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BMC Health Services Research

, 16:575

Health systems and services in low and middle income settings

Abstract

BackgroundCervical cancer is the greatest cause of age-weighted years of life lost in the developing world. Human papillomavirus HPV infection is associated with a high proportion of cervical cancers, and HPV vaccination may help to reduce the incidence of cancer. The aim of the study was to identify barriers, obstacles, and strategies and to analyze key concerns and lessons learned with respect to the implementation of HPV vaccination program in low- and middle-income countries.

MethodsThe Gardasil Access Program GAP is a donation program established to enable organizations and institutions in eligible low-resource countries to gain operational experience designing and implementing HPV vaccination programs. This study used an online survey to capture the experiences and insights of program managers participating in the GAP. Different factors related to HPV vaccination program management were collected. A mixed-method approach enabled the presentation of both quantitative measurements and qualitative insights.

ResultsTwenty-nine programs implemented by 23 institutions in 19 low- and middle-income countries were included. Twenty programs managers 97.7 % reported that their institution implemented sensitization strategies about vaccination prior to the launch of vaccination campaign. The most frequently reported obstacles to HPV vaccination by the program managers were erroneous perceptions of population related to the vaccine’s safety and efficacy. Reaching and maintaining follow-up with target populations were identified as challenges. Insufficient infrastructure and human resources financing and the vaccine delivery method were identified as significant health system barriers. Coupling HPV vaccination with other health interventions for mothers of targeted girls helped to increase vaccination and cervical cancer screening. The majority of program managers reported that their programs had a positive impact on national HPV vaccination policy. The majority of institutions had national and international partners that provided support for human resources, technical assistance, and training and financial support for health professionals.

ConclusionLocal organizations and institutions can implement successful HPV vaccination campaigns. Adequate and adapted planning and resources that support information sharing, sensitization, and mobilization are essential for such success. These results can inform the development of programs and policies related to HPV vaccination in low- and middle-income countries.

KeywordsHuman papillomavirus vaccine, type 16 L1, 18 Vaccination Preventive health services Immunization uterine cervical neoplasms Developing countries Vaccines Program evaluation AbbreviationsEPIExpanded programme on immunization

GAPGardasil access program

HPVHuman papilloma virus

LMICsLow and middle-income countries

MoHMinistry of Health

NGONon-Governmental Organization

STISexually Transmitted Infections

UNUnited Nations

WHOWorld Health Organisation

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Autor: Joël Ladner - Marie-Hélène Besson - Etienne Audureau - Mariana Rodrigues - Joseph Saba

Fuente: https://link.springer.com/







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