-- HPV Vaccine Demonstration Projects: Learning by Doing

Monday, 28th of January 2013

Abstract Title: HPV vaccine demonstration projects: Learning by doing

Presenter: D. Scott LaMontagne, PhD MPH, FRSPH

Investigators / Collaborators: Vivien Davis Tsu1; D. Scott LaMontagne1

Affiliation: 1 PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121 USA

Country: United States

Objectives

Delivery of the human papillomavirus (HPV) vaccine presents significant challenges to immunization programs, especially in countries with limited health care resources. Using vaccine manufacturer donations, several countries have been able to conduct

demonstration programs. Structured evaluations have enabled some of these projects to produce valuable lessons that can guide national best practices. The GAVI Alliance is now making this opportunity available to additional low-income countries. The objective of this paper is to identify strategies for maximizing what can be learned from HPV vaccine demonstration projects.

Method

Careful review was undertaken of experience from four demonstration projects carried out by PATH in collaboration with ministries of health in India, Peru, Uganda, and Vietnam.

Results

Both how the demonstration project is structured and how it is evaluated have an impact on the potential for deriving useful lessons. In setting up demonstration projects, it is important that they rely on existing immunization programs and health systems.

Site selection is critical to ensure that regions with different characteristics are adequately represented. If different delivery strategies are being considered, demonstration projects offer the chance to test the approaches before going to national scale.

Four critical dimensions for evaluation were identified: vaccine coverage, feasibility of delivery strategies, acceptability, and cost of vaccine delivery. Practical methods for measuring each dimension have been developed and validated. These include

household surveys that gather data on coverage and reasons for acceptance or non-acceptance of vaccine; interviews, record reviews, and observations of health workers to see the impact of vaccine delivery on other health services (feasibility); and ingredients-based costing of both start-up and recurrent costs. Results from the four demonstration projects were used to refine national strategies.

Implications and Impact

A well-designed demonstration project can enable an immunization program to test its strategy in different settings, ensure the right target group is being reached, evaluate the effectiveness of its communication materials, identify potential obstacles or efficiencies, estimate the likely financial requirements, and explore opportunities for integration or coordination with other services for young adolescents. Taking advantage of the opportunity being offered by GAVI to conduct demonstration projects before national rollout of HPV vaccine could help overcome some of the hurdles posed by this life-saving, but challenging, new tool in the cervical cancer prevention arsenal.