Feasibility of delivering HPV vaccine to girls aged 10 to 15 years in Uganda

Background: Cervical cancer is a leading cause of mortality among women in Uganda. The availability of the human papillomavirus (HPV) vaccine presents an opportunity to prevent cervical cancer. The Government of Uganda conducted a demonstration project exploring the feasibility of two delivery strategies.Objective: To explore the feasibility of two HPV vaccine delivery strategies: 1) a stand-alone school-based strategy that selected girls based on their enrolment in grade 5 (known as the “grade-based” strategy; and 2) an age-based strategy that delivered the HPV vaccine based on the girls’ age (10-year-olds). This strategy combined the delivery of the vaccine with the distribution of deworming medication and vitamin A through an existing Child Days Plus program.Methods: A qualitative study that explored the feasibility of the two delivery strategies from the perspective of health workers, district leaders, and staff of the Uganda National Expanded Programme on Immunization, utilizing in-depth interviews and focus group discussions.Results: Coverage data showed that more girls (88%) were vaccinated using the grade-based strategy and completed all three doses compared to those (73%) vaccinated using the age-based strategy. Health workers and teachers indicated that determining vaccination eligibility was easier by grade than by age and there were minor disruptions to health services and school programs during vaccinations, as reported by health workers and teachers using the grade-based strategy.Conclusion: HPV vaccine delivery at schools using grade eligibility was more feasible than selecting girls by age. Lessons learned in Uganda could be relevant for countries considering implementing HPV vaccinations.Keywords: HPV, vaccination, immunization, cervical cancer, school-based program, adolescent girl

Screen-and-treat approach to cervical cancer prevention using visual inspection with acetic acid and cryotherapy: experiences, perceptions, and beliefs from demonstration projects in Peru, Uganda, and Vietnam.

Cervical cancer is preventable but continues to cause the deaths of more than 270,000 women worldwide each year, most of them in developing countries where programs to detect and treat precancerous lesions are not affordable or available. Studies have demonstrated that screening by visual inspection of the cervix using acetic acid (VIA) is a simple, affordable, and sensitive test that can identify precancerous changes of the cervix so that treatment such as cryotherapy can be provided. Government partners implemented screening and treatment using VIA and cryotherapy at demonstration sites in Peru, Uganda, and Vietnam. Evaluations were conducted in the three countries to explore the barriers and facilitating factors for the use of services and for incorporation of screen-and-treat programs using VIA and cryotherapy into routine services. Results showed that use of VIA and cryotherapy in these settings is a feasible approach to providing cervical cancer prevention services. Activities that can help ensure successful programs include mobilizing and educating communities, organizing services to meet women's schedules and needs, and strengthening systems to track clients for follow-up. Sustainability also depends on having an adequate number of trained providers and reducing staff turnover. Although some challenges were found across all sites, others varied from country to country, suggesting that careful assessments before beginning new secondary prevention programs will optimize the probability of success

SEARCH STRATEGIES | Knowledge, attitudes, and practice of sexual and reproductive health and rights in Uganda: a scoping review of qualitative studies

A comprehensive literature search was conducted by a health sciences informationist (GKR) in May 2022 and updated in May 2023. The eight databases searched were MEDLINE (via Ovid interface), EMBASE (via Embase.com), Scopus, CINAHL (via EBSCOhost), Web of Science Core Collection (via Thomson Reuters), Global Health (via CABI), PsycINFO (via EBSCOhost) and Women's Studies International (via EBSCOhost). Keyword and controlled vocabulary search terms were used to represent concepts related to SRHR in Uganda. Geographic search terms focused search retrieval on articles referencing Uganda at the country level, by district [1] or capital city of Kampala. A revised qualitative/mixed methods search filter was used in all eight database searches [2]. Two unique qualitative/mixed methods search filters were revised for use in Ovid Medline to maximize retrieval of qualitative studies [2,3]. Final search strategies were determined through test searching and search syntax to enhance search retrieval. Search results were limited to articles published from 2002 to 2023. No language limits were applied. The comprehensive literature search was conducted to address overall sexual reproductive health and rights (SRHR) in Uganda as a whole. Due to the breadth and scope of the literature retrieval, this one search was used to inform two scoping reviews on qualitative studies: one to address family planning and comprehensive abortion care in Uganda [4]; and this review which addresses SRHR in Uganda. The study selection for each of the two scoping reviews was differentiated by their use of inclusion and exclusion criteria. _________________________________________________________________________________________ 1. Government of Uganda. (2021, August 19). DISTRICTS - Ministry of Local Government. https://molg.go.ug/districts/ _________________________________________________________________________________________ 2. El Sherif R, Pluye P, Gore G, Granikov V, Hong QN. Performance of a mixed filter to identify relevant studies for mixed studies reviews. J Med Libr Assoc. 2016;104(1):47-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4722642/ _________________________________________________________________________________________ 3. Slater, Linda G. A Comprehensive Filter to Retrieve Qualitative Studies from the OVID MEDLINE Database (based on McKibbon, Eady and Marks (1999) and Evans (2002). John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB. Oct 4, 2017. https://docs.google.com/document/d/1KdReD-h5NL5pX3vdEsOLxK2VtAsRe8ZM_uzuZPWcitQ/edit _________________________________________________________________________________________ 4. Buser, J. et al.(2024). Scoping review of qualitative studies on family planning in Uganda. [Unpublished manuscript].U-M Center for International Reproductive Health Traininghttp://deepblue.lib.umich.edu/bitstream/2027.42/178183/1/05_27_2022 SEARCH STRATEGIES - UGANDA _ ScR of qual studies.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/178183/2/05_12_2023 SEARCH UPDATE _ SEARCH STRATEGIES - UGANDA _ ScR of qual studies .pdf-1Description of 05_27_2022 SEARCH STRATEGIES - UGANDA _ ScR of qual studies.pdf : LITERATURE SEARCH STRATEGIES_27_MAY_2022Description of 05_12_2023 SEARCH UPDATE _ SEARCH STRATEGIES - UGANDA _ ScR of qual studies .pdf : SEARCH UPDATE_LITERATURE SEARCH STRATEGIES_12_MAY_2023SEL

