Abstract
In April 2014, a national school-based human papillomavirus (HPV) vaccination program was rolled out in South Africa, targeting Grade 4 girls aged ≥9 years. A bivalent HPV vaccine with a 2-dose (6 months apart) schedule was used. At the request of the National Department of Health (NDoH), we conducted an external assessment of the first-dose phase of the vaccination program to evaluate program coverage and vaccine safety and identify factors that influenced implementation. We based our cross-sectional and mixed-methods approach on a process evaluation framework, which included a review of key planning and implementation documents and monitoring data; observation at vaccination sites; key informant interviews (N=34); and an assessment of media coverage and content related to the campaign.Findings: There was overall success in key measures of coverage and safety. Over 350,000 Grade 4 girls were vaccinated in more than 16,000 public schools across South Africa, which translated to 94.6% of schools reached and 86.6% of age-eligible learners vaccinated. No major adverse events following immunization were detected. We attributed the campaign's successes to careful planning and coordination and strong leadership from the NDoH. The primary challenges we identified were related to obtaining informed consent, vulnerabilities in cold chain capacity, and onsite management of minor adverse events. While campaign planners anticipated and prepared for some negative media coverage, they did not expect the use of social media for spreading misinformation about HPV vaccination. The first phase of the national school-based HPV vaccination campaign was successfully implemented at scale in this setting. Future implementation will require improvement in the storage and monitoring of vaccine doses, better communication of role expectations to all stakeholders, and streamlined consent processes to ensure program sustainability.
Highlights
Global Health: Science and Practice 2018 | Volume 6 | Number 3 infection with human papillomavirus (HPV)4,5—the sexually transmitted virus responsible for almost all cases (99%) of cervical cancer—and tend to experience a poorer prognosis than women without HIV.[6,7] Despite policy changes to improve coverage, screening uptake in South Africa is generally low,[8] and there is high loss to follow-up of women identified with abnormal cytology.[7]Traditional cytology-based screening procedures are likely to be replaced soon by more sensitive HPV testing,[9] but a national HPV vaccination program is a critical component of effective primary prevention
The campaign was housed within the relaunched Integrated School Health Program (ISHP)—a program jointly implemented by the National Department of Health (NDoH) and the Departments of Basic Education (DBE) and Social Development (DSD)
The campaign was introduced in the context of a high-level political mandate, and interview data showed that the strong political commitment to the campaign was an important factor driving results
Summary
Global Health: Science and Practice 2018 | Volume 6 | Number 3 infection with human papillomavirus (HPV)4,5—the sexually transmitted virus responsible for almost all cases (99%) of cervical cancer—and tend to experience a poorer prognosis than women without HIV.[6,7] Despite policy changes to improve coverage, screening uptake in South Africa is generally low,[8] and there is high loss to follow-up of women identified with abnormal cytology.[7]Traditional cytology-based screening procedures are likely to be replaced soon by more sensitive HPV testing,[9] but a national HPV vaccination program is a critical component of effective primary prevention. Global Health: Science and Practice 2018 | Volume 6 | Number 3 infection with human papillomavirus (HPV)4,5—the sexually transmitted virus responsible for almost all cases (99%) of cervical cancer—and tend to experience a poorer prognosis than women without HIV.[6,7] Despite policy changes to improve coverage, screening uptake in South Africa is generally low,[8] and there is high loss to follow-up of women identified with abnormal cytology.[7]. Vaccinating girls prior to sexual debut (9 to 13 years), as recommended by the World Health Organization (WHO),[10] is the most cost-effective public health measure against cervical cancer in high-prevalence settings.[11]. In April 2014, a national school-based human papillomavirus (HPV) vaccination program was rolled out in South Africa, targeting Grade 4 girls aged ≥9 years.
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