Department of Social Policy, London School of Economics, Houghton Street, London WC2A 2AE, UK.
Vaccine. 2013 Aug 20;31(37):3811-7. doi: 10.1016/j.vaccine.2013.06.016. Epub 2013 Jun 15.
Prophylactic vaccines for human papillomavirus (HPV) are being introduced in many countries for the prevention of cervical cancer, the second most important cause of cancer-related death in women globally. This is likely to have a significant impact on the future burden of cervical cancer, particularly where screening is non-existent or limited in scale. Previous research on the challenges of vaccinating girls with the HPV vaccine has focused on evidence from developed countries. We conducted a systematic search of the literature in order to describe the barriers and challenges to implementation of HPV vaccine in low- and middle-income countries. We identified literature published post-2006 to September 2012 from five major databases. We validated the findings of the literature review with evidence from qualitative key informant interviews. Three key barriers to HPV vaccine implementation were identified: sociocultural, health systems and political. A linked theme, the sustainability of HPV vaccines programmes in low- and middle-income countries, cuts across these three barriers. Delivering HPV vaccine successfully will require multiple barriers to be addressed. Earlier research in developed countries emphasised sociocultural issues as the most significant barriers for vaccine roll-out. Our evidence suggests that the range of challenges for poorer countries is significantly greater, not least the challenge of reaching girls for three doses in settings where school attendance is low and/or irregular. Financial and political barriers to HPV vaccine roll-out continue to be significant for many poorer countries. Several demonstration and pilot projects have achieved high rates of acceptability and coverage and lessons learned should be documented and shared.
预防性人乳头瘤病毒 (HPV) 疫苗正在许多国家推出，以预防宫颈癌，这是全球女性癌症相关死亡的第二大主要原因。这可能会对宫颈癌的未来负担产生重大影响，特别是在筛查不存在或规模有限的地方。以前关于用 HPV 疫苗为女孩接种疫苗的挑战的研究主要集中在发达国家的证据上。我们进行了系统的文献搜索，以描述在低收入和中等收入国家实施 HPV 疫苗的障碍和挑战。我们从五个主要数据库中确定了 2006 年后至 2012 年 9 月发表的文献。我们通过定性关键知情人访谈的证据验证了文献综述的结果。确定了实施 HPV 疫苗的三个主要障碍：社会文化、卫生系统和政治。一个相关的主题是，HPV 疫苗在低收入和中等收入国家的可持续性贯穿这三个障碍。成功推出 HPV 疫苗需要解决多个障碍。早期在发达国家进行的研究强调社会文化问题是疫苗推出的最大障碍。我们的证据表明，较贫穷国家面临的挑战范围要大得多，尤其是在出勤率低和/或不规则的情况下，为女孩接种三剂疫苗的挑战。对许多较贫穷国家来说，HPV 疫苗推出的财政和政治障碍仍然很大。一些示范和试点项目已经实现了高接受率和覆盖率，应该记录和分享所吸取的经验教训。
