Social mobilisation, consent and acceptability: a review of human papillomavirus vaccination procedures in low and middle-income countries.

Severin Kabakama,D Scott Lamontagne,Helen E D Burchett,Natasha Howard,Ulla K Griffiths,Katherine E Gallagher,Sandra Mounier-Jack,Marta Feletto,Deborah Watson-Jones

doi:10.1186/s12889-016-3517-8

Abstract

BackgroundSocial mobilisation during new vaccine introductions encourages acceptance, uptake and adherence to multi-dose schedules. Effective communication is considered especially important for human papillomavirus (HPV) vaccine, which targets girls of an often-novel age group. This study synthesised experiences and lessons learnt around social mobilisation, consent, and acceptability during 55 HPV vaccine demonstration projects and 8 national programmes in 37 low and middle-income countries (LMICs) between January 2007 and January 2015.MethodsA qualitative study design included: (i) a systematic review, in which 1,301 abstracts from five databases were screened and 41 publications included; (ii) soliciting 124 unpublished documents from governments and partner institutions; and (iii) conducting 27 key informant interviews. Data were extracted and analysed thematically. Additionally, first-dose coverage rates were categorised as above 90 %, 90–70 %, and below 70 %, and cross-tabulated with mobilisation timing, message content, materials and methods of delivery, and consent procedures.ResultsAll but one delivery experience achieved over 70 % first-dose coverage; 60 % achieved over 90 %. Key informants emphasized the benefits of starting social mobilisation early and actively addressing rumours as they emerged. Interactive communication with parents appeared to achieve higher first-dose coverage than non-interactive messaging. Written parental consent (i.e., opt-in), though frequently used, resulted in lower reported coverage than implied consent (i.e., opt-out). Protection against cervical cancer was the primary reason for vaccine acceptability, whereas fear of adverse effects, exposure to rumours, lack of project/programme awareness, and schoolgirl absenteeism were major reasons for non-vaccination.ConclusionsDespite some challenges in obtaining parental consent and addressing rumours, experiences indicated effective social mobilisation and high HPV vaccine acceptability in LMICs. Social mobilisation, consent, and acceptability lessons were consistent across world regions and HPV vaccination projects/programmes. These can be used to guide HPV vaccination communication strategies without additional formative research.

Highlights

Social mobilisation during new vaccine introductions encourages acceptance, uptake and adherence to multi-dose schedules
A delivery experience was defined as human papillomavirus (HPV) vaccine delivery to a specific target population, using a specific vaccination venue within a specific project/programme, as defined by funding source
Sub-themes related to social mobilisation were target audiences, Table 1 Social mobilisation and consent procedures by first-dose

Summary

Introduction

Social mobilisation during new vaccine introductions encourages acceptance, uptake and adherence to multi-dose schedules. This study synthesised experiences and lessons learnt around social mobilisation, consent, and acceptability during 55 HPV vaccine demonstration projects and 8 national programmes in 37 low and middle-income countries (LMICs) between January 2007 and January 2015. While routine vaccination is generally provided to children aged less than 1 year, HPV vaccine is typically delivered to adolescent girls aged between 9 and 13 years, or older if catch-up campaigns are conducted [4]. Providing vaccination to this age group raises issues around informed consent, including how parental consent should be sought prior to vaccination [9,10,11]. Delivering vaccination at school, a common strategy for HPV vaccination, is novel in some countries [6, 12, 13]

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Results

Discussion

Conclusion