Feasibility and acceptability of delivering adolescent health interventions alongside HPV vaccination in Tanzania

Watson-Jones, Deborah; Lees, Shelley; Mwanga, Joseph R.; Neke, Nyasule; Changalucha, John; Broutet, Nathalie; Maduhu, Ibrahim; Kapiga, Saidi; Chandra-Mouli, Venkatraman; Bloem, Paul; Ross, David A.

doi:10.1093/heapol/czv119

Cited by 23 publications

(26 citation statements)

References 22 publications

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“…Suggestions to improve vaccination programs included decreasing the number of vaccine doses (from three to two doses) to minimize loss of follow-up, reducing vaccine cost, and reaching girls who have dropped out of school to earn money for their families (Dochez et al, 2017). Stakeholders also agreed that interventions for boys and age groups outside those receiving the vaccine were important (Watson-Jones et al, 2016).…”

Section: Resultsmentioning

confidence: 99%

Cervical cancer in Tanzania: A systematic review of current challenges in six domains

Runge

Bernstein

Lucas

et al. 2019

Gynecologic Oncology Reports

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Cervical cancer is the most common cancer in Tanzania. After excluding human immunodeficiency virus, lower respiratory infections, malaria, diarrheal diseases, and tuberculosis, cervical cancer kills more women than any other form of illness in the country. Unfortunately, Tanzania has a low doctor-to-patient ratio (1:50,000) and nearly 7000 women die each year from this disease. The clinical problem is further magnified by the country's lack of resources and prevailing poverty, sporadic cervical cancer screening, prevalence of high-risk oncogenic human papillomavirus subtypes, and relatively high rates of human immunodeficiency virus co-infection. In recent years, addressing the cervical cancer problem has become a priority for the Tanzanian government. In this systematic review of 39 peer-reviewed publications that appeared in the PubMed/MEDLINE (NCBI) database from 2013 to 2018, we synthesize the growing body of literature to capture current trends in Tanzania's evolving cervical cancer landscape. Six domains were identified, including risk factors, primary prevention, barriers to screening, treatment, healthcare worker education, and sustainability. In addition to traditional risk factors associated with sexual behavior, acetowhite changes observed during visual inspection of the cervix with acetic acid, lower education, rural setting, and HIV positivity also have a noteworthy clinical impact.

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Section: Resultsmentioning

confidence: 99%

Cervical cancer in Tanzania: A systematic review of current challenges in six domains

Runge

Bernstein

Lucas

et al. 2019

Gynecologic Oncology Reports

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“…In Tanzania, the most feasible interventions were found to be deworming, HIV, and menstrual or adolescent reproductive health education. However, stakeholders have raised concerns as to whether health workers would have time in the midst of vaccination visits to carry out these extra activities ( Watson-Jones et al, 2016 ). Although outcomes are not yet known, countries have reported integration with Vitamin A administration (Uganda), deworming (Belize, Ecuador, Rwanda, South Africa, Uganda), iron and folic acid supplementation (Belize), health check-ups (Fiji, Malaysia, Suriname), and growth/visual/dental or oral checks (Dominica, Fiji, Guatemala, Thailand) ( WHO, 2020a ).…”

Section: Experience To Date and Main Lessons Learnedmentioning

confidence: 99%

National implementation of HPV vaccination programs in low-resource countries: Lessons, challenges, and future prospects

Tsu

LaMontagne

Atuhebwe

et al. 2021

Preventive Medicine

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More than 90% of cervical cancer deaths occur in low- and middle-income countries (LMICs), which have limited capacity to mount the comprehensive national screening and precancer treatment programs that could prevent most of these deaths. The development of vaccines against the human papillomavirus (HPV) has dramatically altered the landscape of cervical cancer prevention. As of mid-2020, 56 LMICs (41% of all LMICs) have initiated national HPV vaccination programs. This paper reviews the experience of LMICs that have introduced HPV vaccine into their national programs, key lessons learned, HPV vaccination sustainability and scale-up challenges, and future mitigation measures. As international guidance evolved and countries accumulated experience, strategies for national introduction shifted with regard to target groups, delivery site and timing, preparation and planning, communications and social mobilization, and ultimately monitoring, supervision and evaluation. Despite the successes that LMICs have been able to achieve in reaching large proportions of eligible girls, there are still considerable challenges countries encounter in overcoming rumors, reaching out-of-school girls, completing the vaccine series, estimating target populations, monitoring program performance, and assuring vaccination sustainability. New opportunities, such as the entry of additional vaccine manufacturers and ongoing studies to evaluate one-dose delivery, could help overcome the outstanding barriers to higher coverage and financial sustainability. Effective use of the experience to date and advances on the horizon could enable all LMICs to move towards the coverage levels that are needed to achieve eventual elimination.

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“…In this regard, one of the major concerns with delivering other adolescent health services alongside the HPV vaccination programme lies with the capacity of vaccinators or school health teams -in terms of availability, capability, workload, and staffing -to adequately administer these services during their visits. Watson-Jones et al (73) previously assessed the feasibility and acceptability of delivering other adolescent health services alongside HPV vaccination in Tanzania and found general support for the intervention among key stakeholders. Similar findings have been reported in the South African context (63).…”

Section: Opportunities For Delivering Other Adolescent Health Services Alongside the Hpv Vaccinementioning

confidence: 99%

Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services?

Amponsah-Dacosta

Blose

Nkwinika

et al. 2022

Front. Public Health

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Compared to other regions of the world, sub-Saharan Africa has made limited progress in the implementation and performance of nationwide human papillomavirus (HPV) vaccination programmes. Without urgent intervention, this will serve to undermine cervical cancer elimination efforts in this region. The primary intent of this narrative review is to highlight the programmatic successes and challenges of the school-based HPV vaccination programme in South Africa since its inception in 2014, with the aim of contributing to the evidence base needed to accelerate implementation and improve programme performance in other sub-Saharan African countries. As of 2020, the proportion of adolescent girls aged 15 years who had received at least one dose of the HPV vaccine at any time between ages 9–14 years was 75%, while 61% had completed the full recommended two-dose schedule. This gives some indication of the reach of the South African HPV vaccination programme over the past 6 years. Despite this, vaccine coverage and dose completion rates have persistently followed a downward trend, slowing progress toward attaining global elimination targets. There is evidence suggesting that declining public demand for the HPV vaccine may be a result of weakening social mobilization over time, inadequate reminder and tracking systems, and vaccine hesitancy. Another concern is the disproportionate burden of HPV and HIV co-infections among adolescent girls and young women in South Africa, which predisposes them to early development of invasive cervical cancer. Moving forward, national policy makers and implementers will have to explore reforms to current age eligibility criteria and vaccine dose schedules, as well as implement strategies to support vaccine uptake among populations like out-of-school girls, girls attending private schools, and HIV positive young women. Additional opportunities to strengthen the South African HPV vaccination programme can be achieved by scaling up the co-delivery of other adolescent health services such as comprehensive sexual and reproductive health and rights education, deworming, and health screening. This calls for reinforcing implementation of the integrated school health policy and leveraging existing adolescent health programmes and initiatives in South Africa. Ultimately, establishing tailored, adolescent-centered, integrated health programmes will require guidance from further operational research.

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Feasibility and acceptability of delivering adolescent health interventions alongside HPV vaccination in Tanzania

Cited by 23 publications

References 22 publications

Cervical cancer in Tanzania: A systematic review of current challenges in six domains

Cervical cancer in Tanzania: A systematic review of current challenges in six domains

National implementation of HPV vaccination programs in low-resource countries: Lessons, challenges, and future prospects

Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services?

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