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

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

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 Unpublished literature, including evaluation reports, was solicited from country representatives; 188 documents were received.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.

MeSH terms

  • Adolescent
  • Developing Countries
  • Female
  • Humans
  • Papillomavirus Vaccines / administration & dosage*
  • Papillomavirus Vaccines / adverse effects

Substances

  • Papillomavirus Vaccines

Grant support

This work was supported by the Bill & Melinda Gates Foundation [grant OPP1115326]. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation or PATH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.