Elin Larsson

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.

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.

Postpartum care represents a key opportunity to improve women’s sexual, reproductive health and rights (SRHR), as it facilitates women’s choice of effective contraceptive methods. This, in turn, supports birth spacing and indirectly prevents unintended pregnancies and abortions. In European studies, immigrant women report lower use of effective contraception, higher fertility rates, unintended pregnancies and abortions compared to native-born women.In Sweden, the rate of repeat abortions is increasing among women of childbearing age. Among women who did not intend to have more children, 32% chose to use less effective or no contraception, reflecting the need for improved counseling.  Almost 1/3 of women giving birth in Sweden are immigrants.The IMPROVE project aims to promote SRHR equity and improve immigrant women’s choice of effective postpartum contraceptive methods. The project will involve cooperation between immigrant women and men and health care professionals. Immigrant women and men from the largest immigrant groups in Sweden will be included in focus group discussions on reproductive decision making, contraception, how to involve partners and how to improve postpartum contraceptive services (Study 1).Using a cluster randomized trial with a process-evaluation, informed by the results from study 1, we aim to enhance contraceptive services for immigrant women by evaluating a Quality Improvement Collaborative through registration of contraception in the Swedish Pregnancy Register (Study 2).By combining qualitative studies, and a cluster randomized controlled trail with process evaluation, we will gain an in-depth understanding of how to improve contraceptive services with and for immigrant women, and how best to involve partners when seeking to support immigrant women’s choice of effective postpartum contraceptive methods.