Building HPV vaccine confidence through codesigned interventions with and for healthcare workers in Nigeria: protocol for a pilot cluster randomised controlled trial

The human papillomavirus (HPV) vaccine can effectively prevent cervical cancer, yet HPV vaccine uptake is particularly low in some low-income settings, due to supply and vaccine confidence barriers. HPV vaccine confidence has also been found to be lacking among healthcare workers in some countries, including Nigeria. Nigeria has a long history of low vaccine confidence in some parts of the country. HPV vaccine rumours and concerns have been observed throughout the country, including among healthcare workers. Interventions that specifically address healthcare workers’ vaccine confidence are limited, since vaccine confidence is often assumed among this group. The aim of our pilot cluster randomised control trial (cRCT) is to evaluate the feasibility of conducting a trial that evaluates codesigned interventions to improve HPV vaccine confidence in healthcare workers and the acceptability and feasibility of delivering this intervention. This is a 3-arm pilot cRCT, using a mixed-methods approach to assess the feasibility of the trial design, alongside the feasibility and acceptability of intervention delivery in two states in Nigeria (Jigawa and Oyo). We will implement two interventions: one with a focus on digital delivery, and one with an HPV champion present at a health facility. Both will be compared with a control arm, providing standard information on HPV vaccine only. Overall, 12 trial clusters (six in Jigawa and six in Oyo), defined as government primary healthcare facilities, will be randomised using a 1:1:1 ratio, stratified by state. All healthcare workers within these facilities will be eligible to take part in the intervention and evaluation. The primary outcome of interest will be intervention uptake, as a measure of subsequent trial feasibility given concerns around contamination in control clusters. This will be assessed through an endline healthcare worker survey. Intervention feasibility and acceptability will be assessed through quantitative intervention monitoring and qualitative interviews with healthcare workers. Ethics and dissemination: We received approval from Jigawa State Ethics Committee (ref: JGHREC/2023/151), Jigawa Ministry of Health (ref: MOH/PH/PHRAT/MN/23/003), Oyo State Research Ethics Review Committee (ref: AD/13/479/362A), The University of Ibandan and University College Hospital Research Ethics Committee (UI/UCH Ethics Committee) (ref: UI/EC/23/308) and from the Swedish National Ethics Review Board (2023-04772-01-471058). Data will be presented in manuscript form and submitted to relevant conferences for dissemination. Registration details: The pilot trial has been registered with ISRCTN—the UK’s Clinical Study Registry, registration numberISRCTN37847119.