Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.
College of Medicine, University of the East - Ramon-Magsaysay Memorial Medical Center, Quezon City, Philippines.
Asia Pac J Clin Oncol. 2021 Dec;17(6):530-545. doi: 10.1111/ajco.13513. Epub 2021 Feb 26.
The increasing burden of human papillomavirus (HPV)-related diseases in low- and middle-income countries (LMICs) could be alleviated by effective HPV vaccination programs. In this systematic review, we examined barriers to introduction, implementation, and/or sustainability of HPV vaccination programs in LMICs in the Asia-Pacific region (AP-LMICs).
A systematic search of literature from the past 10 years (2010-2019) was performed through PubMed, Cochrane CENTRAL, and Google Scholar. Studies were included if they reported barriers to HPV vaccination in AP-LMICs. All study designs were included except commentaries and editorials. The journal articles were assessed using the Joanna Briggs Institute critical appraisal checklists.
A total of 46 eligible articles were included. An increase in publications was noted from 2010 to 2019. Barriers were diverse and were classified into four levels--government, healthcare providers (HCPs), society, and individual. The top specific barriers that were identified across AP-LMICs are lack of funding and political support at the government level, lack of awareness among HCP and lack of vaccination programs at the level of health providers, and the perceived cost/benefit ratio for the individual level.
Barriers to successful implementation of HPV vaccination programs differ among Asia-Pacific LMICs. Policymakers will need to evaluate the relative importance of these barriers in their target areas and population in order to draft an effective dissemination and implementation strategy.
在中低收入国家（LMICs），人乳头瘤病毒（HPV）相关疾病的负担不断增加，可以通过有效的 HPV 疫苗接种计划来缓解。在这项系统评价中，我们研究了亚太地区（AP-LMICs）低收入国家中 HPV 疫苗接种计划引入、实施和/或可持续性的障碍。
通过 PubMed、Cochrane CENTRAL 和 Google Scholar 对过去 10 年（2010-2019 年）的文献进行了系统搜索。如果研究报告了 AP-LMICs 中 HPV 疫苗接种的障碍，则纳入研究。纳入所有研究设计，除评论和社论外。使用 Joanna Briggs 研究所的批判性评估清单评估期刊文章。
共纳入 46 篇合格文章。从 2010 年到 2019 年，出版物的数量有所增加。障碍多种多样，分为政府、医疗保健提供者（HCPs）、社会和个人四个层面。在整个亚太地区被确定的主要特定障碍是政府层面缺乏资金和政治支持、卫生提供者层面的 HCP 缺乏意识和缺乏疫苗接种计划、以及个人层面的感知成本/效益比。
HPV 疫苗接种计划在亚太地区 LMICs 中的实施障碍不同。政策制定者需要评估这些障碍在其目标地区和人群中的相对重要性，以便制定有效的传播和实施策略。
