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将其他服务与人类乳头瘤病毒疫苗接种相结合;生命历程早期的经验教训凸显了新政策及实施证据的必要性。

Integration of other services with human papillomavirus vaccination; lessons from earlier in the life course highlight the need for new policy and implementation evidence.

作者信息

Morgan Christopher, Giattas Mary Rose, Holroyd Taylor, Pfitzer Anne, Engel Danielle, Sidibe Anissa, Holloway Megan, Bloem Paul, Fields Rebecca, Shimp Lora, Kumar Somesh

机构信息

Jhpiego, a Johns Hopkins University Affiliate, 1615 Thames St, Baltimore, MD 21231, USA; School of Population and Global Health, University of Melbourne, Victoria 3010, Australia; Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia.

Jhpiego Tanzania, Dar es Salaam, Tanzania.

出版信息

Vaccine. 2022 Mar 31;40 Suppl 1:A94-A99. doi: 10.1016/j.vaccine.2021.12.066. Epub 2022 Jan 31.

Abstract

Integration of vaccination against human papillomavirus (HPV) with other essential health services for adolescents has been proposed in global strategies and tested in demonstration projects in low- and middle-income countries (LMIC). Published experiences, global guidance, and one key example, the implementation of "HPV Plus" in Tanzania, all demonstrate the need for greater operational evidence to guide future implementation and policy. Review of experiences earlier in the life course, integrating post-partum family planning with infant immunization, show lessons from 13 LMICs that can apply to provision of adolescent health information and services alongside HPV vaccination. Three distinct models of integration emerge from this review comprising: 1) multiple tasks and functions by health staff providing vaccination and other care, or 2) secondary tasks added to the main function of vaccination, or 3) co-location of matched services provided by different staff. These models, with strengths and weaknesses demonstrated in family planning and immunization experiences, apply in different ways to the three main platforms used for HPV vaccination: school, facility or community. For HPV vaccination policy and programming, an initial need is to combine the existing evidence on vaccine service delivery - including coverage, efficiency, cost, and cost-effectiveness information - with what is known on how integration works in practice; the operational detail and models employed. This synthesis may enable assessment which models best suit the different service delivery platforms. An additional need is to link this with more tailored local assessments of the adolescent burden of disease and other determinants of their well-being to develop new thinking on what can and cannot be done to integrate other services alongside HPV vaccination. New approaches placing adolescents at the center are needed to design services tailored to their preferences and needs. The potential synergies with cervical cancer screening and treatment for older generations of women, also require further exploration. Coordinated action aligning HPV vaccination with broader adolescent health and wellbeing will generate social, economic and demographic benefits, which in themselves are sufficient justification to devote more attention to integrated approaches.

摘要

全球战略中已提议将人乳头瘤病毒(HPV)疫苗接种与青少年的其他基本卫生服务相结合,并在低收入和中等收入国家(LMIC)的示范项目中进行了测试。已发表的经验、全球指南以及一个关键实例,即坦桑尼亚实施的“HPV Plus”,均表明需要更多的操作证据来指导未来的实施和政策制定。对生命早期将产后计划生育与婴儿免疫相结合的经验进行回顾,发现来自13个低收入和中等收入国家的经验教训可应用于在HPV疫苗接种的同时提供青少年健康信息和服务。此次回顾产生了三种不同的整合模式,包括:1)卫生工作人员在提供疫苗接种和其他护理时承担多项任务和职能;2)在疫苗接种的主要职能基础上增加次要任务;3)由不同工作人员提供的匹配服务在同一地点提供。这些模式在计划生育和免疫经验中展现出了优势和劣势,并以不同方式应用于HPV疫苗接种所使用的三个主要平台:学校、医疗机构或社区。对于HPV疫苗接种政策和规划而言,最初需要将关于疫苗服务提供的现有证据(包括覆盖率、效率、成本和成本效益信息)与整合在实际中如何运作的已知情况相结合;即所采用的操作细节和模式。这种综合分析可能有助于评估哪种模式最适合不同的服务提供平台。另一个需求是将此与针对青少年疾病负担和其他幸福决定因素的更具针对性的本地评估相联系,以形成关于在HPV疫苗接种的同时整合其他服务的可行与不可行做法的新思维。需要采用以青少年为中心的新方法来设计符合他们偏好和需求的服务。与老年女性宫颈癌筛查和治疗的潜在协同作用也需要进一步探索。将HPV疫苗接种与更广泛的青少年健康和福祉相协调的行动将产生社会、经济和人口效益,这些效益本身就足以成为更加关注综合方法的充分理由。

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