Abstract
BackgroundAdolescents are a difficult population to access for preventive health care, particularly in less resourced countries. Evidence from developed countries indicates that the HPV vaccine schedule may be a useful platform from which to deliver other adolescent health care services. We conducted a qualitative cross sectional study to assess the potential for using the HPV vaccine in the South African public health care system as an opportunity for integrated health care services for adolescents.MethodsParents, young adolescents, community members and key informants participated in interviews and focus group discussions about feasibility and acceptability, particularly the use of the HPV vaccination as the basis for an integrated adolescent package of care. Health care providers in both provinces participated in focus group discussions and completed a pairwise ranking exercise to compare and prioritise interventions for inclusion in an adolescent package of care.ResultsParticipants were in favour of integration and showed preference for detailed information about the HPV vaccine, general health information and specific sexual and reproductive health information. Among health care workers, results differed markedly by location. In North West, prioritisation was given to information, screening and referral for tobacco and alcohol abuse, and screening for hearing and vision. In Gauteng integration with referral for male circumcision, and information, screening and referral for child abuse were ranked most highly.ConclusionsThere is generally support for the delivery of adolescent preventive health services. Despite national priorities to address adolescent health needs, our data suggest that national policies might not always be appropriate for vastly different local situations. While decisions about interventions to include have traditionally been made at country level, our results suggest that local context needs to be taken account of. We suggest low resource strategies for ensuring that national policies are introduced at local level in a manner that addresses local priorities, context and resource availability.
Highlights
Adolescents are a difficult population to access for preventive health care, in less resourced countries
The World Health Organization (WHO) has recommended leveraging this potential symbiosis by suggesting that the required Human Papilloma Virus (HPV) vaccination schedule be used as a platform from which to deliver screening programmes, provision of information, services, commodity delivery or other vaccines, in low- and middle-income countries (LMIC) [15]
In each province data collection was conducted with adolescents, parents, community members, teachers and health care providers using qualitative methods including In-depth Interviews (IDIs) and Focus Group Discussions (FGDs)
Summary
Adolescents are a difficult population to access for preventive health care, in less resourced countries. Evidence from developed countries indicates that the HPV vaccine schedule may be a useful platform from which to deliver other adolescent health care services. Experience from high income countries has shown that high levels of vaccine uptake have been achieved through school-based vaccination programmes [12] Evidence from these countries suggests that adolescents use scheduled HPV vaccination visits to health care providers (HCP) to address other health care requirements [13] A study of adolescent women using academic health centres and private practices in the US for HPV vaccination noted that almost half used their vaccine visit to receive other medical or preventive services [14]. Available HPV vaccine delivery mechanisms include expanding the existing state immunization programme or developing a school-based vaccine programme [17]
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