Human papillomavirus (HPV) vaccine coverage achievements in low and middle-income countries 2007-2016

Abstract

Introduction: Since 2007, HPV vaccine has been available to low and middle income countries (LAMIC) for small-scale 'demonstration projects', or national programmes. We analysed coverage achieved in HPV vaccine demonstration projects and national programmes that had completed at least 6 months of implementation between January 2007-2016.

Methods: A mapping exercise identified 45 LAMICs with HPV vaccine delivery experience. Estimates of coverage and factors influencing coverage were obtained from 56 key informant interviews, a systematic published literature search of 5 databases that identified 61 relevant full texts and 188 solicited unpublished documents, including coverage surveys. Coverage achievements were analysed descriptively against country or project/programme characteristics. Heterogeneity in data, funder requirements, and project/programme design precluded multivariate analysis.

Results: Estimates of uptake, schedule completion rates and/or final dose coverage were available from 41 of 45 LAMICs included in the study. Only 17 estimates from 13 countries were from coverage surveys, most were administrative data. Final dose coverage estimates were all over 50% with most between 70% and 90%, and showed no trend over time. The majority of delivery strategies included schools as a vaccination venue. In countries with school enrolment rates below 90%, inclusion of strategies to reach out-of-school girls contributed to obtaining high coverage compared to school-only strategies. There was no correlation between final dose coverage and estimated recurrent financial costs of delivery from cost analyses. Coverage achieved during joint delivery of HPV vaccine combined with another intervention was variable with little/no evaluation of the correlates of success.

Conclusions: This is the most comprehensive descriptive analysis of HPV vaccine coverage in LAMICs to date. It is possible to deliver HPV vaccine with excellent coverage in LAMICs. Further good quality data are needed from health facility based delivery strategies and national programmes to aid policymakers to effectively and sustainably scale-up HPV vaccination.

Keywords: Completion; Coverage; HPV; Low and middle income countries; Uptake; Vaccine/vaccination.

Fig. 1

Coverage survey results (n = 17) from demonstration projects in 13 countries, plotted against estimates of primary school net enrolment ratios, by delivery strategy. Net primary school enrolment ratio: The number of children who belong to the age group that officially corresponds to that of primary schooling who are enrolled in primary school, divided by the total population of the same age group.

Fig. 2

Uptake, coverage and completion achievements as documented in coverage surveys and the estimated recurrent financial cost of delivery per dose in 5 Gavi demonstration projects and 5 other demonstration projects. Recurrent financial cost of delivery per dose is presented as calculated in the source cost analyses. These analyses used different methods but were restricted to reporting costs likely to be ‘recurrent’ at every vaccination session i.e. not capital costs or start-up costs, and costs that were not already assumed by the routine immunisation system i.e. not economic costs; e.g. the additional allowances paid to staff for outreach activities specific to HPV vaccination were counted in the recurrent financial cost but core staff salaries were not included.