title: Performance of 21 HPV vaccination programs implemented in low and middle-income countries, 2009-2013.
abstract: BACKGROUND
  Cervical cancer is the third most common cancer in women worldwide, with high incidence in lowest income countries. Vaccination against Human Papilloma Virus (HPV) may help to reduce the incidence of cervical cancer. The aim of the study was to analyze HPV vaccination programs performance implemented in low and middle-income countries.
  
  
  METHODS
  The Gardasil Access Program provides HPV vaccine at no cost to help national institutions gain experience implementing HPV vaccination. Data on vaccine delivery model, number of girls vaccinated, number of girls completing the three-dose campaign, duration of vaccination program, community involvement and sensitization strategies were collected from each program upon completion. Vaccine Uptake Rate (VUR) and Vaccine Adherence between the first and third doses (VA) rate were calculated. Multivariate linear regressions analyses were fitted.
  
  
  RESULTS
  Twenty-one programs were included in 14 low and middle-income countries. Managing institutions were non-governmental organizations (NGOs) (n = 8) or Ministries of Health (n = 13). Twelve programs were school-based, five were health clinic-based and four utilized a mixed model. A total of 217,786 girls received a full course of vaccination.Mean VUR was 88.7% (SD = 10.5) and VA was 90.8% (SD = 7.3). The mean total number of girls vaccinated per program-month was 2,426.8 (SD = 2,826.6) in school model, 335.1 (SD = 202.5) in the health clinic and 544.7 (SD = 369.2) in the mixed models (p = 0.15). Community involvement in the follow-up of girls participating in the vaccination campaign was significantly associated with VUR. Multivariate analyses identified school-based (β = 13.35, p = 0.001) and health clinic (β = 13.51, p = 0.03) models, NGO management (β = 14.58, p < 10(-3)) and duration of program vaccination (β = -1.37, p = 0.03) as significant factors associated with VUR.
  
  
  CONCLUSIONS
  School and health clinic-based models appeared as predictive factors for vaccination coverage, as was management by an NGO; program duration could play a role in the program's effectiveness. Results suggest that HPV vaccine campaigns tailored to meet the needs of communities can be effective. These results may be useful in the development of national HPV vaccination policies in low and middle-income countries.
authors: Rouen University Hospital, Epidemiology and Public Health Department, Hôpital Charles Nicolle, 1, rue de Germont, 76 031 Rouen, France. joel.ladner@univ-rouen.fr.
authors: Joël
authors: J
authors: Ladner
authors: Marie-Hélène
authors: MH
authors: Besson
authors: Mariana
authors: M
authors: Rodrigues
authors: Etienne
authors: E
authors: Audureau
authors: Joseph
authors: J
authors: Saba
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003906:Developing Countries; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015397:Program Evaluation / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*
chemical_list: D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines