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PLoS One. 2017 Jun 2;12(6):e0177773. doi: 10.1371/journal.pone.0177773. eCollection 2017.

Lessons learnt from human papillomavirus (HPV) vaccination in 45 low- and middle-income countries.

Author information

1
Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
2
Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
3
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
4
PATH, Center for Vaccine Innovation and Access, Seattle, Washington, United States of America.

Abstract

OBJECTIVE:

To synthesise lessons learnt and determinants of success from human papillomavirus (HPV) vaccine demonstration projects and national programmes in low- and middle-income countries (LAMICs).

METHODS:

Interviews were conducted with 56 key informants. A systematic literature review identified 2936 abstracts from five databases; after screening 61 full texts were included. Unpublished literature, including evaluation reports, was solicited from country representatives; 188 documents were received. A data extraction tool and interview topic guide outlining key areas of inquiry were informed by World Health Organization guidelines for new vaccine introduction. Results were synthesised thematically.

RESULTS:

Data were analysed from 12 national programmes and 66 demonstration projects in 46 countries. Among demonstration projects, 30 were supported by the GARDASIL® Access Program, 20 by Gavi, four by PATH and 12 by other means. School-based vaccine delivery supplemented with health facility-based delivery for out-of-school girls attained high coverage. There were limited data on facility-only strategies and little evaluation of strategies to reach out-of-school girls. Early engagement of teachers as partners in social mobilisation, consent, vaccination day coordination, follow-up of non-completers and adverse events was considered invaluable. Micro-planning using school/ facility registers most effectively enumerated target populations; other estimates proved inaccurate, leading to vaccine under- or over-estimation. Refresher training on adverse events and safe injection procedures was usually necessary.

CONCLUSION:

Considerable experience in HPV vaccine delivery in LAMICs is available. Lessons are generally consistent across countries and dissemination of these could improve HPV vaccine introduction.

PMID:
28575074
PMCID:
PMC5456063
DOI:
10.1371/journal.pone.0177773
[Indexed for MEDLINE]
Free PMC Article

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