title: Achieving high uptake of human papillomavirus vaccine in Cameroon: lessons learned in overcoming challenges.
abstract: BACKGROUND
  Cameroon has the highest age-standardized incidence rate of cervical cancer (30/100,000 women) in Central Africa. In 2010-2011, the Cameroon Baptist Convention Health Services (CBCHS) received donated human papillomavirus (HPV) vaccine, Gardasil, from Merck & Co. Inc. through Axios Healthcare Development to immunize 6400 girls aged 9-13 years. The aim was to inform the Cameroon Ministry of Health (MOH) of the acceptability, feasibility, and optimal delivery strategies for HPV vaccine.
  
  
  RESULTS
  Following approval by the MOH, CBCHS nurses educated girls, parents, and communities about HPV, cervical cancer, and HPV vaccine through multimedia coverage, brochures, posters, and presentations. Because educators were initially reluctant to allow immunization in schools, due to fear of adverse events, the nurses performed 40.7% of vaccinations in the clinics, 34.5% in community venues, and only 24.7% in schools. When no adverse events were reported, more schools and communities permitted HPV vaccine immunization on their premises. To recover administrative costs, CBCHS charged a fee of US$8 per 3-dose series only to those who were able to pay. Despite the fee, 84.6% of the 6,851 girls who received the first dose received all three doses.
  With adequate education of all stakeholders, HPV vaccination is acceptable and feasible in Cameroon. Following this demonstration project, in 2014 the Global Access to Vaccines and Immunization (GAVI) Alliance awarded the Cameroon MOH HPV vaccine at a price of US$4.50 per dose to immunize sixth grade girls and girls aged 10 years who are not in school in two districts of Cameroon.
authors: University of Massachusetts Medical School, Worcester, MA, United States. Electronic address: javier.ogembo@umassmed.edu.
authors: Javier Gordon
authors: JG
authors: Ogembo
authors: Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
authors: Simon
authors: S
authors: Manga
authors: Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
authors: Kathleen
authors: K
authors: Nulah
authors: Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
authors: Lily H
authors: LH
authors: Foglabenchi
authors: Pathfinder International, Watertown, MA, United States.
authors: Stacey
authors: S
authors: Perlman
authors: Northeastern University, Boston, MA, United States.
authors: Richard G
authors: RG
authors: Wamai
authors: Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
authors: Thomas
authors: T
authors: Welty
authors: Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
authors: Edith
authors: E
authors: Welty
authors: Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
authors: Pius
authors: P
authors: Tih
mesh_terms: D000293:Adolescent; D000328:Adult; D002163:Cameroon; D002648:Child; D005260:Female; D006266:Health Education; D006801:Humans; D030361:Papillomavirus Infections / Q000276:immunology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D011247:Pregnancy; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cameroon; Cervical cancer; Human papillomavirus; Vaccine