, &lt
    20,000 people) including intervention outcomes as well as additional quantitative and qualitative data collection. The project is expected to take 3 years and is a collaboration involving a very experienced and skilled team of Swedish and Ugandan researchers who earlier received a joint VR Links grant. The project is anticipated to yield high quality unique evidence about the impact of pandemic restrictions, including extensive school closures on AGYWs. The expected results will contribute to better resilience and pandemic preparedness in resource-poor health systems across Africa.
  • Swedish Research Council
    1 December 2022 - 30 November 2026
    In sub-Saharan Africa, adolescent girls and young women (AGYW) aged 15-24 years are more likely than older women to acquire HIV, and once pregnant, to transmit HIV to their infants and drop out of care. This highlights an urgent need to revisit the current one-size-fits-all model of prevention of mother-to-child transmission (PMTCT) programs. The purpose of this project is to optimize PMTCT care for AGYWs, and later their infants, in Tanzania – a setting where HIV remains endemic. To do so, we will use data from a large registry-based cohort (N≈13,800 with 22% 15-24 years) to investigate PMTCT service uptake, retention and health outcomes for AGYWs, as well as subsequent pregnancies and contraceptive use (study 1). We will combine this with a nested prospective cohort to identify social-structural predictors of these outcomes (study 2). We will utilize findings to develop (together with young women, health providers and managers) and prototype a package of micro-interventions that can be implemented in routine care to optimize PMTCT services for AGYWs. Using a cluster-randomized design, we will pilot-test the intervention package for feasibility and preliminary effect, as well as cost-effectiveness.  This five-year project is highly feasible considering the multidisciplinary team with skills and experience in both implementation and experimental research, and will contribute much-needed evidence to advance PMTCT care for AGYWs in line with their unique needs.
  • Swedish Research Council
    1 January 2021 - 31 December 2023
  • Swedish Research Council
    1 January 2020 - 31 December 2022

Employments

  • Assistant Professor, Department of Global Public Health, Karolinska Institutet, 2020-2027

Degrees and Education

  • Docent, Karolinska Institutet, 2023

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