Feasibility and acceptability of delivering adolescent health interventions alongside HPV vaccination in Tanzania.

Deborah Watson-Jones,Shelley Lees,John Changalucha,Nathalie Broutet,Nyasule Neke,Joseph Mwanga,Venkatraman Chandra-Mouli,Paul Bloem,Ibrahim Maduhu,Saidi Kapiga,David A Ross

doi:10.1093/heapol/czv119

Abstract

Background: Human papillomavirus (HPV) vaccination offers an opportunity to strengthen provision of adolescent health interventions (AHI). We explored the feasibility of integrating other AHI with HPV vaccination in Tanzania.Methods: A desk review of 39 policy documents was preceded by a stakeholder meeting with 38 policy makers and partners. Eighteen key informant interviews (KIIs) with health and education policy makers and district officials were conducted to further explore perceptions of current programs, priorities and AHI that might be suitable for integration with HPV vaccination.Results: Fourteen school health interventions (SHI) or AHI are currently being implemented by the Government of Tanzania. Most are delivered as vertical programmes. Coverage of current programs is not universal, and is limited by financial, human resource and logistic constraints. Limited community engagement, rumours, and lack of strategic advocacy has affected uptake of some interventions, e.g. tetanus toxoid (TT) immunization. Stakeholder and KI perceptions and opinions were limited by a lack of experience with integrated delivery and AHI that were outside an individual’s area of expertise and experience. Deworming and educational sessions including reproductive health education were the most frequently mentioned interventions that respondents considered suitable for integrated delivery with HPV vaccine.Conclusions: Given programme constraints, limited experience with integrated delivery and concern about real or perceived side-effects being attributed to the vaccine, it will be very important to pilot-test integration of AHI/SHI with HPV vaccination. Selected interventions will need to be simple and quick to deliver since health workers are likely to face significant logistic and time constraints during vaccination visits.

Highlights

At 1.2 billion, adolescents (10- to 19-year-olds) make up one sixth of the world’s population (Sawyer et al 2012), with almost 90% living in low and middle-income countries
The pilot Human papillomavirus (HPV) vaccination project conducted in Mwanza between 2010 and 2011 showed that school vaccination teams could be small who would normally only visit a particular school on one day during each vaccine dosing round (Watson-Jones et al 2012a)
We explored the feasibility of integrating an adolescent health package with HPV vaccination in Tanzania through a 3 step process comprising a desk review, a national stakeholder meeting, and key informant interviews (KIIs)

Summary

Introduction

At 1.2 billion, adolescents (10- to 19-year-olds) make up one sixth of the world’s population (Sawyer et al 2012), with almost 90% living in low and middle-income countries Preventive interventions in this age group are often critical for future adult health and for the health of the generation, in addition to adolescents’ own health (Goodburn and Ross 2000). Eighteen key informant interviews (KIIs) with health and education policy makers and district officials were conducted to further explore perceptions of current programs, priorities and AHI that might be suitable for integration with HPV vaccination. Stakeholder and KI perceptions and opinions were limited by a lack of experience with integrated delivery and AHI that were outside an individual’s area of expertise and experience. Selected interventions will need to be simple and quick to deliver since health workers are likely to face significant logistic and time constraints during vaccination visits

Methods

Results

Conclusion