DESIGNING AN HPV VACCINATION CAMPAIGN IN RURAL HAITI

Transcription

1 DESIGNING AN HPV VACCINATION CAMPAIGN IN RURAL HAITI October 22, 2018 Claudine Joseph Bernard Eva O Brien Fond-des-Blancs, Haiti

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3 OVERVIEW AND OBJECTIVES This presentation will explore strategies developed to implement an effective vaccination campaign to protect over 4500 girls from cervical cancer in rural Haiti During the sessions we will explore how the St. Boniface Haiti Foundation s community health team combined vaccination best practices with innovative tools to ensure success We will demonstrate the feasibility of implementing this replicable model on a large-scale in other resource-limited settings At the end of this session participants will be able to understand factors needed to initiate an HPV campaign, and common challenges

4 CERVICAL CANCER IN HAITI Disproportionate Burden of Cervical Cancer In Resource Limited Settings: More than 90% of the women diagnosed with cervical cancer live in low and middle-income countries Haiti has the highest incidence of cervical cancer in the world A woman in Haiti is 13x more likely to die from cervical cancer than a woman in the United States Without urgent attention, deaths due to cervical cancer in Haiti are projected to rise by 25% over the next 10 years. High prevalence of HPV in Haiti reaches beyond cervical cancer and results in extremely high rates of other HPV-related cancers in BOTH genders (ie head & neck or rectal cancers) **There is no radiation therapy in Haiti and access to chemotherapy is severely limited* Scaling-up HPV Vaccine Introduction. World Health Organization, HPV Fact Sheet

5 HPV VACCINATION AROUND THE WORLD Did you, or your children, receive the HPV vaccine? What was the experience like? (where, when, how) The World Health Organization (WHO) states that HPV vaccination for 9 14 year-old girls is the most cost-effective public health measure against cervical cancer. WHO recommends vaccination should be a core strategy for primary prevention of cervical cancer and supports national HPV immunization programs/systems Less than 5% of girls who could benefit from HPV vaccine worldwide are fully immunized against HPV infection More than 130 countries (including Haiti) have yet to adopt a national program or introduce the vaccine Scaling-up HPV Vaccine Introduction. World Health Organization, 2016.

6 IMMUNIZATION IN HAITI Estimated coverage rates in 2017 : DPT3 60% - 72% MCV 53% Barriers to Immunization in Haiti: Very limited budget & limited gov financial support Geographic barriers rural populations & lack of general infrastructure (public + healthcare) Restricted storage space & difficulty ensuring cold chain capacity Lack of laws in favor of vaccination Advanced or mobile strategies not widely used Migration of patient population Haiti s Ministry of Health has recently added HPV vaccination to national vaccination cards despite not having a national HPV vaccine campaign.

7 HPV VACCINATION 101 Vaccine Name Gardasil quadrivalent Gardasil 9 nonavalent HPV 6, 11, 16 & 18 Cervarix HPV 16 &18 Details IM injection 2 doses (0, 60 mo) OR 3 doses (0, 2, 6 mo) HPV 6, 11, 16, 18, 31, 33, 45, 52, & 58 IM injection 2 doses (0, 60 mo) OR 3 doses (0, 2, 6 mo) IM injection 3 doses (0, 1, 6 mo) Manufacturer Merck & Co. Merck & Co. GSK TARGET POPULATIONS & DOSE ADMINISTRATION SCHEDULES VARY BY REGIONAL GUIDELINES: US Guidelines- target is both boys and girls ages ** can start as early as 9 years old WHO Guideline- target is girls 9-13 and high-risk children (HIV+) ALMOST ALL VACCINATION PRORGAMS IN LMICS ARE SCHOOL-BASED

8 There have only been 3 HPV vaccination campaigns in Haiti to date (as of Oct 2018) all of which were siloed projects led by NGOs (Gheskio, Zanmi Lasante, St Boniface Haiti Foundation) In March 2018, the St. Boniface Haiti Foundation (SBHF) conducted the first ever HPV vaccine campaign in Southern Haiti Due to lack of GAVI support for HPV vaccine in Haiti, and lack of public financing capacity, campaigns relied on the generous donation of vaccines from Merck & Co.

