Assessing the impact of a gender-neutral approach to HPV vaccination on vaccination coverage for nine-year-old girls in Cameroon: A retrospective, cross-sectional study

Abstract

Cameroon introduced the human papilloma virus vaccine (HPVV) into the routine immunization schedule in October 2020. By the end of 2022, coverage remained low. To increase coverage, Cameroon switched to a country-wide, gender-neutral vaccination (GNV) approach in 2023, coupled with a revamped delivery strategy of Community Dialogues (CDs) and Periodic Intensification of Routine Immunization (PIRIs) activities in selected health districts (HDs). We assessed the impact of these programmatic changes, notably the GNV approach, on HPVV coverage. This retrospective, cross-sectional study measured the effect of GNV and CDs+PIRIs on HPVV coverage among 9-year-old girls in Cameroon (2022–2023). Data on HPV vaccination from all 203 HDs were extracted from DHIS2, and coveragecalculated at the HD level based on the estimated population eligible of 9-year-old girls. Descriptive statistics and multiple regression models were employed to assess the impact of GNV on vaccination coverage, while adjusting for CDs+PIRIs, baseline (2022) coverage, region, urban/rural status. In 2023, of the 203 HDs, 115 (56.7%) conducted GNV only and 74 (36.5%) implemented GNV & CDs+PIRIs. Among age-eligible girls, there was an overall increase in HPV vaccination coverage, with coverage rising 39.2 percentage points from 2022 to 2023. Following multiple linear regression, there was a significant association between percentage point increase in HPVV coverage in HDs with GNV & CDs+PIRIs, compared to those with no GNV and no CDs+PIRIs in the adjusted model (β:44.5, 95%CI: 29.4, 59.6, p < 0.001). Furthermore, there was a significant association between increase in HPVV coverage in HDs with GNV only compared to those with no GNV or no CDs+PIRIs in the adjusted model (β:15.5, 95%CI: 1.23, 29.8 p < 0.001). Overall, the GNV approach was associated with an increase in HPVV coverage for girls, with greater magnitude and predicted precision when implemented alongside CDs+PIRIs.