Routine HPV vaccination: Reflection on delivery strategies based on countries' experiences.

Despite the introduction of the human papillomavirus (HPV) vaccine in many low- and middle-income countries (LMICs), countries are still struggling to maintain HPV vaccination coverage and manage sustainable delivery strategies. This article explores the challenges and effective strategies for HPV vaccine delivery in LMICs, with a focus on reflecting upon current HPV vaccine delivery strategies in the World Health Organization (WHO) HPV vaccine introduction guidelines to align with practical implementation experiences. The article utilizes presentations and discussions from Coalition to Strengthen the HPV Immunization Community (CHIC) symposia, field experiences of program implementers who participated in the meeting and immunization expert opinions, to inform its findings. Several countries are spotlighted for their delivery strategies. These include routinized campaign mode vaccinations at schools in The Gambia, Zambia, and Ethiopia; routine health facility services in Tanzania, Kenya, and Maldives; and outreach strategies targeting out-of-school girls. By evaluating these diverse strategies, the article suggests a need to delve deeper and build an understanding of the routinized campaign mode of HPV vaccine delivery, and advocates for expanding the scope of delivery strategies and consequently updating the WHO HPV vaccine delivery guidelines in line with the evolving landscape of HPV vaccination delivery to ensure comprehensive, cost-effective, and sustainable programs in LMICs.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: FK reports writing assistance was provided by Immunization and Vaccine Development Program, Ministry of Health, Tanzania. YLT reports writing assistance was provided by Maternal and Child Health Directorate, Ministry of Health, Ethiopia. YLT also reports a relationship with Maternal and Child Health Directorate, Ministry of Health, Ethiopia that includes non-financial support. JB reports writing assistance was provided by World Health Organization and a relationship with World Health Organization that includes non-financial support. CN reports a relationship with PATH that includes employment. AV reports financial support was provided by Bill and Melinda Gates Foundation and reports a relationship between his institute Center for Evaluation of Vaccination, Faculty of Medicine and Health Sciences with GlaxoSmithKline Biologicals SA, Roche Diagnostics Corp, Becton Dickinson and Company, Hologic Inc and Merck that includes funding grant. DNW and AB reports financial support was provided by Bill and Melinda Gates Foundation. Rest of the co-authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. For the authors identified as personnel of the WHO, the authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions, policies, or views of the WHO. The designations used and the presentation of the material in this article do not imply the expression of any opinion whatsoever on the part of WHO about the legal status of any country, territory, city, or area, or its authorities, or concerning the delimitation of its frontiers or boundaries.
(Copyright © 2023. Published by Elsevier Ltd.)