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Table 2 Strategies used, obstacles, and difficulties reported by the institutions, Gardasil Access Program 2009-2014 (N = 23)

From: Experiences and lessons learned from 29 HPV vaccination programs implemented in 19 low and middle-income countries, 2009-2014

  Number Percent
Vaccination sensitization strategies
 No sensitization conducted 1 4.3
 At least one sensitization conducted 22 95.7
 Sensitizations conducted
  Meetings in the communities 22 100
  Meetings with girls to be vaccinated 22 100
  Media campaigns (radio, TV, newspapers) 17 77.2
  Meetings with mothers at time of cervical cancer screening 13 59.1
Obstacles for vaccination reported by the parents
 No obstacle reported 4 17.4
 At least one obstacle reported 19 82.6
 Obstacles reported
  Vaccination is a way to sterilize the girls 11 57.9
  Vaccine is not safe 8 42.1
  Vaccination only for girls and not for boys 7 36.8
  Vaccination is a family planning medication 5 26.3
  Girls aged 9 years are too young to receive vaccination 5 26.3
  Vaccination is not effective in preventing HPV infection and cervical cancer 4 21.1
  Vaccination gives girls permission to have sex 3 15.8
Strategies to reach girls lost to follow-up
 No strategy implemented 0 0
 At least one strategy implemented 23 100
 Strategies implemented   
  Teachers and school administration contact 17 73.9
  Phone calls to girls or family 15 65.2
  Community leader contact 13 56.5
  Visit to girl at home 8 34.8
  Religious leader contact 2 8.7
  Girls’ peers 2 8.7
Obstacles for girls’ follow-up
 No challenge reported 3 13.0
 At least one obstacle reported 20 87.0
 Obstacles reported
  Girls have changed schools or move away 16 80.0
  School vacation or examination 11 55.0
  Incorrect reporting or lack of details on identity 8 40.0
  Limited transportation vehicles available 7 35.0
  Limited financial resources available 7 35.0
  Limited human resources available 5 25.0
Difficulties of supply chain management
 No difficulty reported 10 43.5
 At least one difficulty reported 13 56.5
 Difficulties reported
  Vaccines reached expiration date 6 46.2
  Difficulties in transporting unused vaccines from sites 5 38.5
  Projections of vaccine needed on site did not match number of girls in the field 3 23.1
  Insufficient storage capacity at site level 1 7.7
  Vaccines damaged during transportation to site 1 7.7
Difficulty of data management
 No difficulty reported 7 30.4
 At least one difficulty reported 16 69.6
 Difficulties reported
  Reports from vaccination sites were not received in time 14 87.5
  Reports from vaccination sites were incomplete or incorrect 7 43.8
  The system in place was time-intensive and cumbersome 3 18.8