HPV Vaccination in HIV Infected and HIV Uninfected Adolescents in Eswatini


This is a multi-site, open-label non-inferiority study of the 9vHPV vaccine among a population of children, adolescents and young women living with HIV in Eswatini. This protocol seeks to assess immunogenicity of a two-dose 9vHPV vaccine regimen among girls and boys (9-14 years) and young women (15-26 years) living with HIV on antiretroviral therapy versus a three-dose 9vHPV vaccine regimen among HIV uninfected young women (15-26 years) in Eswatini. The secondary objectives include examining the safety profiles of the two-dose 9vHPV regimen in those living with HIV and the three-dose 9vHPV regimen in HIV-uninfected young women, as well as measuring the completion of the vaccination series among those living with HIV and those who are not infected with HIV.

Full Title of Study: “A Multi-site, Open-label Non-inferiority Trial to Assess Immunogenicity of Two Doses of the Nonavalent Human Papillomavirus (HPV) Vaccine Among Children, Adolescents and Young Adults (9-26 Years) Living With HIV vs Three Doses of Nonavalent HPV Vaccine Among HIV Uninfected Young Women (15-26 Years) in Eswatini”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Non-Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Prevention
    • Masking: None (Open Label)
  • Study Primary Completion Date: May 31, 2023

Detailed Description

Cervical cancer remains a significant threat to public health worldwide and remains the leading cause of cancer-associated mortality in women in Sub Saharan Africa. Cervical cancer-associated morbidity and mortality is preventable through HPV vaccination, and screening and treatment of pre-cancerous lesions. To date, there is no nationwide HPV vaccination program in Eswatini and the country is not eligible for Global Alliance for Vaccines and Immunization (GAVI) procurement of HPV vaccines, and yet the triad of HIV, sexually transmitted infections (STI) and cervical cancer generates a severe disease burden warranting immediate introduction of this intervention. Given the global limitations in vaccine supply and the high cost for procurement, country programs, including in Eswatini, must optimize vaccine resources in order to maximize HPV vaccine coverage.


  • Biological: Gardasil ® 9
    • GARDASIL 9 is a vaccine indicated in girls and women 9 through 45 years of age for the prevention of the following diseases: Cervical, vulvar, vaginal, and anal cancer, and Genital warts (condyloma acuminata) caused by Human Papillomavirus (HPV). 0.5-mL suspension for intramuscular injection as a single-dose vial and prefilled syringe at the following regimen/schedule: 9 through 14 years – 2-dose at 0, 6 to 12 months OR 3-dose at 0, 2, 6 months 15 through 45 years – 3-dose at 0, 2, 6 months

Arms, Groups and Cohorts

  • Experimental: 2-dose regimen group
    • Boys and girls (aged 9-14 years) and young women (aged 15-26 years) living with HIV will receive a two-dose regimen of the HPV vaccine at baseline (Month 0) and Month 6.
  • Active Comparator: 3-dose regimen group (SOC)
    • HIV-uninfected young women (aged 15-26 years) will receive the standard of care three-dose regimen of the HPV vaccine at baseline (Month 0), Month 2 and Month 6.

Clinical Trial Outcome Measures

Primary Measures

  • Anti-HPV geometric mean antibody titers
    • Time Frame: Month 7 (4 weeks post Month 6 vaccine dose)
    • Serum antibodies against HPV antigens (IgG, IFNg, TNF, IL2, CXCL10, granzyme, perforin, PTX3). Geometric mean titers will be summarized by treatment group, and the ratios of mean GMTs between treatment and control and their 95% confidence intervals calculated around point estimates.
  • Number of seroconversions
    • Time Frame: Month 7 (4 weeks post Month 6 vaccine dose)
    • Number of participants who seroconvert, defined as having no HPV antibodies pre-vaccination, but detectable HPV antibodies at 4 weeks post month 6 vaccine dose

Secondary Measures

  • Number of participants with serious adverse events (SAE)
    • Time Frame: Up to 6 months
    • Number of participants who reported experiences of SAE. SAE is defined as those that experienced death, life-threatening conditions or hospitalizations.
  • Number of participants completing vaccination series
    • Time Frame: Up to 6 months
    • Number of eligible participants completing the 2-dose or 3-dose regimens will be tallied.

Participating in This Clinical Trial

Inclusion Criteria

For people living with HIV receiving two-dose regimen:

  • Females 9-26 years and males 9-14 years, – Documented HIV infection, – Aware of HIV+ status, – Currently receiving antiretroviral treatment (ART) for HIV infection for at least six months, – Living in Eswatini, – For individuals 18+ years: able to provide informed consent, – For individuals 15-17 years: able to provide informed assent, – For individuals 9-14 years of age: able to provide informed assent AND accompanied by an adult caregiver who is able to give informed consent, – Intending to remain in the vicinity of the study sites for the study period For reference group of HIV-uninfected women receiving three-dose regimen: – Females 15-26 years, – Documented negative HIV test at baseline – Living in Eswatini, – Able to provide informed assent (15-17 years) or informed consent (18-26 years) – Intending to remain in the vicinity of the study sites for the study period Exclusion Criteria:

For all participants:

  • Diagnosis of other immunosuppressive diseases or receipt of immunosuppressive medications, – Diagnosis of other acute or chronic illness, – Receipt of other vaccinations within 2-3 weeks before or after study vaccination, – Receipt of blood-derived products within 6 months before or during the study, – Previous receipt of an HPV vaccine, – Currently pregnant, – Known allergies to a vaccine component

Gender Eligibility: All

Minimum Age: 9 Years

Maximum Age: 26 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Columbia University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Elaine J. Abrams, MD, Professor of Pediatrics and Epidemiology – Columbia University
  • Overall Official(s)
    • Elaine Abrams, MD, Principal Investigator, Columbia University
    • Xolisile Dlamini, Principal Investigator, Ministry of Health, Eswatini
  • Overall Contact(s)
    • Harriet Nuwagaba-Biribonwoha, MD, PhD, +268 24045797, hn2158@cumc.columbia.edu

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