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Introduction: Formative research can inform country-level HPV vaccine delivery strategies, communication messages, and advocacy plans. This paper describes our formative research's conceptual framework; details our applied methodology; summarizes our field experience and challenges; and outlines best practices for formative research in vaccine introduction. Methods: From 2006-2008, literature reviews, stakeholder mapping, sociocultural studies, health system assessments, and policy reviews were conducted. Data collection at individual, interpersonal, community, institutional, and policy levels included in-depth interviews, focus groups, surveys, observations, secondary data, and facility audits. Data were analyzed thematically using an iterative process. Discussion: Integrated formative research can be implemented in low-resource settings, but may require overcoming operational challenges. Best practices in applied formative research include a conceptual framework, multidisciplinary approach, and rapid dissemination of results. Conclusions: Formative research informs effective health program planning by examining complex and interrelated factors surrounding vaccination. Methodologically sound formative research provides valid and reliable evidence for country-level vaccine introduction.

This paper presents findings from a study conducted in 2007 and 2008 in two states in India: Andhra Pradesh and Gujarat. The objectives of the study were to: (i) design effective and appropriate HPV vaccine delivery systems for 10-to 14-year-old girls; (ii) design a communication strategy for HPV vaccine delivery; and (iii) devise an HPV vaccine advocacy strategy.The study populations included girls, parents, and local-, district-, and national-level stakeholders. A mixture of group discussions, visual representation techniques, face-to-face interviews, desk and health facility record reviews, field observations, and consultative workshops were used to collect the data.Study findings showed that the policymakers, health care providers, parents, and adolescents were aware and concerned about cervical cancer; would welcome vaccination if safe, effective, affordable, and accessible. Health systems did not require large infrastructure investments to introduce HPV vaccine; basic cold chain and logistic equipment were available. New outreach systems for adolescent girls need to be tested through demonstration projects. No policies would compromise the introduction of HPV vaccination.An HPV vaccine program, requiring public education and provider training, could be delivered. Policymakers' safety and vaccine efficacy concerns can be addressed through targeted advocacy efforts. Three broad approaches were suggested: (i) merge HPV vaccination with already established immunization services; (ii) package HPV immunization with adolescent health services or as a part of a cancer control service; and (iii) deliver HPV vaccinations through either routine immunization services or a campaign using schools as sites for school-going girls and anganwadi or village health centers for non-school-going girls.

Objectives. We evaluated the effectiveness of the Sure Start project, which was implemented in 7 districts of Uttar Pradesh, India, to improve maternal and newborn health. Methods. Interventions were implemented at 2 randomly assigned levels of intensity. Forty percent of the areas received a more intense intervention, including community-level meetings with expectant mothers. A baseline survey consisted of 12 000 women who completed pregnancy in 2007; a follow-up survey was conducted for women in 2010 in the same villages. Our quantitative analyses provide an account of the project's impact. Results. We observed significant health improvements in both intervention areas over time; in the more intensive intervention areas, we found greater improvements in care-seeking and healthy behaviors. The more intensive intervention areas did not experience a significantly greater decline in neonatal mortality. Conclusions. This study demonstrates that community-based efforts, especially mothers' group meetings designed to increase care-seeking and healthy behaviors, are effective and can be implemented at large scale.

The objectives of this analysis are: (1) to describe the policy environment related to human papillomavirus (HPV) vaccine introduction; (2) to identify the policy processes and key stakeholders in HPV vaccine introduction; (3) to summarize specific characteristics about HPV vaccines and their introduction that may be barriers to introduction; and (4) to recommend advocacy strategies to achieve a positive environment for cervical cancer prevention.This descriptive qualitative study of HPV vaccine policy development used an iterative, inductive, theme-based approach to data analysis. The study was conducted in four developing countries-India, Peru, Uganda, and Vietnam. Study participants were comprised of a total of 237 national policymakers, legislators, officials, and senior managers from ministries of health, finance, and planning; leaders of medical and health professional associations; cancer institutes; heads of nongovernmental organizations; and women's health advocates.While differences existed among low-income countries in specific cervical cancer, women's health, adolescent health, or immunization policy environments, we found the policymaking process itself, specific concerns related to HPV vaccines, and the information needs of policymakers for HPV vaccine introduction to be strikingly similar. Data on burden of cervical cancer, HPV vaccine safety and efficacy, and cost-effectiveness and vaccine affordability were top issues reported by policymakers. Advocacy strategies need to address these issues in order for HPV vaccine policy formulation and approval to be successful.

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A373Poster presentations when to screen women < 25 years are needed. Such measures will help detect precancerous lesions and avert cervical cancer. Background The Sure Start project is a seven year initiative implemented by PATH to improve maternal and newborn health and save lives in India. In Pune, Maharashtra, Sure Start focused on reducing maternal and newborn mortality rates and HIV among pregnant women, including the additional health care needs of HIV positive pregnant women. The objective was to raise awareness of HIV among pregnant women and motivate them to undergo HIV testing and to test the feasibility of convergence of HIV/AIDS and MNH for synergy in impact. Monitoring of Maternal and Newborn Status (MOMS) committees were involved for regular monitoring and follow-up in the community. Methods A quasi-experimental study was conducted with preand post-intervention surveys, without a comparison group. Quantitative methods were used to capture changes associated with implementation of a Common Minimum Package and qualitative methods to assess model specific changes. Results Percent of women who received three or more antenatal checkups increased from 83% to 97% from baseline to end-line, the percent of women initiating breastfeeding within one hour increased from 47% to 52% during the same period. Percent of women having institutional deliveries increased from 84% to 95%. Percent of mothers who visited a health facility for a checkup during the postnatal period increased from 49% to 73%. 92% of women had heard about HIV/AIDS, among these women 69% knew about medication available to reduce the risk of transmission to a baby. Sure Start in Academic Medical Center (AMC), Amsterdam, The NetherlandsBackground For HIV-infected men who have sex with men (MSM), implementation of routine STI screening into care at HIV treatment centres can substantially reduce STI incidence and possibly HIV incidence in the MSM population. Some countries already combine STI and HIV care, but its cost-effectiveness has not been explored. This study was designed to estimate the cost-effectiveness of providing routine anorectal chlamydia screening to MSM in care at HIV treatment centres in the Netherlands, where STI and HIV care are not currently combined. Method Outcomes of a transmission model describing the sexual transmission of HIV and chlamydia in MSM over a 20-year period were used as input for an economic model. Inclusion of multiple STIs were not allowed due to the complexity of the transmission model. The incremental cost-effectiveness ratio (ICER) was P6.011 P6.012 calculated for four scenarios: once-and twice-yearly routine chlamydia screening at HIV treatment centres among MSM who do/do not seek screening elsewhere. Results Costs will be saved by routine chlamydia screening of MSM in care at HIV treatment centres if these patients seek little or no screening elsewhere. Opportunistic screening is considerably more expensive than routine screening offered within a scheduled visit. Adding once-yearly chlamydia screening ...