9 SBHF S ROLE IN HAITI S HEALTH SYSTEM SBHF has been a key partner to Haiti s Ministry of Health for 30+ years Operates a tertiary referral hospital over 2.3 million people in southern Haiti 136 bed hospital over 110,000 patient visits per year national training center for specialty/advanced care training over 95 medical professionals per year SBHF s model is driven by robust community health service delivery network of 74 CHWs and community health RNs conduct home visits & rally posts focus on WASH, malnutrition, vaccination, prevention/screening and education

10 SBHF S HPV VACCINATION STRATEGY SBHF recognizes the best way to reduce burden of HPV-related morbidity & mortality is by investing in sustainable HPV vaccination systems We have become an advocate for national adoption of the HPV vaccine, and demonstrate the feasibility of a successful vaccination program by creating a replicable model for national implementation

11 SBHF S HPV VACCINE CAMPAIGN OBJECTIVES 1) Vaccinate 4500 girls aged 9-16 within SBHF s direct primary care catchment area 2) Achieve 100% completion rate for 2-dose vaccine administration (doses must be administered minimum 6 months apart, HIV+ children receive 3 dose regimen ) 3) Conduct extensive community education/outreach campaign in Fond des Blancs, raising community awareness about cervical cancer and HPV vaccination 4) Develop a replicable model for the Ministry of Health to adapt for a national rollout of HPV vaccine and sustainable integration into existing vaccination programs 5) Trial an innovative mobile data collection tool for community programs to allow point-of-care data entry and analysis 6) Leverage successful program outcomes and data to become an international advocate for HPV vaccine in Haiti-- Demonstrating the feasibility of an HPV vaccine program despite a pervasive negative narrative

12 GROUP SIMMULATION ACTIVITY How would YOU design SBHF s HPV Vaccination program?

13 PLANNING CORE COMPONENTS OF CAMPAIGN LET S BREAK INTO GROUPS! (10 minute breakout session) Logistics, Implementation & Coordination Outreach, Community Mobilization & Education Data Recording, Monitoring & Evaluation Advocacy, Communication Strategy & Results Dissemination

14 ACTIVITY OBJECTIVES/DIRECTIONS Goal of Activity: As a team, work through the details of a specific theme that is critical to successful HPV vaccination campaigns. Together, highlight priority objectives, troubleshoot potential challenges and design an implementation plan as if you were responsible for that component of SBHF s HPV vaccination program in rural Fond des Blancs, Haiti. Directions: Please follow the directions on the brainstorm worksheet. Work together as a group to define concrete answers and discussion points as they relate to your specific content area. Be sure to designate a member of your team to present on behalf your group.

15 EXAMPLE TOPICS: Customs logistics, coordination with Merck & Co. Cold Chain- vaccine MUST stay between 2 C 8 C Vaccine Transport- rural location, poor roads Vaccination schedule and location selection Flow of vaccination sessions Procurement, management, disposal of material (needles, sharps containers etc ) Logistics, Implementation, & Coordination

16 Outreach, Community Mobilization, & Education EXAMPLE TOPICS: Outreach campaign logistics & strategy Messaging theme & topics for education Community leader engagement and education and approvals CHW training Stigma and myth mitigation Creative youth engagement activities Integration into other community health activities

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18 Data Recording, Monitoring, & Evaluation EXAMPLE TOPICS: Adverse event monitoring and reporting Loss-to-follow-up reduction strategies Point of care data collection in rural location (ie no internet) Data analysis tools

19 Advocacy, Communication Strategy, & Results Dissemination EXAMPLE TOPICS: National advocacy for adoption of vaccine GAVI advocacy strategy Donor communications for fundraising Working against Haiti is hopeless narrative Sharing model for others to adapt/implement

20 REPORT OUT AND DISCUSSION What did you choose to focus on? What were your strategies for success? What were your solutions for over-coming potential challenges? HOW DOES THIS COMPARE TO WHAT SBHF IMPLEMENTED? WHAT WERE SBHF S MAJOR CHALLENGES? WHAT LESSONS DID WE LEARN?

