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Experience with Implementation of Human Papilloma VIRUS (HPV) Vaccination In A Country with Limited Resources

Saturday, October 20, 2012
Room 346-347 (Morial Convention Center)
Marylena Arita, MD, MPH1, Meredith Paddock, MPH2, Suyapa Bejarano, MD3, Elsa Sabio, B.S., R.N., C.D.E.1 and Hernan Sabio, M.D., M.S.4, (1)Catholic Medical Mission Board, Tegucigalpa, Honduras, (2)Catholic Medical Mission Board, New York, New York, (3)Liga Contra El Cancer, San Pedro Sula, Honduras, (4)Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC

Background: Honduras is the second poorest country in the Americas. It has achieved one of the highest childhood immunization rates in the world (>98%). Cervical cancer is a leading cause of death among women in Honduras. Therefore, efforts at early diagnosis and prevention of cervical cancer become a healthcare priority.

Methods: Doses of the quadrivalent HPV vaccine were made available through a sponsoring program and administered through an NGO. Because of the very high childhood vaccination rate in Honduras, the national vaccination program was sought as a partner. This proved to be a strategic decision since planning this limited vaccination program led health authorities to develop guidelines for future nationwide implementation of an HPV vaccination program. Partnerships were also established with a major community-based cancer society and with other local civic groups. A critical component of HPV vaccination is education of the population at risk and their caretakers. This was successfully accomplished through the above mentioned partnerships, with active participation of administrative and docent school personnel and appropriate use of mass media to enhance community awareness and support. Another level of complexity in HPV vaccination is the three-dose regimen. Vaccination was planned to begin on the second month of a nine month school year, anticipating that all three doses could be administered during the school year. Vaccination sites were private and public schools. Vaccination was limited to 11 year old and 10 year old female students. The areas in the country selected for HPV vaccination (approximately 72,000 total doses) were targeted according to the regional incidence of cervical cancer.  

Program Evaluation: An area of interest was the acceptance of the HPV vaccine by parents, the community and the students to be vaccinated.   The caretakers of girls eligible for vaccination could accept or decline vaccination. The acceptance rate became a surrogate marker of successful education. Because of the time constraints of completing the 3 dose vaccination program during the school year, initiation of the first dose within the second month of school was critical and utilized as an index of successfully coordinated logistics by the collaborative partnerships.

  Results: Parental and community acceptance of the HPV vaccination program was >95%.The initial report of this limited and complex vaccination program revealed >12,000 doses administered during the first two weeks of vaccination. Vaccination in two different regions of the country was initiated during the prescribed initial two months of the school year.  The significance of these initial milestones is further highlighted by the challenges of insecurity, transportation to remote areas and prevailing labor disputes encountered during the vaccination program. This experience suggests that, although complex; HPV vaccination can be successfully implemented in resource-limited countries through the development of key partnerships including governmental, community and NGO resources.