SEARCH STRATEGIES | Scoping review of qualitative studies on family planning in Uganda

A comprehensive literature search was conducted using eight scholarly databases: MEDLINE (via Ovid interface), EMBASE (via Embase.com), Scopus, CINAHL (via EBSCOhost), Web of Science Core Collection (via Thomson Reuters), Global Health (via CABI), PsycINFO (via EBSCOhost) and Women's Studies International (via EBSCOhost). Keyword and controlled vocabulary search terms were used to represent concepts related to sexual and reproductive health in the context of FP or CAC in Uganda. The search was conducted by a health sciences informationist (GKR) in May 2022 then updated in May 2023. Geographic search terms were used to focus search retrieval on articles referencing Uganda at the country level, by district [20] or capital city of Kampala. Lastly, a revised qualitative/mixed methods search filter was used in all eight database searches [21]. Two unique qualitative/mixed methods search filters were revised for use in Ovid Medline to strive to maximize retrieval of qualitative studies [21,22]. Final search strategies were determined through test searching and the use of search syntax to enhance search retrieval. No language limits were applied. A search was conducted in May 2022, followed by an update of search results in May 2023. Search results were limited to articles published from 2002 to 2022, resulting in 4,217 citations exported to EndNote for processing and removal of duplicate citations. A final count of 1,422 citations were assessed and screened in Rayyan [23] according to inclusion and exclusion criteria.http://deepblue.lib.umich.edu/bitstream/2027.42/191720/1/05_27_2022 SEARCH STRATEGIES - UGANDA _ ScR of qual studies.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/191720/2/05_12_2023 SEARCH UPDATE _ SEARCH STRATEGIES - UGANDA _ ScR of qual studies .pdfSEL

A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries.

BACKGROUND: This systematic review provides a narrative synthesis of the evidence on the effectiveness of mental health promotion interventions for young people in low and middle-income countries (LMICs). Commissioned by the WHO, a review of the evidence for mental health promotion interventions across the lifespan from early years to adulthood was conducted. This paper reports on the findings for interventions promoting the positive mental health of young people (aged 6-18 years) in school and community-based settings. METHODS: Searching a range of electronic databases, 22 studies employing RCTs (N = 11) and quasi-experimental designs conducted in LMICs since 2000 were identified. Fourteen studies of school-based interventions implemented in eight LMICs were reviewed; seven of which included interventions for children living in areas of armed conflict and six interventions of multicomponent lifeskills and resilience training. Eight studies evaluating out-of-school community interventions for adolescents were identified in five countries. Using the Effective Public Health Practice Project (EPHPP) criteria, two reviewers independently assessed the quality of the evidence. RESULTS: The findings from the majority of the school-based interventions are strong. Structured universal interventions for children living in conflict areas indicate generally significant positive effects on students' emotional and behavioural wellbeing, including improved self-esteem and coping skills. However, mixed results were also reported, including differential effects for gender and age groups, and two studies reported nonsignficant findings. The majority of the school-based lifeskills and resilience programmes received a moderate quality rating, with findings indicating positive effects on students' self-esteem, motivation and self-efficacy. The quality of evidence from the community-based interventions for adolescents was moderate to strong with promising findings concerning the potential of multicomponent interventions to impact on youth mental health and social wellbeing. CONCLUSIONS: The review findings indicate that interventions promoting the mental health of young people can be implemented effectively in LMIC school and community settings with moderate to strong evidence of their impact on both positive and negative mental health outcomes. There is a paucity of evidence relating to interventions for younger children in LMIC primary schools. Evidence for the scaling up and sustainability of mental health promotion interventions in LMICs needs to be strengthened

Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries.

OBJECTIVE: To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. METHODS: Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. FINDINGS: Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. CONCLUSION: High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake