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Challenges to National Human Papillomavirus Vaccine Program Implementation in Developing Countries [18H]

Shirazian, Taraneh MD; Smith, Courtney MPH; Fisher, Julia
doi: 10.1097/01.AOG.0000514920.21673.ef
Sunday, May 7, 2017: PDF Only

INTRODUCTION:In 2012, an estimated 527,624 women were diagnosed with cervical cancer globally, and an estimated 265,653 women died from the disease. Of deaths attributed to cervical cancer, 90% occur in low and middle-income countries (LMIC) due to lack of access to screening and treatment. Vaccines protecting against the strains of human papillomavirus (HPV) causing cervical cancer have been available since 2006, but little is known about their national implementation in LMIC.

METHODS:Using the PubMed database, literature was reviewed for any LMIC with national or pilot HPV programs. 2014 World Bank definitions and data were used to identify LMIC. In addition to the literature search, websites of organizations with information regarding cervical cancer programs, including Cervical Cancer Action, ICO Information Centre on HPV and Cancer, and PATH, were reviewed.

RESULTS:Thirty LMIC were identified with national HPV programs. Four of the thirty began their programs in 2015 or 2016 with little data available. Fifteen countries do not report coverage rates or programmatic features, suggesting limited scope of their HPV national programs. Of eleven countries reporting coverage rates, these rates vary dramatically, from 5% to 99%. Of countries with available data, all of them target girls aged 9-17 but use a variety of school and clinic-based delivery methods. Only three of the thirty countries receive GAVI support for vaccine purchasing.

CONCLUSION:Given the disproportionate burden of cervical cancer-related mortality in LMIC and the availability of the HPV vaccine, further research on the effectiveness of national HPV vaccine programs is warranted.

Financial Disclosure: The authors did not report any potential conflicts of interest.

Received February 19, 2017

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.