Acceptability of an integrated school-based HPV vaccination program within two districts of Tanzania: A qualitative descriptive study.

Tanzania has one of the highest cervical cancer incidence and mortality rates in sub-Saharan Africa. The Tanzanian Ministry of Health developed an integrated adolescent health program, HPV-Plus, that combines HPV vaccination with additional health services: nutritional assessments, vision screening, and vaccination for adolescent girls, and education for all genders. This qualitative descriptive study evaluated the acceptability of the HPV-Plus program in two districts in Tanzania. Key informants comprising of adolescent girls, parents, program planners, and program implementers in Njombe and Dar es Salaam Tanzania were interviewed to assess the program acceptability. Transcripts were analyzed using a team-based iterative thematic analysis approach, consisting of both inductive and deductive coding. The Theoretical Framework of Acceptability was used to guide analysis, with themes categorized according to theoretical constructs of intervention coherence, affective attitudes and perceptions, and perceived effectiveness. Overall acceptability of the HPV-Plus program was high among stakeholders. The most salient finding regarding factors that influenced HPV vaccine acceptability was largely related to education and knowledge levels surrounding the HPV, cervical cancer, and HPV vaccines. The educational component of the HPV-Plus program was key in increasing acceptability. Parents reported the lowest acceptability towards the program. This was found to be primarily due to perceptions of not being sufficiently engaged throughout program implementation. Increasing acceptability of HPV vaccination programs among key stakeholders is critical to facilitating vaccine uptake and meeting vaccination coverage targets. Our results demonstrate that the inclusion of a comprehensive education component within the HPV-Plus program was key in facilitating HPV vaccine acceptability amongst stakeholders.

Feasibility and sustainability of a school-based platform for integrated delivery of HPV vaccination with adolescent health services in Tanzania: qualitative insights from stakeholders.

To meet lofty human papillomavirus (HPV) immunization goals in Tanzania, the Ministry of Health integrated HPV vaccination with adolescent health services using a school-based approach. A qualitative study was conducted in June-July 2021, examining the feasibility and sustainability of an integrated service package, HPV Plus. In-depth interviews with 46 programme implementers (i.e. health-care workers and teachers) and planning stakeholders (i.e. government officials and school administrators) in Dar es Salaam and Njombe Regions explored enablers and constraints to HPV Plus programme implementation, including resource and staffing requirements. Two facilitators and three barriers to HPV Plus feasibility and sustainability were identified from thematic analysis of interviews. Interviewed stakeholders emphasized the programme's feasibility, especially if the efficiencies offered by a school-based platform were optimized. Implementation facilitators included (1) optimized service delivery efficiency through a school-based platform and (2) resources saved by combining adolescent health services and HPV immunization into a single programme package. Key barriers to HPV Plus feasibility and sustainability were (1) time, space and resource constraints (e.g. commodity stockouts and challenges delivering the complete service package to large cohorts of students within allotted times); (2) human resource gaps and increased workloads within the health workforce and (3) insufficient referral mechanisms linking schools to health facilities. Scaling up HPV Plus will require proactive commodity procurement and security; resource mobilization to reach ambitious service delivery targets and close co-ordination of programme implementation with school administrators.

Understanding determinants of vaccine hesitancy and acceptance in India: A qualitative study of government officials and civil society stakeholders.

INTRODUCTION: Few studies have described the drivers of vaccine hesitancy and acceptance in India from the perspective of those involved in the design and implementation of vaccine campaigns-such as government officials and civil society stakeholders-a prerequisite to developing approaches to address this barrier to high immunization coverage and further child health improvements. METHODS: We conducted a qualitative study to understand government officials and civil society stakeholders' perceptions of the drivers of vaccine hesitancy in India. We conducted in-depth phone interviews using a structured guide of open-ended questions with 21 participants from international and national non-governmental organizations, professional associations, and universities, and state and national government-six national-level stakeholders in New Delhi, six state-level stakeholders in Uttar Pradesh, six in Kerala, and three in Gujarat-from July 2020 to October 2020. We analyzed data through a multi-stage process following Grounded Theory. We present findings on individual-level, contextual, and vaccine/vaccination program-specific factors influencing vaccine hesitancy. RESULTS: We identified multiple drivers and complex ways they influence vaccine beliefs, attitudes, and behaviors from the perspective of government officials and civil society stakeholders involved in vaccine campaigns. Important individual-level influences were low awareness of the benefits of vaccination, safety concerns, especially related to mild adverse events following immunization, and mistrust in government and health service quality. Contextual-level factors included communications, the media environment, and social media, which serves as a major conduit of misinformation and driver of hesitancy, as well as sociodemographic factors-specific drivers varied widely by income, education, urban/rural setting, and across religious and cultural groups. Among vaccine/vaccination-level issues, vaccine program design and delivery and the role of health care professionals emerged as the strongest determinants of hesitancy. CONCLUSIONS: Drivers of vaccine hesitancy in India, as elsewhere, vary widely by local context; successful interventions should address individual, contextual, and vaccine-specific factors. While previous studies focused on individual-level factors, our study demonstrates the equal importance of contextual and vaccine-specific influences, especially the communication and media environment, influential leaders, sociodemographic factors, and frontline health workers.

A Failure to Communicate? How Public Messaging Has Strained the COVID-19 Response in the United States.

A pandemic, especially when caused by a novel virus, induces tremendous uncertainty, fear, and anxiety. To mitigate panic and encourage appropriate behavioral action, communication is critical. The US Centers for Disease Control and Prevention's Crisis and Emergency Risk Communication (CERC) guidance is designed to assist public health authorities, government officials, and other stakeholders in using risk communication during an emergency. For each of the 6 core communication principles outlined in the CERC guidance, we describe the use or nonuse of these principles at critical points during the coronavirus disease 2019 (COVID-19) pandemic by US public health and government officials. With the knowledge that the pandemic will continue to rage for some time and that new communication challenges will arise, including issues related to vaccination and treatment options, many lessons are to be learned and shared. To reduce fear and uncertainty among those living in the United States, COVID-19 communication should be rapid and accurate, while building credibility and trust and showcasing empathy-all with a unified voice.

Characterizing mothers and children at risk of being under-immunized in India: A latent class analysis approach.

OBJECTIVES: While India has made substantial progress in introducing new vaccines and scaling up immunization coverage, inequities persist sub-nationally. This study was performed to investigate the risk of under-immunization based on class membership and to identify heterogeneous classes based on sociodemographic characteristics in pediatric and maternal populations in India through latent class analysis. METHODS: Data from the most recent National Family Health Survey conducted in 2015-2016 were used. Latent class analysis was used to model immunization coverage in children aged 12-23 months and mothers, and to identify subgroups to characterize those at risk of not being immunized. RESULTS: Patterns of sociodemographic characteristics were found to contribute to non-immunization or under-immunization among pediatric and maternal populations in India. Individuals who fit into one of three categories were identified in both populations: those at high, medium, and lower risk of not being immunized. Lower socioeconomic status, lack of antenatal care, and lower maternal education put individuals at higher risk of not being immunized with routine childhood vaccines and maternal tetanus toxoid. CONCLUSIONS: Predisposing risk factors can persistently impact immunization status despite improvements in immunization access in India. Tailored programmatic interventions should be developed to improve immunization coverage among those children and mothers who are at highest risk of being under-immunized or not immunized.