title: Organization and quality of HPV vaccination programs in Europe.
abstract: BACKGROUND
  HPV vaccination is underway in most European countries, but there are limited efforts toward optimization and standardization of organization, monitoring and evaluation. Our Europe-wide survey sought to identify how programs are currently organized, the costs associated with the organizing and ensuring quality of the program and how quality and effectiveness measurements are carried out.
  
  
  METHODS
  A comprehensive questionnaire was developed through systematic literature review and the European guidelines for quality assurance in cervical screening. The survey was piloted in a sub-set of countries and then sent to program organizers, Ministries of Health, and key experts in 34 EU and EFTA countries (including countries within the UK). Detailed information on program organization and target population, monitoring and evaluation (including indicators used for evaluating the impact of vaccination), and associated costs were collected. In addition, documentation of program guidelines, protocols, and publications were requested.
  
  
  RESULTS
  Of the 34 countries contacted, 27 responded. The majority of countries had some level of vaccination activity, with approximately half of the countries reporting an organized vaccination program. Centralized vaccine registries were in place in the majority of countries with an organized program, allowing for monitoring of key indicators at the national level. Costs of organization and monitoring were difficult to estimate and varied significantly, as some countries were able to use existing infrastructures while others had to create new systems, incurring greater costs.
  
  
  CONCLUSIONS
  The organization and quality of HPV vaccination programs differ across countries and, in some instances, even across regions within the same country. The monitoring being performed varies across programs with regard to level of detail but engagement in the survey from the participating countries demonstrates that there is strong interest in reflecting on and improving program performance. This survey could serve as a basis for strengthening surveillance of HPV vaccination programs.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden. Electronic address: miriam.elfstrom@ki.se.
authors.forename: K Miriam
authors.initials: KM
authors.lastname: Elfström
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institutet, Alfred Nobels Allé 8, 141 83 Stockholm, Sweden. Electronic address: joakim.dillner@ki.se.
authors.forename: Joakim
authors.initials: J
authors.lastname: Dillner
authors.affiliation: Department of Laboratory Medicine, Karolinska Institutet, Alfred Nobels Allé 8, 141 83 Stockholm, Sweden. Electronic address: lisen.Arnheim.Dahlstrom@Ki.Se.
authors.forename: Lisen
authors.initials: L
authors.lastname: Arnheim-Dahlström
mesh_terms: D000293:Adolescent; D002648:Child; D003362:Cost-Benefit Analysis; D005060:Europe; D005260:Female; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration* / Q000592:standards* / Q000706:statistics & numerical data; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000592:standards* / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines
keywords: Guidelines; Health policy; Human papillomavirus vaccination; Monitoring and evaluation; Quality