Challenges to HPV Vaccination delivery at Rural Health Facilities Following Roll-Out of the Uganda National Program: A Cross-Sectional Study

Objectives. National roll-out of new vaccines into the routine immunization program can present significant challenges at the time of initiation, especially in resource-limited settings. Evaluating various aspects of new vaccination programs and changes over time can provide insight, lessons learned, and opportunities for improvement. Our aim was to assess the frequency of health facility-reported HPV vaccination and vaccination documentation in a rural district in Northern Uganda. Methods. In this study, we evaluated the frequency of delivery of HPV vaccination activities at the health facility level before and during the expansion from school-based vaccination campaigns to integration of HPV vaccination into the routine immunization program using a cross-sectional study design. We conducted standardized interviews with health facility staff to evaluate HPV vaccination delivery and reviewed vaccination registries to determine the availability of HPV vaccination records at the health facility. Results. Although delivery of vaccinations increased over time, we found significant heterogeneity in the frequency of documentation of HPV vaccination activities over the study period, which presents opportunities to improve documentation to better track administration and evaluate program implementation. Conclusions. Our assessment provides critical insight into the challenges of HPV vaccination in the early stages of the national roll-out and can be used to evaluate current and future progress.