The aims of this study are: 1. To determine feasibility of a school-based human papillomavirus (HPV) vaccination programme in Tanzania. 2. To measure the uptake and acceptability of two different vaccination strategies in rural and urban schools. 3. To examine the characteristics of accepters/refusers of vaccination and to identify reasons for acceptance, refusal or non-completion. 4. To measure the cost of implementing a school-based HPV vaccination programme in Tanzania.
Vaccines against human papillomavirus infection, the primary cause of cervical cancer, are an attractive cervical cancer prevention strategy for resource poor settings which lack the infrastructure for establishing and maintaining complex screening programmes.Feasibility and costs of setting up and sustaining an HPV vaccination programme will depend on whether it can be added onto an existing health programme within schools, if one exists, or whether it has to be established as a separate health intervention. Other factors will also affect vaccine coverage. For example, uptake and overall effectiveness will be critically dependent on parental and community acceptability of a vaccine that prevents a sexually transmitted infection and how the vaccine is promoted and delivered by health-care providers will influence its uptake and acceptability. This study will determine feasibility, uptake and acceptability of different delivery strategies of school-based HPV vaccination in Tanzania, examine factors related to acceptance or refusal of vaccination and measure the cost of implementing a school-based HPV vaccination programme in Tanzania. Three doses of quadrivalent human papillomavirus (HPV) vaccine, (Gardasil®; Merck \& Co) given at 0, 2 and 6 months, will be provided to 5000 primary school girls at 134 randomly selected schools in Mwanza Region in Tanzania. Selected schools will be randomly assigned to one of two delivery strategies (age-based or class-based) and coverage and acceptability of these vaccine delivery strategies will be compared. Qualitative research will be conducted before, during and after vaccination to examine barriers to vaccination and reasons for failure to complete vaccination as well as general community perceptions. To determine factors associated with refusal a case control study will be conducted on a 1:1 sample of 350 vaccine refusers and 350 accepters. The costs of introducing and scaling up HPV vaccines in schools will be estimated using established costing methods.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
5,532
0.5 ml given at 0, 2, 6 months
National Institute for Medical Research
Mwanza, Tanzania
Vaccine coverage by delivery strategy
Vaccine coverage will be estimated for each dose given and for those completing the full course of vaccination and compared by delivery strategy.
Time frame: Month 12
Vaccine coverage (dose 2) by delivery strategy
Time frame: Month 5
Vaccine coverage (dose 1) by delivery strategy
Time frame: Month 3
Factors associated with refusal to vaccinate or to complete vaccination course
A case control study to determine factors associated with refusal will be conducted on a 1:1 sample of 350 vaccine refusers and 350 accepters.
Time frame: Month 12
Identification of barriers to HPV vaccination
Qualitative research will be conducted to examine barriers to vaccination and reasons for failure to complete vaccination.
Time frame: Month 14
Estimation of the costs of introducing and scaling up HPV vaccines in schools
Full financial and economic costs from the provider's perspective will be collected for the intervention. Total costs of a district vaccination programme and cost per urban school and rural school reached (if urban/rural differences are identified) and cost per fully-vaccinated girl will be estimated for the two alternative delivery strategies.
Time frame: Month 10
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