Qualitative Study of the Feasibility of HPV Vaccine Delivery to Young Adolescent Girls in Vietnam: Evidence from a Government-Implemented Demonstration Program

"Recently concluded pilots of HPV vaccination in low-income countries have provided important lessons learned for these settings; however, rigorous evaluations of the feasibility of these delivery strategies that effectively reach young adolescents have been few."

With the goal of supporting the effort to prevent cervical cancer, this paper presents results from a qualitative evaluation of a demonstration programme which delivered human papillomavirus (HPV) vaccinations to all girls in grade 6 (if school-based) or 11 years of age (if health-centre-based) for 2 years in 4 districts of Vietnam. Using semi-structured interviews of 131 health and education staff from local, district, province, and national levels, as well as 26 focus group discussions with local project implementers (n=153), the researchers conducted a qualitative 2-year evaluation to measure the impact of HPV vaccinations on the health and education systems.

As reported here, both the health and education systems were temporarily challenged with the extra workload, but HPV vaccine delivery at schools or health centres was made feasible by:

• Close collaboration between the health and education sectors;
• Detailed planning for implementation;
• Clearly defined roles and responsibilities for project implementers;
• Effective management and supervision of vaccinations during delivery; and
• Engagement with community organisations for support.

Selected lessons learned include:

• Communication is important in terms of implementation. For example: "Health staff emphasized that introduction of a new vaccine required greater investment in communication activities and training to deliver the first dose, leading to significant changes in their workload, which decreased for the second and third doses." A staff member from Can Tho City district health staff quoted in the paper said: "Communicators at villages were involved in communication. District reproductive health staff also supported us in training communicators. During vaccination days, we ourselves divided into small teams to go to communes. As this vaccine is new, communication to parents was conducted in the school, but several people still did not understand well. Thus, we must visit families to explain more."
• "Collaboration across sectors was a major theme reiterated by most respondents as being critically important to the success of the HPV vaccinations implemented. The example of collaboration was set at the national level and reinforced by provincial and district-level collaboration between the health and education sectors, all of which created a supportive environment for health and education collaborations at the lowest level of the communes....Meetings were held by the two sectors to agree on a joint document that clearly outlined the roles and responsibilities of each party in implementing HPV vaccinations. At district and commune levels, local authorities were more directly involved in project activities. Study participants credited the direction and participation of local authorities for the favorable support received from different departments and organizations....At the commune level, the collaboration involved joint implementation of project activities. Respondents reported that health centers were the responsible contact, directing all project activities at communes, with schools participating in preparation, communication activities, and vaccination sessions. School activities included: a) preparing lists of eligible girls; b) organizing parent meetings at schools; c) conducting communication sessions for students and parents, which included inviting health officials to speak; d) delivering invitation letters and reminding girls of the vaccination day; and e) participating jointly on vaccination days....Local project implementers reported that the People's Committee leaders not only mobilized the participation of other organizations, but also directly launched the first dose of the HPV vaccination campaign and actively supervised and encouraged project implementers during those vaccination days. Under the direction of local authorities, many other organizations, such as cultural and information departments, Women's Unions, and Youth Unions, also participated in project implementation. Respondents suggested that, like other development projects, the participation of local authorities in coordinating project activities for HPV vaccinations facilitated community acceptability and participation of the health and education sectors."

"In summary, most of the challenges for the feasibility of HPV vaccine delivery found in our study were logistical, commonly found in a diversity of other HPV vaccination programs, and they were overcome through additional coordination and planning in subsequent rounds of vaccinations."