title: Effective nonvaccine interventions to be considered alongside human papilloma virus vaccine delivery.
abstract: World Health Organization recommends that girls, ages 9-13 years, get the human papilloma virus (HPV) vaccine. Global Alliance for Vaccines Initiative, which provides low-cost vaccine to eligible countries, requires that an additional intervention to be offered alongside the vaccine. We systematically searched and assessed the published literature in lower- and middle-income countries to identify effective interventions. We conducted systematic searches of four databases: PubMed, EMBASE, Global Index Medicus Regional Databases, and Cochrane Reviews for effective adolescent health interventions that could be delivered with the HPV vaccine in the following areas: (1) iron and folic acid supplementation (iron alone or with folic acid); (2) voucher delivery and cash transfer programs; (3) hand washing and soap provision; (4) vision screening; (5) promotion of physical activity/exercise; (6) menstrual hygiene education; (7) sexual and reproductive health education; (8) human immunodeficiency virus prevention activities; and (9) condom promotion, condom use skill building, and demonstration. We found limited evidence of consistent positive impact. Iron supplementation reduced iron-deficiency anemia and raised serum ferritin levels. Promotion of physical activity lowered blood pressure and reduced weight gain. Sexual and reproductive health and human immunodeficiency virus interventions improved adolescent communication with adults but did not influence behavioral outcomes. Countries should consider locally relevant and proven interventions to be offered alongside the HPV vaccine.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: mhindin@jhu.edu.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Hindin
authors.affiliation: Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Bloem
authors.affiliation: Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
authors.forename: Jane
authors.initials: J
authors.lastname: Ferguson
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D018798:Anemia, Iron-Deficiency / Q000517:prevention & control; D002648:Child; D017280:Condoms; D003906:Developing Countries; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D015658:HIV Infections / Q000517:prevention & control; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D014944:World Health Organization
chemical_list: D053918:Papillomavirus Vaccines; D005492:Folic Acid; D007501:Iron
keywords: Effective; Human papilloma virus vaccine; Interventions; Lower- and middle-income countries