The Mother-Daughter Initiative (MDI) is a research collaboration by Jhpiego – affiliate of Johns Hopkins University with the Philippines and Thailand that test the feasibility and acceptability of a strategy to deliver comprehensive cervical cancer prevention services by integrating the HPV vaccine for girls ages 9-13 into already successful screening and treatment programs for mothers.
In the Philippines, the goal was to: 1) vaccinate 50% of 9-13-year-old girls in 3 established CECAP sites namely Los Banos, Laguna; Minglanilla, Cebu; and Pagbilao, Quezon;2) Assess the mothers’ acceptability of their daughter receiving all 3 doses after the mothers are screened or treated for cervical pre-cancer; and3) Share the information and experiences from this research that would encourage women to bring their daughters for vaccination while undergoing cancer screening.
The study started in September 2010, and finalized in November 2012.The number of girls given the 1st dose was – 4000 (1,333 in Los Banos, 1,334 in Mingnallia and 1,333 in Pagbilao); 3,847 girls for the second dose (1,301 in Los Banos, 1,334 in Mingnallia and 1,212in Pagbilao) 96.18% of the first batch vaccinated, and 3,524 or 88.1% for the third dose (1,278 in Los Banos, 1,334in Mingnallia and 912 in Pagbilao).
Meanwhile, screening, treatment and participation on other activities for women took place from February 2011 to June 2012. The number of Women screened for cervical cancer were 7,310 in total – 3,867 in Los Banos, 1,747 in Minglanilla, and 1,696 in Pagbilao. 10, 5 and 5 women in Los Banos, Minglanilla and Pagbilao respectively were treated for pre cancerous lesion. For other CECAP promotion activities, 13,674, 1,858, 2,441 people participated in Los Banos, Minglanilla and Pagbilao respectively – with 17,973 participants in all.
Over the duration of the MDI project, the challenges faced were 1) the existence of myths and misconceptions (such as rumours that HPV vaccines were an abortifacient and could cause infertility) causing hesitation on the part of potential participants; 2) the securing of consent from legal guardians especially when the parents were not present; 3) the coinciding HPV vaccination and school schedules; 4) the heavy workload of providers; 5) the accessibility for girls in geographically isolated areas; 6) severe weather conditions; and 7) adverse events or pregnancy cases.
Despite the challenges, the MDI implementation phase in the Philippines was satisfactorily completed; 4,000 young girls received HPV vaccines. With 88% of the girls that received the first dose also completing the full three dose schedule; 300 HPV Knowledge and Intention Interview and 400 Post Dose HPV Vaccine Interview were conducted and completed; 17,973 individuals participated in CECAP awareness campaign activities; and 7,310 women aged 25-45 went for cervical cancer screening and 20 received treatment for precancerous lesion.