Since 2007, HPV vaccine has been available to LMICs for small-scale pilot ‘demonstration projects’, or national programmes, through manufacturer donations, the GARDASIL® Access Program, Gavi The Vaccine Alliance, or other means. We analysed coverage achieved in HPV vaccine demonstration projects and national programmes that had completed at least one year of implementation between January 2007-January 2015.
A mapping exercise identified 37 LMICs with HPV vaccine delivery experience. Estimates of coverage and factors related to high coverage were obtained from a systematic published literature search of 5 databases that identified 41 relevant full texts and 9 conference abstracts, 124 solicited unpublished documents, including coverage surveys, and 27 key informant interviews. Coverage achievements were analysed descriptively against country or project/programme characteristics.
Estimates of dose 1 uptake, completion rates and/or final dose coverage were available from 30 of 37 LMICs (45 demonstration projects and 4 national programmes). Only 10 estimates from 10 countries were from surveys; most were administrative estimates. All final dose coverage estimates were over 50%; the majority between 70-90%. There was no correlation between year of delivery of dose 1 and coverage. Dose 1 uptake was generally high across different delivery strategies; however, strategies that included schools attained higher average final dose coverage than health facility-based strategies. In countries with school enrolment rates below 90%, inclusion of strategies to reach out-of-school girls contributed to higher coverage compared to school-only strategies. Among school-based strategies, higher coverage was observed when the Ministry of Education was involved in both planning and implementation of vaccination. Other important factors were political commitment, intensive social mobilisation, community engagement and timely delivery of vaccine within one school year.
While the heterogeneity in data quality, funder requirements, project/programme organisation and design precluded multivariate analysis; this is the most comprehensive descriptive analysis of HPV vaccine coverage in LMICs to date. It is possible to deliver HPV vaccine with excellent coverage in LMICs. Planning and delivery strategies can affect coverage. School-based delivery strategies provide high coverage. Ministry of Education participation, and strategies to vaccinate out-of-school girls are also essential. Social mobilisation should be intensive and all doses should be delivered within one school year.