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Papillomavirus Res. 2017 Dec;4:72-78. doi: 10.1016/j.pvr.2017.09.001. Epub 2017 Oct 3.

Human papillomavirus (HPV) vaccine coverage achievements in low and middle-income countries 2007-2016.

Author information

1
London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania. Electronic address: Katherine.Gallagher@lshtm.ac.uk.
2
London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom.
3
Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.
4
PATH, Center for Vaccine Innovation and Access, PO Box 900922, Seattle, WA 98109, United States.
5
London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.

Abstract

INTRODUCTION:

Since 2007, HPV vaccine has been available to low and middle income countries (LAMIC) for small-scale 'demonstration projects', or national programmes. We analysed coverage achieved in HPV vaccine demonstration projects and national programmes that had completed at least 6 months of implementation between January 2007-2016.

METHODS:

A mapping exercise identified 45 LAMICs with HPV vaccine delivery experience. Estimates of coverage and factors influencing coverage were obtained from 56 key informant interviews, a systematic published literature search of 5 databases that identified 61 relevant full texts and 188 solicited unpublished documents, including coverage surveys. Coverage achievements were analysed descriptively against country or project/programme characteristics. Heterogeneity in data, funder requirements, and project/programme design precluded multivariate analysis.

RESULTS:

Estimates of uptake, schedule completion rates and/or final dose coverage were available from 41 of 45 LAMICs included in the study. Only 17 estimates from 13 countries were from coverage surveys, most were administrative data. Final dose coverage estimates were all over 50% with most between 70% and 90%, and showed no trend over time. The majority of delivery strategies included schools as a vaccination venue. In countries with school enrolment rates below 90%, inclusion of strategies to reach out-of-school girls contributed to obtaining high coverage compared to school-only strategies. There was no correlation between final dose coverage and estimated recurrent financial costs of delivery from cost analyses. Coverage achieved during joint delivery of HPV vaccine combined with another intervention was variable with little/no evaluation of the correlates of success.

CONCLUSIONS:

This is the most comprehensive descriptive analysis of HPV vaccine coverage in LAMICs to date. It is possible to deliver HPV vaccine with excellent coverage in LAMICs. Further good quality data are needed from health facility based delivery strategies and national programmes to aid policymakers to effectively and sustainably scale-up HPV vaccination.

KEYWORDS:

Completion; Coverage; HPV; Low and middle income countries; Uptake; Vaccine/vaccination

PMID:
29179873
PMCID:
PMC5710977
DOI:
10.1016/j.pvr.2017.09.001
[Indexed for MEDLINE]
Free PMC Article

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