title: Geospatial Planning and the Resulting Economic Impact of Human Papillomavirus Vaccine Introduction in Mozambique.
abstract: Research has shown that the distance to the nearest immunization location can ultimately prevent someone from getting immunized. With the introduction of human papillomavirus (HPV) vaccine throughout the world, a major question is whether the target populations can readily access immunization.
  
  
  
  In anticipation of HPV vaccine introduction in Mozambique, a country with a 2015 population of 25,727,911, our team developed Strategic Integrated Geo-temporal Mapping Application) to determine the potential economic impact of HPV immunization. We quantified how many people in the target population are reachable by the 1377 existing immunization locations, how many cannot access these locations, and the potential costs and disease burden averted by immunization.
  
  
  
  If the entire 2015 cohort of 10-year-old girls goes without HPV immunization, approximately 125 (111-139) new cases of HPV 16,18-related cervical cancer are expected in the future. If each health center covers a catchment area with a 5-km radius (ie, if people travel up to 5 km to obtain vaccines), then 40% of the target population could be reached to prevent 50 (44-55) cases, 178 (159-198) disability-adjusted life years, and US $202,854 (US $140,758-323,693) in health care costs and lost productivity. At higher catchment area radii, additional increases in catchment area radius raise population coverage with diminishing returns.
  
  
  
  Much of the population in Mozambique is unable to reach any existing immunization location, thereby reducing the potential impact of HPV vaccine. The geospatial information system analysis can assist in planning vaccine introduction strategies to maximize access and help the population reap the maximum benefits from an immunization program.
authors.affiliation: From the *Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA; †Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina-Chapel Hill, Chapel Hill, NC; §Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; and ∥Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Leila A
authors.initials: LA
authors.lastname: Haidari
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.forename: Dagna
authors.initials: D
authors.lastname: Constenla
authors.forename: Eli
authors.initials: E
authors.lastname: Zenkov
authors.forename: Marie
authors.initials: M
authors.lastname: Ferguson
authors.forename: Gatien
authors.initials: G
authors.lastname: de Broucker
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ozawa
authors.forename: Samantha
authors.initials: S
authors.lastname: Clark
authors.forename: Allison
authors.initials: A
authors.lastname: Portnoy
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D017048:Health Care Costs; D052162:Human papillomavirus 16 / Q000276:immunology; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D009073:Mozambique; D030361:Papillomavirus Infections / Q000150:complications / Q000191:economics / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D062206:Spatial Analysis; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000517:prevention & control / Q000821:virology; D000073887:Vaccination Coverage / Q000191:economics*
chemical_list: D053918:Papillomavirus Vaccines