Human papillomavirus (HPV) vaccination in a privately funded program in Ghana: A qualitative case study

HPV vaccination is one of the safest and most effective interventions against HPV-related cancers. From 2013 to 2018, HPV vaccination was piloted in Ghana in preparation for a national program. Yet, at the time of this study, there was no publicly funded HPV vaccination program in Ghana. We explored an existing privately funded HPV vaccination program in Ghana to identify challenges and gaps and to gather insights to inform vaccination practice and national policy. This study used a qualitative case study research design. We conducted semi-structured interviews on experiences, barriers, and challenges in HPV vaccination at the Greater-Accra Regional Hospital between October 1 and November 26, 2023. Participants (<i>N</i> = 16) included HPV vaccinators (<i>n</i> = 8) and program/policy leaders (<i>n</i> = 8). Our thematic analysis focused on HPV vaccination processes, practice challenges, and policy interests. Four main themes emerged from our analyses. Our findings revealed many challenges faced by the HPV vaccination program. These include a lack of guiding policy/framework for the HPV vaccination program, an emphasis on sexual history, cervical screening, and HPV DNA test in determining vaccination eligibility by vaccinators, and a lack of formal provider and recipient HPV education programs. Although many vaccinators advocated for a universal HPV program, some policy/program leaders were reluctant to prioritize HPV vaccination advocacy due to their focus on acute health concerns. A vaccination program without a policy can be limited in quality and efficiency, as there will be no accountability and sustainability measures. We recommend the need to develop standardized guidelines to support evidence-based HPV vaccination practice.

人乳头瘤病毒（Human Papillomavirus，简称HPV）疫苗接种是防控HPV相关癌症最安全且高效的干预手段之一。2013年至2018年间，加纳为筹备国家层面的HPV疫苗接种计划开展了试点工作。然而在本研究开展之时，加纳尚未设有公共资助的HPV疫苗接种项目。本研究针对加纳当前运营的私营HPV疫苗接种项目展开调研，旨在识别该项目面临的挑战与不足，并收集相关见解以指导疫苗接种实践与国家政策制定。本研究采用质性案例研究设计，于2023年10月1日至11月26日期间，在大阿克拉地区医院开展关于HPV疫苗接种的体验、障碍与挑战的半结构化访谈。本次研究的参与者共16名，包括8名HPV疫苗接种医护人员与8名项目/政策负责人。我们的主题分析围绕HPV疫苗接种流程、实践挑战与政策关注点展开，最终提炼出四大核心主题。研究结果揭示了HPV疫苗接种项目面临的诸多挑战，包括：HPV疫苗接种项目缺乏指导性政策与实施框架；疫苗接种医护人员在确定接种资格时，过度依赖性史、宫颈筛查及HPV DNA检测结果；未建立针对接种医护人员与疫苗受种者的正规HPV相关教育项目。尽管多数接种医护人员支持推行全民HPV疫苗接种计划，但部分政策/项目负责人因聚焦急性健康问题，不愿将HPV疫苗接种宣传列为优先工作事项。缺乏政策支撑的疫苗接种项目，其质量与效率均会受到限制，因为此类项目缺乏问责机制与可持续性保障手段。基于此，我们建议制定标准化指南以支持基于证据的HPV疫苗接种实践。