Abstract
BackgroundIntroduction of human papillomavirus (HPV) vaccine in national programs has proceeded apace since 2006, mostly in high-income countries. Recently concluded pilots of HPV vaccination in low-income countries have provided important lessons learned for these settings; however, rigorous evaluations of the feasibility of these delivery strategies that effectively reach young adolescents have been few. This paper presents results from a qualitative evaluation of a demonstration program which implemented school-based and health center–based HPV vaccinations to all girls in grade 6, or 11 years of age, for two years in four districts of Vietnam.MethodsUsing semi-structured interviews of 131 health and education staff from local, district, province, and national levels and 26 focus-group discussions with local project implementers (n = 153), we conducted a qualitative two-year evaluation to measure the impact of HPV vaccinations on the health and education systems.ResultsHPV vaccine delivery at schools or health centers was made feasible by: a. close collaboration between the health and education sectors, b. detailed planning for implementation, c. clearly defined roles and responsibilities for project implementers, d. effective management and supervision of vaccinations during delivery, and e. engagement with community organizations for support. Both the health and education systems were temporarily challenged with the extra workload, but the disruptions were short-lived (a few days for each of three doses) and perceived as worth the longer-term benefit of cervical cancer prevention.ConclusionThe learning from Vietnam has identified critical elements for successful vaccine delivery that can provide a model for other countries to consider during their planning of national rollout of HPV vaccine.
Highlights
Introduction of human papillomavirus (HPV) vaccine in national programs has proceeded apace since 2006, mostly in high-income countries
Some evidence of the feasibility of HPV vaccine delivery in developing countries is emerging from the evaluation of pilot projects or demonstration programs, which have provided insight into both the challenges of implementation and the components of the programs that have been successful [7,19,20]
Using reporting guidelines for qualitative studies (RATS), this paper presents the findings from a two-year qualitative evaluation of the feasibility of HPV vaccine delivery to determine the impact of incorporating HPV vaccine on the health and education systems in Vietnam
Summary
Introduction of human papillomavirus (HPV) vaccine in national programs has proceeded apace since 2006, mostly in high-income countries. Concluded pilots of HPV vaccination in low-income countries have provided important lessons learned for these settings; rigorous evaluations of the feasibility of these delivery strategies that effectively reach young adolescents have been few. Some evidence of the feasibility of HPV vaccine delivery in developing countries is emerging from the evaluation of pilot projects or demonstration programs, which have provided insight into both the challenges of implementation and the components of the programs that have been successful [7,19,20]. A review of eight pilots done through small donations of HPV vaccine suggested that insufficient training and sensitization of teachers and school headmasters, lack of community participation, and loss-to-followup can be significant barriers for feasible programs [20]
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