Soi et al., 2018¹⁰

Not specified

Development of a semi structured interview guide to capture information on the selected CFIR constructs and used it to conduct 40 key informant interviews (KIIs) at the Ministry of Health (MOH) central level and all three demonstration districts

Factors associated with uptake of the HPV vaccine:

1) Little access to knowledge and poor information given by teachers for lack of training;

2) Exclusion of the opinion of important religious leaders in the community;

3) Mistrust and misbeliefs regarding the target population for vaccination.

Barriers to service delivery:

1) Implementation of the HPV vaccine predominantly out of health facilities, because health workers had to rely on non-health workers, teachers in school-based and community leaders in community based vaccination;

2) Unclear roles and duties in the context of multiple implementing entities;

3) Lack of knowledge of the exact location of girls who were not in school;

4) Vaccination date scheduled during a local public holiday;

5) The lower socioeconomic development of these low-income districts and the underlying poor state of the transportation network;

6) Few number of schools in low-performing district and at further distances from health facilities, resulting in a higher number of girls unenrolled in school and in increased travel time for school-based vaccination efforts;

7) Insufficient financial resources, organizational incentives and rewards, including lack or insufficient funding by key stakeholders;

8) Lack of learning climate (extent to which evaluation is integrated in demonstration project), which leads to lack of interest in improving coverage.

Ladner et al., 2014¹¹

Bhutan (2009) - 3200

Bolivia (2009) - 3480

Bolivia (2010) - 7500

Bolivia (2010) - 30,900

Bolivia (2011) - 50,000

Cambodia (2009) - 9600

Cambodia (2010) - 2000

Cameroon (2010) - 6400

Georgia (2010) - 6400

Haiti (2009) - 3300

Honduras (2011) - 3200

Honduras (2012) - 1575

Kenya (2011) - 3000

Lesotho (2009) - 40,000

Lesotho (2010) - 40,100

Moldova (2009) - 6934

Nepal (2010) - 3000

Nepal (2011) - 10,000

Tanzania (2010) - 5532

Uganda (2010) - 985

Uzbekistan (2009) - 8450

Organizations and institutions participating in GAP were required to submit final program reports. These reports gathered financial data (if available) and information related to community involvement actions, communication key messages and methods.

Barriers to service delivery:

1) Programs managed by Ministries of Health (MoH) due to more internal bureaucratic hurdles;

2) Lack of community sensitization about the availability and value of vaccinating school-aged girls against HPV;

3) Lack of community involvement in following-up with girls participating in the vaccination campaign;

4) Lack of key messages about the safety and efficacy of the vaccine at the launch of a vaccine campaign ;

5) Long-term vaccination programs, mainly longer interval between vaccine shipment and administration of the doses, that reflects difficulty in vaccinating girls against HPV in a timely manner;

6) Difficulties in conducting effective cost analyses around HPV vaccination in low and middle-income countries due to costs associated to financing of pre-introduction activities, development of new delivery infrastructure and the deployment of new human resources or reallocation of existing personnel;

7) Loss of interest in completing all three doses of vaccine among girls and their parents due to the lack of momentum within a given program;

8) Lower effectiveness in Health-centre-based delivery compared to School-based delivery, because daily attendance of target girls at school allows them to be vaccinated more quickly than might occur at a health clinic that requires the girl to make a special trip;

Lack of information disseminated by schools, that is more important than information provided by local media with respect to vaccine uptake.