title: The value of demonstration projects for new interventions: The case of human papillomavirus vaccine introduction in low- and middle-income countries.
abstract: Demonstration projects or pilots of new public health interventions aim to build learning and capacity to inform country-wide implementation. Authors examined the value of HPV vaccination demonstration projects and initial national programmes in low-income and lower-middle-income countries, including potential drawbacks and how value for national scale-up might be increased. Data from a systematic review and key informant interviews, analyzed thematically, included 55 demonstration projects and 8 national programmes implemented between 2007-2015 (89 years' experience). Initial demonstration projects quickly provided consistent lessons. Value would increase if projects were designed to inform sustainable national scale-up. Well-designed projects can test multiple delivery strategies, implementation for challenging areas and populations, and integration with national systems. Introduction of vaccines or other health interventions, particularly those involving new target groups or delivery strategies, needs flexible funding approaches to address specific questions of scalability and sustainability, including learning lessons through phased national expansion.
authors.affiliation: a London School of Hygiene and Tropical Medicine , Department of Global Health and Development , Tavistock Place, London , UK.
authors.forename: N
authors.initials: N
authors.lastname: Howard
authors.affiliation: a London School of Hygiene and Tropical Medicine , Department of Global Health and Development , Tavistock Place, London , UK.
authors.forename: S
authors.initials: S
authors.lastname: Mounier-Jack
authors.affiliation: b London School of Hygiene and Tropical Medicine , Clinical Research Department , Keppel St, London , UK.|c Mwanza Intervention Trials Unit, National Institute for Medical Research , Mwanza , Tanzania.
authors.forename: K E
authors.initials: KE
authors.lastname: Gallagher
authors.affiliation: c Mwanza Intervention Trials Unit, National Institute for Medical Research , Mwanza , Tanzania.
authors.forename: S
authors.initials: S
authors.lastname: Kabakama
authors.affiliation: a London School of Hygiene and Tropical Medicine , Department of Global Health and Development , Tavistock Place, London , UK.
authors.forename: U K
authors.initials: UK
authors.lastname: Griffiths
authors.affiliation: d PATH, Vaccine Access and Delivery , Seattle , WA , USA.
authors.forename: M
authors.initials: M
authors.lastname: Feletto
authors.affiliation: d PATH, Vaccine Access and Delivery , Seattle , WA , USA.
authors.forename: D S
authors.initials: DS
authors.lastname: LaMontagne
authors.affiliation: a London School of Hygiene and Tropical Medicine , Department of Global Health and Development , Tavistock Place, London , UK.
authors.forename: H E D
authors.initials: HE
authors.lastname: Burchett
authors.affiliation: b London School of Hygiene and Tropical Medicine , Clinical Research Department , Keppel St, London , UK.|c Mwanza Intervention Trials Unit, National Institute for Medical Research , Mwanza , Tanzania.
authors.forename: D
authors.initials: D
authors.lastname: Watson-Jones
mesh_terms: D003906:Developing Countries; D006801:Humans; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D010865:Pilot Projects
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV; Papillomavirus; demonstration projects; low and middle-income countries; vaccination