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22 SBHF IMPLEMENTATION HIGLIGHTS Logistics, Implementation & Coordination Relied upon existing network for logistics and integrated into other vaccination systems already at SBHF for ease of coordination used same process for customs clearance and transport as all other meds/supplies integrated vaccine management into same system used for other vaccination programs at SBHF these programs are supported by MSPP and UNICEF and carefully tracked leveraged existing capacity for cold supply management (industrial cold room, portable cold boxes), procurement of materials, waste disposal VACCINE SHIPMENT WAS DELAED BY SEVERAL MONTHS AND WERE NO LONGER ON TRACKTO COMPLETE VACCINATION IN ACADEMIC YEAR had to decide whether to break with school schedule--- although not recommended practice, SBHF believed was feasible if leveraged community health team & data collection tools created a hybrid model & vaccine schedule- consisted of schools AND rally posts

23 SBHF IMPLEMENTATION HIGLIGHTS CONT Outreach, Community Mobilization, & Education Held meetings with school administrators and community leaders prior to vaccination to ensure engagement and educate them on HPV + HPV vaccination Teachers are a core member of vaccination team Ensured teachers and community members would assist with rumor mitigation, adverse event reporting, loss-to-follow-up prevention and ongoing education Pran Vaksen Kont HPV Jodia, Pou Nou Pa Gen Kansè Kòl Matris Demen Rumor Mitigation! created hotline for questions Education materials/outreach campaign targeted ALL community members (men, elderly etc..) Trained CHWs and SBHF clinical staff on cervical cancer and details about HPV vaccine Radio ads, mobile caravans and soccer games --- a creative strategy for community engagement activities Created an educational radio ad about HPV and HPV vaccine Off-roading caravan of community health staff (including RNs) played continual announcements, stopped to hold education sessions and answer questions Organized large community events like soccer games with educational messaging and branding materials

24 SBHF IMPLEMENTATION HIGLIGHTS CONT Data Recording, Monitoring, & Evaluation Adverse event monitoring and reporting was a MAJOR priority Designed vaccination space to monitor each child for 15 mins after vaccine Educated teachers and CHWs, so they would call SBHF if child doesn t appear for school following vaccination, or shows symptoms of an adverse event SBHF RN made home visits to children if didn t show up to school within days following vaccination or for any suspected events Data collection tool included adverse reporting data points Created a dedicated hotline to call-in reports or questions Customized our own point of care mobile data collection tool Wanted to improve efficiency of vaccination workflow and ensure ease of use during vaccine administration in field Tool had to use technology that didn t rely on internet Had to allow for real-time tracking of students for lost-to-follow-up prevention real time interventions Collected information on family (name + contact info), location of home, community leaders in area, so CHW could outreach in case of lost-to-follow up Each girl given a card with date of next appointment and hotline number

25 SBHF IMPLEMENTATION HIGLIGHTS CONT Advocacy, Communication Strategy, & Results Dissemination Included Ministry of Health (MSPP) from beginning of process Tried to use as many existing MSPP systems as possible, integrating into current vaccination infrastructure Included MSPP in adverse event reporting protocols Hope to use data from this pilot to demonstrate it is possible to achieve 100% 2-dose completion rate spanning 2 school years we believe high vaccine completion rates can be achieved even if not integrated into school schedule Will share POC data collection tool that we created with other organizations is an opensource platform mobile app that others can customize To ensure process was replicable in all settings, we also have paper records for settings where tablets aren t feasible Will aim to present findings at international forums and share best-practices with technical groups, other NGOs, Ministries of Health, etc.

26 SBHF RESULTS TO DATE ROUND 1 Began March 2018 ROUND 2 Began September schools visited Vaccines given at SBHF hospital for HIV+ boys & girls 4450 girls aged 9-16 vaccinated TBD Over 300,000 community members outreached/educated Target 2 Dose Completion Rate = 100 %

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28 Men anpil chay pa lou Many hands the load is not heavy Many thanks to our partner, Merck & Co. for their incredible support Through Merck s generous donation, SBHF has been able to change thousands of lives and become an advocate for global HPV vaccination

29 REFERENCES Bruni L, Barrionuevo-Rosas L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. (2017). ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Haiti. Summary Report 27 July GAVI (2017). Haiti Factsheet.. HPV Fact Sheet (2017). Sherris, J., Herdman, C., & Elias, C. (2001). Cervical cancer in the developing world. The Western Journal of Medicine, 175(4), 231. World Health Organization (2016). Scaling-up HPV Vaccine Introduction., apps.who.int/iris/bitstream/handle/10665/251909/ eng.pdf?sequence=1.

30 MESI ANPIL!