Background: Poor access to immunisation services remains a major barrier to achieving equity and expanding vaccination coverage in many sub-Saharan African countries. In Kenya, the extent to which spatial access affects immunisation coverage is not well understood. The aim of this study was to quantify spatial accessibility to immunising health facilities and determine its influence on immunisation uptake in Kenya while controlling for potential confounders. Methods: Spatial databases of immunising facilities, road network, land use and elevation were used within a cost friction algorithim to estimate the travel time to immunising health facilities. Two travel scenarios were evaluated; (1) Walking only and (2) Optimistic scenario combining walking and motorized transport. Mean travel time to health facilities and proportions of the total population living within 1-h to the nearest immunising health facility were computed. Data from a nationally representative cross-sectional survey (KDHS 2014), was used to estimate the effect of mean travel time at survey cluster units for both fully immunised status and third dose of diphtheria-tetanus-pertussis (DPT3) vaccine using multi-level logistic regression models. Results: Nationally, the mean travel time to immunising health facilities was 63 and 40 min using the walking and the optimistic travel scenarios respectively. Seventy five percent of the total population were within one-hour of walking to an immunising health facility while 93% were within one-hour considering the optimistic scenario. There were substantial variations across the country with 62%(29/47) and 34%(16/47) of the counties with < 90% of the population within one-hour from an immunising health facility using scenarios 1 and 2 respectively. Travel times > 1-h were significantly associated with low immunisation coverage in the univariate analysis for both fully immunised status and DPT3 vaccine. Children living more than 2-h were significantly less likely to be fully immunised [AOR:0.56(0.33–0.94) and receive DPT3 [AOR:0.51(0.21–0.92) after controlling for household wealth, mother’s highest education level, parity and urban/rural residence. Conclusion: Travel time to immunising health facilities is a barrier to uptake of childhood vaccines in regions with suboptimal accessibility (> 2-h). Strategies that address access barriers in the hardest to reach communities are needed to enhance equitable access to immunisation services in Kenya.

Background: Human Papillomavirus (HPV) is the primary cause of cervical cancer. Single-dose HPV vaccination can effectively prevent high-risk HPV infection that causes cervical cancer and accelerate progress toward achieving cervical cancer elimination goals. We modelled the potential impact of adopting single-dose HPV vaccination strategies on health and economic outcomes in Kenya, where a two-dose schedule is the current standard. Methods: Using a validated compartmental transmission model of HPV and HIV in Kenya, we evaluated the costs from the payer’s perspective to vaccinate girls by age 10 with either one or two doses and increasing coverage levels (0%, 70%, 77%, 90%). Additionally, we modelled single-dose strategies supplemented with either catch-up vaccination of adolescent girls and young women or vaccination for all by age 10, funded with the first five-years of cost savings of switching from a two- to one-dose schedule. Costs and outcomes were discounted at 3% annually, and incremental cost-effectiveness ratios (ICERs) were calculated per disability-adjusted-life-year (DALY) averted. Results: All one-dose and the two-dose 90% coverage strategies were on the efficiency frontier, dominating the remaining two-dose strategies. The two-dose 90% coverage strategy had a substantially higher ICER (US$6508.80/DALY averted) than the one-dose 90% coverage (US$197.44/DALY averted). Transitioning from a two- to one-dose schedule could result in US$21.4 Million saved over the first five years, which could potentially fund 2.75 million supplemental HPV vaccinations. With this re-investment, all two-dose HPV vaccination scenarios would be dominated. The greatest DALYs were averted with the single-dose HPV vaccination schedule at 90% coverage supplemented with catch-up for 11–24-year-old girls, which had an ICER of US$78.73/DALYs averted. Conclusions: Considering the logistical and cost burdens of a two-dose schedule, a one-dose schedule for girls by age 10 would generate savings that could be leveraged for catch-up vaccination for older girls and accelerate cervical cancer elimination in Kenya.

