Lessons learnt from human papillomavirus (HPV) vaccination in 45 low-and middle income countries
Lessons learnt from human papillomavirus (HPV) vaccination in 45 low-and middle income countries
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DOI：
10.1371/journal.pone.0177773
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发表时间：
2017-06-02
期刊：
影响因子：
3.7
通讯作者：
Watson-Jones, Deborah
中科院分区：
文献类型：
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作者：
Gallagher, Katherine E.;Howard, Natasha;Watson-Jones, Deborah
目的综合经验教训和成功的决定因素，从人乳头瘤病毒（HPV）疫苗示范项目和国家计划在低收入和中等收入国家（LAMICs）。一项系统性文献综述从5个数据库中识别出2936篇摘要;筛选后纳入61篇全文。向国家代表征求了未发表的文献，包括评价报告;共收到188份文件。世界卫生组织关于引进新疫苗的指导方针为数据提取工具和概述关键调查领域的访谈主题指南提供了信息。对46个国家的12个国家方案和66个示范项目的数据进行了分析。在示范项目中，30个项目得到了GARDASIL无障碍方案的支持，20个项目得到了Gavi的支持，4个项目得到了PATH的支持，12个项目得到了其他方式的支持。以学校为基础提供疫苗，并辅之以保健设施为基础向失学女童提供疫苗，实现了高覆盖率。关于仅针对设施的战略的数据有限，对帮助失学女童的战略的评价也很少。教师作为合作伙伴及早参与社会动员、同意、疫苗接种日协调、未完成者的随访和不良事件被认为是非常宝贵的。使用学校/设施登记册的微观规划最有效地列举了目标人群;其他估计被证明是不准确的，导致疫苗估计不足或过高。复习培训的不良事件和安全注射程序通常是necessary.ConclusionConsiderable经验，HPV疫苗交付LAMIC。各国的经验教训通常是一致的，这些经验教训的传播可以改善HPV疫苗的引进。
ObjectiveTo synthesise lessons learnt and determinants of success from human papillomavirus (HPV) vaccine demonstration projects and national programmes in low- and middle-income countries (LAMICs).MethodsInterviews were conducted with 56 key informants. A systematic literature review identified 2936 abstracts from five databases; after screening 61 full texts were included. Unpublished literature, including evaluation reports, was solicited from country representatives; 188 documents were received. A data extraction tool and interview topic guide outlining key areas of inquiry were informed by World Health Organization guidelines for new vaccine introduction. Results were synthesised thematically.ResultsData were analysed from 12 national programmes and 66 demonstration projects in 46 countries. Among demonstration projects, 30 were supported by the GARDASIL Access Program, 20 by Gavi, four by PATH and 12 by other means. School-based vaccine delivery supplemented with health facility-based delivery for out-of-school girls attained high coverage. There were limited data on facility-only strategies and little evaluation of strategies to reach out-of-school girls. Early engagement of teachers as partners in social mobilisation, consent, vaccination day coordination, follow-up of non-completers and adverse events was considered invaluable. Micro-planning using school/facility registers most effectively enumerated target populations; other estimates proved inaccurate, leading to vaccine under-or over-estimation. Refresher training on adverse events and safe injection procedures was usually necessary.ConclusionConsiderable experience in HPV vaccine delivery in LAMICs is available. Lessons are generally consistent across countries and dissemination of these could improve HPV vaccine introduction.