Key decision-making factors for human papillomavirus (HPV) vaccine program introduction in low-and-middle-income-countries: Global and national stakeholder perspectives

Abstract

Low-and-middle-income countries (LMICs) experience a high burden of cervical cancer. The human papillomavirus (HPV) vaccine prevents high-risk strains of HPV that cause cervical cancer; however, the integration of HPV vaccines into national immunization programs within many LMICs has been suboptimal. Our study evaluated key factors that drive the decision-making process for the implementation of HPV vaccine programs in LMICs. Stakeholder analysis and semi-structured in-depth interviews were conducted with national and global stakeholders. Interview data were analyzed through qualitative descriptive methods. Findings from our study revealed the decision-making process for HPV vaccines requires the involvement of multiple institutions and stakeholders from national and global levels, with decision-making being a country-specific process. Partner considerations, locally driven processes, availability of data, and infrastructure and resource considerations were found to be critical factors in the decision-making process. Future programs should evaluate the best approaches for investing in initiatives to enhance coordination, ensure vaccine introduction is locally driven, increase the availability of data needed for decision-making, and equip countries with the necessary resources to guide country decision-making in the face of increasingly complex decision-making environments.

Planning, implementation, and sustaining high coverage of human papillomavirus (HPV) vaccination programs: What works in the context of low-resource countries?

“…We categorized results by drawing on the domains outlined in the WHO guide on introducing HPV vaccines in national immunization Health information systems such as databases or registries to record and report data on vaccination are essential for decisionmaking (57), optimal planning, tracking and determining accurate coverage. Lack of local service data was highlighted as a major challenge and contributed to delaying the decisionmaking process.…”

Global perspectives of determinants influencing HPV vaccine introduction and scale-up in low- and middle-income countries

“…adolescents, parents) [ 24 , 27 , 28 ]. The perspectives of global stakeholders are crucial to highlight as the financial and technical support from global partners has been influential in facilitating country decisions to introduce HPV vaccines, and the implementation of vaccination programs [ 22 ].…”

Sociodemographics and health-literacy as predictors of cervical cancer screening practices among Haitian women: A secondary data analysis of 2016–17 DHS surveys

“…For instance, the use of social media and mobile phone platforms that provide interactive audiovisual content in both Haitian Creole and French, may improve motivation in engaging in cervical cancer prevention for communities at-large. Lastly, more implementation research is needed in expanding cervical cancer prevention efforts in Haiti, and evaluating how key stakeholders can influence the scale-up of cervical cancer prevention efforts in a setting with numerous health challenges [57]. Of note, the incidence of high-risk strains of HPV are likely to increase among Haitan womeni due to the current sociopolitical crisis which has resulted in unforseen rates of sexual violence [58].…”