Objectives To evaluate the cost of delivering childhood respiratory syncytial virus (RSV) prevention interventions to the health system in Kenya. Design A prospective (cost projection) activity-based costing study. Setting Kenya, national introduction of interventions. Participants Not applicable. Interventions A single-dose RSV maternal vaccine and a single-dose, long-acting monoclonal antibody (mAb). Primary and secondary outcome measures Cost per eligible target population; cost per dose administered; non-commodity cost of delivery. Costs are reported in 2023 USD. Results RSV interventions are expected to be delivered using existing systems: maternal vaccine using the antenatal care platform and the mAb delivered similar to existing birth dose vaccines. Assuming a price of US$3 per dose (for both interventions) and baseline coverage rates averaging 50% for the maternal vaccine and 86% for the mAb, the estimated cost of delivering maternal vaccine was US$1.74 (financial) and US$6.60 (economic) per vaccinated woman, and the cost of delivering mAbs was US$1.56 (financial) and US$6.27 (economic) per vaccinated child. Excluding commodity cost, the cost of delivering maternal vaccine was US$1.32 (financial) and US$2.72 (economic) and that for mAb was US$1.23 (financial) and US$2.48 (economic). Cost differences between the two interventions are driven by the anticipated baseline coverage. Health worker training, service delivery and programme planning and coordination were major cost drivers. Conclusion This study presents the prospective cost of new RSV intervention introduction and delivery in low-income and middle-income country settings, which is largely unknown. Cost estimates incorporate anticipated health system strengthening activities needed to deliver the future RSV interventions. These cost estimates support country-level and global-level decision-makers evaluating implementation feasibility and intervention affordability.

Background/Objectives: Healthcare workers (HCWs) are at increased risk of hepatitis B virus infection through occupational exposure, yet completion of the recommended hepatitis B vaccination schedule remains suboptimal in Kenya. We assessed vaccination completion, associated factors, motivators, and barriers among HCWs. Methods: We conducted a mixed methods study combining a cross-sectional survey of 1,614 HCWs in 178 health facilities across Kakamega, Nakuru, Mombasa, and Siaya counties with nine focus group discussions. The survey was conducted in August–September 2023 and the focus groups during June 2024–January 2025. Logistic regression was used to identify factors associated with completion of three vaccine doses, and qualitative data were analyzed thematically. Results: Among 1,583 HCWs with known vaccination status, 700 (44.2%; 95% CI: 41.8–46.7) reported completing three doses, 410 (25.9%) had received one or two doses, and 473 (29.9%) had never been vaccinated. The main motivator was self-protection (71.7%). Common barriers were vaccine unavailability (57.5%), lack of knowledge (28.8%), the vaccine not being offered on site (28.2%), and cost (17.4%). Completion was more likely among male HCWs and those working in private, urban, and referral facilities, and less likely among support staff, administrative staff, and allied health professionals than among nurses/midwives. Conclusions: Fewer than half of HCWs reported completing the three-dose hepatitis B vaccination schedule. Improving vaccine availability, reducing out-of-pocket costs, strengthening dose-reminder systems, and addressing knowledge gaps may improve completion among HCWs in Kenya.

Background/Objectives: Healthcare workers (HCWs) are at an increased risk of hepatitis B virus infection through occupational exposure, yet completion of the recommended hepatitis B vaccination schedule remains suboptimal in Kenya. We assessed vaccination completion, associated factors, motivators, and barriers among HCWs. Methods: We conducted a mixed-methods study combining a cross-sectional survey of 1614 HCWs in 178 health facilities across Kakamega, Nakuru, Mombasa, and Siaya counties with nine focus group discussions. The survey was conducted in August–September 2023 and the focus groups during June 2024–January 2025. Mixed-effects logistic regression with a random intercept for health facility was used to identify factors associated with completion of three vaccine doses, and qualitative data were analyzed thematically. Results: Among 1583 HCWs with a known vaccination status, 700 (44.2%; 95% CI: 41.8–46.7) reported completing three doses, 410 (25.9%) had received one or two doses, and 473 (29.9%) had never been vaccinated. The main motivator was self-protection (71.7%). Common barriers were vaccine unavailability (57.5%), lack of knowledge (28.8%), the vaccine not being offered on site (28.2%), and cost (17.4%). Completion was more likely among male HCWs, those working in urban areas facilities, and those with 6–10 or 11–20 years of healthcare work experience, and less likely among support staff, administrative staff, clinicians and allied health professionals than among nurses/midwives. Conclusions: Fewer than half of HCWs reported completing the three-dose hepatitis B vaccination schedule. Improving vaccine availability, reducing out-of-pocket costs, strengthening dose-reminder systems, and addressing knowledge gaps may improve completion among HCWs in the study counties.