National introduction of human papillomavirus (HPV) vaccine in Tanzania: Programmatic decision-making and implementation

Mphuru, Alex; Li, Anyie J.; Kyesi, Furaha; Mwengee, William; Mazige, Fikiri; Nshunju, Raphael; Shayo, Berrington; Giattas, Mary Rose; Loharikar, Anagha; Lyimo, Dafrossa

doi:10.1016/j.vaccine.2021.04.025

Cited by 23 publications

(45 citation statements)

References 20 publications

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“…A key component of HPV vaccine delivery is multi-stakeholder collaboration. Several studies show that coordination and collaboration between ministries of health, development partners, the education sector, communitybased and professional groups is a key driver of vaccine uptake [8,9,30]. Our study largely supports these findings, coordination between teachers, health care workers, and community leaders was crucial to the success of the pilot program in Yauri.…”

Section: Partnership With Key Influencers and Stakeholderssupporting

confidence: 85%

“…As such, it is imperative that countries implement HPV delivery strategies that are effective, affordable, sustainable, and compatible with their health systems to achieve the highest possible coverage. Since 2012, several global and national programs have introduced pilot programs to determine the best strategies to optimize HPV vaccine delivery in LMICs [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community

et al. 2022

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Background Over 80% of new cervical cancer cases occur in women living in low- and middle-income countries. It is the second highest cause of female cancer deaths in Nigeria. School based vaccination programs are an effective strategy for delivering the HPV vaccine to adolescent girls. This study aims to understand the challenges to implementing school-based HPV vaccination programs, particularly in a remote rural setting where vaccine hesitancy is high. Methods A 22- item interviewer administered questionnaire was used to evaluate HPV knowledge and willingness to get the HPV vaccinate among 100 female secondary school students as part of an HPV vaccination pilot in a rural community in Kebbi State, Nigeria. Additionally, semi-structured interviews were used to assess community knowledge and attitudes on cervical cancer and HPV vaccination. Data collected were analyzed thematically to understand challenges and generate lessons for vaccine delivery in the study setting. Results Knowledge of HPV and cervical cancer among junior secondary school aged girls was fair with a mean score of 66.05%. For senior secondary school aged girls, the knowledge score ranged from 70 to 100% with a mean of 96.25% indicating good knowledge of HPV and cervical cancer. All participants (n = 100) received the first vaccine dose but due to COVID-19, 33 participants were not able to complete the vaccine dosage within the recommended 6-month schedule. Of the parents who provided consent, none could afford the vaccine out of pocket. Challenges to vaccine delivery included operational costs exacerbated by lack of adequate health workforce and infrastructure in the study setting. Conclusion An exploration of sociocultural perspectives and contextual realities is crucial to understanding the complexities of HPV vaccine introduction from the perspective of the target audience, and the local community. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the vaccination program locally relevant. While school-based HPV immunization programs have been shown to be successful, adequate design, planning and monitoring is important. Additionally, considerations must be made to account for the high operational cost of vaccine delivery in rural, hard to reach areas where human resources and infrastructure are limited.

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Section: Partnership With Key Influencers and Stakeholderssupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community

et al. 2022

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“…HPV vaccination is highly effective at preventing HPV infection and associated disease, including cervical and anal precancers; 22 however, Tanzania only started vaccinating girls in 2018 which could not have affected our estimates of prevalence in 2011-2012. 23 Even if there were current gender-neutral HPV vaccination programs in Tanzania, most MSM would not receive its full disease preventive potential; thus, urban Tanzanian MSM will need anal cancer screening for years to come.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of and factors associated with anal high-risk human papillomavirus in urban Tanzanian men who have sex with men, 2011-2012

et al. 2022

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Background: Anal cancer is primarily caused by high-risk human papillomavirus (hrHPV), is associated with HIV infection, and has a very high incidence among men who have sex with men (MSM). We assessed prevalence of hrHPV, and factors associated with hrHPV in anal canal specimens collected in Dar es Salaam, Tanzania from HIV-positive and HIV-negative MSM. Methods: MSM were recruited using respondent-driven sampling in this cross-sectional study. The primary outcome in this ancillary analysis of 116 MSM was prevalence of HPV-16 and other hrHPV types. Prevalence ratios (PR) estimated the association between hrHPV and HIV-negative participants’ demographics, sexual behaviour and sexually transmitted infections. Results: Median age was 23 years and 33.6% of participants were HIV-positive. HrHPV and HPV-16 prevalence was 54.3% and 17.2%, respectively, with HPV-16 prevalence highest among HIV-positive MSM identifying as gay (36.1%) and lowest among HIV-negative MSM identifying as bisexual (2.9%). Having two or more receptive anal sex partners in the past month was associated with hrHPV (PR 3.20, 95%CI 1.69-6.07, vs. 0 partners) among HIV-negative MSM.Conclusions: HrHPV prevalence was high among MSM in Dar es Salaam and highest among HIV-positive MSM identifying as gay. These estimates may be used to support HPV vaccination and screening initiatives.

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“…However, due to the limited global HPV vaccine supply since 2017, Tanzania was only able to receive enough HPV vaccine for a single-age cohort of girls. Tanzania selected the older age cohort of 14-year-old girls to ensure protection to the greatest number of girls because those girls would not be age-eligible in subsequent years (≥15 years old) [ 9 , 42 ]. The multiple-age cohort of 9–14-year-old girls would be vaccinated when sufficient HPV vaccine supplies became available; then Tanzania would continue routinely vaccinating 9-year-old girls each year thereafter.…”

Section: Introductionmentioning

confidence: 99%

“…As more LMICs begin scale-up to nationwide vaccination, there are still many gaps in our understanding of the factors that underpin successful national HPV vaccine program implementation. Tanzania was among the first Gavi-supported countries to introduce HPV vaccine into their national immunization program, administering the vaccine to 14-year-old girls, through a routine delivery strategy [ 15 – 17 , 42 ]. We aimed to better understand the feasibility of Tanzania’s delivery strategy and the ability to reach the target population, key stakeholder awareness and acceptability of the HPV vaccine and program.…”

Section: Introductionmentioning

confidence: 99%

Tanzania’s human papillomavirus (HPV) vaccination program: Community awareness, feasibility, and acceptability of a national HPV vaccination program, 2019

Manzi

Kyesi

et al. 2022

Vaccine

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National introduction of human papillomavirus (HPV) vaccine in Tanzania: Programmatic decision-making and implementation

Cited by 23 publications

References 20 publications

Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community

Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community

Prevalence of and factors associated with anal high-risk human papillomavirus in urban Tanzanian men who have sex with men, 2011-2012

Tanzania’s human papillomavirus (HPV) vaccination program: Community awareness, feasibility, and acceptability of a national HPV vaccination program, 2019

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