Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK.
Research and Development Division, Kintampo Health Research Centre, Kintampo North Municipality, Kintampo, Ghana.
Malar J. 2022 May 12;21(1):147. doi: 10.1186/s12936-022-04168-9.
In 2019, the RTS,S/AS01 malaria vaccine was introduced on a pilot basis in six regions of Ghana by the Ministry of Health/Ghana Health Service as part of the WHO-coordinated Malaria Vaccine Implementation Programme (MVIP). This is the first time a malaria vaccination programme has been implemented in any country. This paper describes the challenges faced, and lessons learned, during the planning and early implementation of the RTS,S/AS01 vaccine in three out of the six regions that implemented the programme in Ghana.
Twenty-one in-depth interviews were conducted with regional and district health service managers and frontline health workers three months after the start of MVIP in May 2019. Data were coded using NVivo software version 12 and a coding framework was developed to support thematic analysis to identify the challenges and lessons learned during the RTS,S/AS01 implementation pilot, which were also categorized into the Consolidated Framework for Implementation Research (CFIR).
Participants reported challenges related to the characteristics of the intervention, such as issues with the vaccine schedule and eligibility criteria, and challenges related to how it was implemented as a pilot programme. Additionally, major challenges were faced due to the spread of rumours leading to vaccine refusals; thus, the outer setting of the CFIR was adapted to accommodate rumours within the community context. Health service managers and frontline health workers also experienced challenges with the process of implementing RTS,S/AS01, including inadequate sensitization and training, as well as issues with the timeline. They also experienced challenges associated with the features of the systems within which the vaccine was being implemented, including inadequate resources for cold-chain at the health facility level and transportation at the district and health facility levels. This study identified the need for a longer, more intensive and sustained delivery of contextually-appropriate sensitization prior to implementation of a programme such as MVIP.
This study identified 12 main challenges and lessons learned by health service managers and health workers during the planning and early implementation phases of the RTS,S/AS01 pilot introduction in Ghana. These findings are highly relevant to the likely scale-up of RTS,S/AS01 within Ghana and possible implementation in other African countries, as well as to other future introductions of novel vaccines.
2019 年，作为世界卫生组织协调的疟疾疫苗实施规划（MVIP）的一部分，加纳卫生部/加纳卫生局在加纳的 6 个地区试点推出了 RTS,S/AS01 疟疾疫苗。这是任何国家首次实施疟疾疫苗接种计划。本文描述了在加纳实施该计划的 6 个地区中的 3 个地区，在 RTS,S/AS01 疫苗规划的规划和早期实施阶段所面临的挑战和吸取的经验教训。
在 2019 年 5 月 MVIP 启动三个月后，对 21 名地区和区卫生服务管理人员和一线卫生工作者进行了 21 次深入访谈。使用 NVivo 软件版本 12 对数据进行编码，并制定了一个编码框架，以支持主题分析，以确定在 RTS,S/AS01 实施试点期间面临的挑战和吸取的经验教训，并将其分为实施研究综合框架（CFIR）。
参与者报告了与干预措施特征相关的挑战，例如疫苗接种时间表和资格标准问题，以及作为试点计划实施的挑战。此外，由于谣言导致疫苗接种拒绝，还面临重大挑战；因此，CFIR 的外部环境进行了调整，以适应社区内的谣言。卫生服务管理人员和一线卫生工作者在实施 RTS,S/AS01 过程中也面临挑战，包括宣传和培训不足以及时间表问题。他们还面临与疫苗实施系统特征相关的挑战，包括卫生机构一级冷链资源不足以及区和卫生机构一级运输问题。本研究确定，在实施 MVIP 等规划之前，需要更长、更密集和持续地开展具有适当背景的宣传。
本研究确定了卫生服务管理人员和卫生工作者在加纳 RTS,S/AS01 试点推出的规划和早期实施阶段所面临的 12 项主要挑战和经验教训。这些发现与 RTS,S/AS01 在加纳的可能扩大规模以及在其他非洲国家的可能实施以及其他新型疫苗的未来引入高度相关。
