title: Assessment of eight HPV vaccination programs implemented in lowest income countries.
abstract: BACKGROUND
  Cervix cancer, preventable, continues to be the third most common cancer in women worldwide, especially in lowest income countries. Prophylactic HPV vaccination should help to reduce the morbidity and mortality associated with cervical cancer. The purpose of the study was to describe the results of and key concerns in eight HPV vaccination programs conducted in seven lowest income countries through the Gardasil Access Program (GAP).
  
  
  METHODS
  The GAP provides free HPV vaccine to organizations and institutions in lowest income countries. The HPV vaccination programs were entirely developed, implemented and managed by local institutions. Institutions submitted application forms with institution characteristics, target population, communication delivery strategies. After completion of the vaccination campaign (3 doses), institutions provided a final project report with data on doses administered and vaccination models. Two indicators were calculated, the program vaccination coverage and adherence. Qualitative data were also collected in the following areas: government and community involvement; communication, and sensitization; training and logistics resources, and challenges.
  
  
  RESULTS
  A total of eight programs were implemented in seven countries. The eight programs initially targeted a total of 87,580 girls, of which 76,983 received the full 3-dose vaccine course, with mean program vaccination coverage of 87.8%; the mean adherence between the first and third doses of vaccine was 90.9%. Three programs used school-based delivery models, 2 used health facility-based models, and 3 used mixed models that included schools and health facilities. Models that included school-based vaccination were most effective at reaching girls aged 9-13 years. Mixed models comprising school and health facility-based vaccination had better overall performance compared with models using just one of the methods. Increased rates of program coverage and adherence were positively correlated with the number of vaccination sites. Qualitative key insights from the school models showed a high level of coordination and logistics to facilitate vaccination administration, a lower risk of girls being lost to follow-up and vaccinations conducted within the academic year limit the number of girls lost to follow-up.
  
  
  CONCLUSIONS
  Mixed models that incorporate both schools and health facilities appear to be the most effective at delivering HPV vaccine. This study provides lessons for development of public health programs and policies as countries go forward in national decision-making for HPV vaccination.
authors.affiliation: Rouen University Hospital, Rouen, France. Joel.Ladner@chu-rouen.fr
authors.forename: Joël
authors.initials: J
authors.lastname: Ladner
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Besson
authors.forename: Rachel
authors.initials: R
authors.lastname: Hampshire
authors.forename: Lisa
authors.initials: L
authors.lastname: Tapert
authors.forename: Mike
authors.initials: M
authors.lastname: Chirenje
authors.forename: Joseph
authors.initials: J
authors.lastname: Saba
mesh_terms: D001208:Asia; D001838:Bolivia; D002163:Cameroon; D002648:Child; D003906:Developing Countries; D005260:Female; D006205:Haiti; D006801:Humans; D017589:Immunization Programs; D007927:Lesotho; D053918:Papillomavirus Vaccines; D011203:Poverty; D015397:Program Evaluation; D036301:Qualitative Research; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines