Strategies to Vaccinate Against Human Papillomavirus (HPV): Assessment of Eight HPV Vaccination Programs Implemented in Low and Middle-Income Countries

Introduction: Gardasil Access Program (GAP) provides free vaccine to low and middle-income countries for structured vaccination programs. The objective was to assess HPV vaccination programmes implemented in low and middle-income countries.

Methods:

Through the program, institutions submitted application forms with institution characteristics, project design, estimated target population, which were reviewed by independent experts and the GAP advisory board. At the end of vaccination, the Program provided a final report, which collected data on the number of girls received vaccine at each doses stratified inside or outside the 9-13 year age-range recommended by WHO, vaccine delivery model used: clinics, school and mixed models. Qualitative data were also collected.

Results: Eight programs conducted in seven countries (Bhutan, Bolivia [2 Programs], Cambodia, Cameroon, Haiti, Lesotho, Nepal). 62.5% of the Programs were managed by non-governmental organizations. The number of vaccination distribution sites ranged from 1 to 258. A total of 87,580 girls were initially targeted, 76,983 (range: 1,033–33,818) received the full 3-dose vaccine course, with an overall estimated coverage rate of 87.9% (range: 64.6-107.4%). The mean project adherence between dose 3 and dose 1 was 88.5% (range: 75.8%-98.7%). Regarding vaccination delivery, the clinic model had an estimated coverage of 77.3%, 93.30% in school model and 93.3% in mixed model. The same trends of results were found for adherence. Coverage and adherence are positively associated to the number of vaccination sites.

Conclusion: Despite implementation in 8 Programs, these first results suggest that scaling-up of HPV vaccination projects is feasible in middle and low-income countries. Number of girls reached, involvement of girls and their parents in campaigns were high. Partnerships between schools and health system may also increase the performance of vaccination Program. As different countries go forward in national decision-making for HPV vaccination, these results provide lessons for development of public health HPV vaccination.