Poliovirus serological assay after the cVDPV1 outbreak in Papua New Guinea: a cross-sectional study from 2020 to 2021.

Background: In June 2018, a type 1 circulating vaccine-derived poliovirus (cVDPV1) outbreak was declared in Papua New Guinea (PNG), resulting in a total of 26 paralytic confirmed cases. Eight vaccination campaign rounds with bivalent oral poliovirus vaccine (bOPV) were carried out in response. Prevalence of neutralizing polio antibodies in children was assessed two years after the outbreak response was completed. Methods: We conducted a cross-sectional serological survey among children aged 6 months-10 years selected from six provinces in PNG to evaluate seroprevalence of neutralizing polio antibodies to the three poliovirus serotypes and analyse sociodemographic risk factors. Findings: We included 984 of 1006 enrolled children in the final analysis. The seroprevalence of neutralizing polio antibodies for serotype 1, 2 and 3 was 98.3% (95% CI: 97.4-98.9), 63.1% (95% CI: 60.1-66.1) and 95.0% (95% CI: 93.6-96.3), respectively. Children <1 year had significantly lower type 1 seroprevalence compared to older children (p < 0.001); there were no significant differences in seroprevalence among provinces. Interpretation: PNG successfully interrupted transmission of cVDPV1 with several high coverage bOPV campaigns and seroprevalence remained high after two years. The emergence of cVDPV strains underscores the importance of maintaining high levels of routine immunization coverage and effective surveillance systems for early detection. Funding: World Health Organization through a Rotary International IPPC grant.

Uncovering the Drivers of Childhood Immunization Inequality with Caregivers, Community Members and Health System Stakeholders: Results from a Human-Centered Design Study in DRC, Mozambique and Nigeria.

BACKGROUND: The importance of immunization for child survival underscores the need to eliminate immunization inequalities. Few existing studies of inequalities use approaches that view the challenges and potential solutions from the perspective of caregivers. This study aimed to identify barriers and context-appropriate solutions by engaging deeply with caregivers, community members, health workers, and other health system actors through participatory action research, intersectionality, and human-centered design lenses. METHODS: This study was conducted in the Demographic Republic of Congo, Mozambique and Nigeria. Rapid qualitative research was followed by co-creation workshops with study participants to identify solutions. We analyzed the data using the UNICEF Journey to Health and Immunization Framework. RESULTS: Caregivers of zero-dose and under-immunized children faced multiple intersecting and interacting barriers related to gender, poverty, geographic access, and service experience. Immunization programs were not aligned with needs of the most vulnerable due to the sub-optimal implementation of pro-equity strategies, such as outreach vaccination. Caregivers and communities identified feasible solutions through co-creation workshops and this approach should be used whenever possible to inform local planning. CONCLUSIONS: Policymakers and managers can integrate HCD and intersectionality mindsets into existing planning and assessment processes, and focus on overcoming root causes of sub-optimal implementation.

Use of a catch-up programme to improve routine immunization in 13 provinces of Papua New Guinea, 2020-2022.

Objective: Routine immunization coverage in Papua New Guinea has decreased in the past 5 years. This persistently low routine immunization coverage has resulted in low population immunity and frequent outbreaks of vaccine-preventable disease across the country. We describe the use of a catch-up programme to improve routine immunization during the coronavirus disease pandemic in Papua New Guinea during 2020-2022. Methods: In June 2020, 13 provinces of Papua New Guinea were selected to undergo a vaccination catch-up programme, with technical support from the World Health Organization (WHO) and the United Nations Children's Fund. Twelve provinces received financial and logistic support through the Accelerated Immunization and Health Systems Strengthening programme, and one received support from WHO. All stakeholders were involved in planning and implementing the catch-up programme. Results: Between July 2020 and June 2022, about 340 health facilities conducted catch-up activities. The highest number of children aged under 1 year were vaccinated in 2022 (n = 33 652 for third dose of pentavalent vaccine). The national coverage of routine immunization (including the catch-up vaccinations) increased between 2019 and 2020 - by 5% for the third dose of pentavalent vaccine, 11% for the measles-rubella vaccine and 16% for the inactivated poliovirus vaccine. The coverage declined slightly in 2021 before increasing again in 2022. Discussion: The catch-up programme was an instrumental tool to improve routine immunization coverage between 2020 and 2022 and during the pandemic in Papua New Guinea. With appropriate technical and logistic support, including financial and human resources, catch-up programmes can strengthen routine immunization coverage across the country.

A Strategic Action Plan to Improve an Integrated Family Planning and HIV Service: Using Multiple Nominal Groups to Ensure Stakeholder Involvement.

Introduction: The World Health Organization recommends that family planning be integrated in HIV services, to improve service offering and uptake; stakeholder involvement is crucial. The purpose of this manuscript is to share the utilization of nominal group technique (NGT) and multiple group analysis as a vehicle to ensure stakeholder involvement in the development of a strategic action plan to improve the implementation of integrated services in Ethiopia. Methods: A qualitative research design, employing a NGT, was applied as data-gathering method to develop a strategic action plan for facilitating the integration of family planning and HIV services. NGT was used to ensure the equal involvement of stakeholders in the development thereof. Twenty-four programme managers in Addis Ababa, Ethiopia - experts in family planning and HIV/AIDS programmes, working in 10 sub-city health departments - participated in the nominal groups to identify the strategies to be included in an action plan development to facilitate integrated services. Results: The first nominal group's participants identified 12 themes, derived from the 21 categories generated from 34 individual ideas. The second group identified nine themes, from 16 categories, generated from 30 individually ideas. A multiple group analysis utilizing the findings from both groups revealed the top five most important themes (leadership and management, capacity building, implementing policies and guidelines, advocacy/awareness and infrastructure) that were selected to be included in a strategic action plan to integrated family planning and HIV services in Ethiopia. Discussion: The strategic action plan developed by the researcher who took into account the findings from the multiple group analysis was validated in a face-to-face validation meeting by all the relevant stakeholder's participation. Stakeholder involvement, utilizing different nominal groups and conducting multiple nominal group analysis ensured ownership of the strategic action plan as those involved in the development, will be the individuals to implement in Ethiopia.

Integrating HIV and Family Planning Services: The Pros and Cons.

BACKGROUND: The integration of HIV and family planning services as a one-stop service is a cost-effective way of service delivery, but it has advantages and disadvantages. METHODS: A cross-sectional study design was applied to conduct this research in Ethiopia from June 2015 to November 2018. Two-stage sampling was applied: 1) a simple random sampling method was used to select 31 public health centers, and 2) 403 clients and 305 service providers were selected by using a stratified simple random sampling. A self-administrator questionnaire was developed to collect the data from service providers, and an interview questionnaire was used to collect data from clients. The data were statistically computed using bi-variate and multivariate logistic regression. RESULTS: Integrated HIV and family planning services allow for the enhancement of the competencies of healthcare workers, client satisfaction, mobilization of fiscal resources, provision of infrastructures, and adequate numbers of human resources available. It can also mobilize additional resources for health education and improve awareness on HIV and family planning services. Despite the mentioned advantages, shortages of human resources, HIV drugs and contraceptives, funding and long waiting times were identified as the disadvantages of HIV and family planning service integration. There was a risk of nine times lower chance of intention to use an integrated HIV and family planning services, if a client waited for more than 1 hour and 6 times risk waited for 30-60 minutes. CONCLUSION: The advantages of offering an integrated service at a one-stop facility by far outweighing the disadvantages. It might be relevant to develop a strategic action plan for stakeholders to facilitate the integration of HIV and family planning services with the aim to improve service utilization and to reduce maternal and child morbidity and mortality.