Strengthening cervical cancer prevention through district-wide HPV vaccination: an implementation case study from Bareilly district,      Uttar Pradesh, India

Anurag Gautam; Prashant Ranjan; Vinit Yajurvedi; Renu Shrivas

doi:10.18203/2320-6012.ijrms20263539

Authors

Anurag Gautam Department of Medical Health and Family Welfare, Government of Uttar Pradesh, India
Prashant Ranjan Department of Medical Health and Family Welfare, Government of Uttar Pradesh, India
Vinit Yajurvedi Department of Medical Health and Family Welfare, Government of Uttar Pradesh, India
Renu Shrivas The Inclen Trust International New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263539

Keywords:

Human papillomavirus, Cervical cancer, HPV vaccine, Implementation science, eVIN, Universal immunization programme, India

Abstract

Background: Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer, one of the leading cancers among women in India. Introduction of HPV vaccination under India's universal immunization programme (UIP) represents an important step towards achieving the World Health Organization (WHO) strategy for cervical cancer elimination. Although vaccine efficacy is well established, published evidence describing district-level implementation experiences remains limited. To describe the planning, implementation, operational performance, and lessons learned from the district-wide HPV vaccination programme in Bareilly district, Uttar Pradesh.

Methods: A retrospective descriptive implementation case study was conducted using programme data collected from 28 February 2026 to 4 August 2026. Data were obtained from district HPV vaccination monitoring reports, session reports, beneficiary registers, microplans, vaccine stock records, supervisory reports, and electronic vaccine intelligence network (eVIN) records. Indicators included session completion, beneficiaries vaccinated, vaccine utilization, and reconciliation between administrative and eVIN records.

Results: A total of 3,865 vaccination sessions were planned and 3,863 (99.95%) were conducted. Overall, 25,276 adolescent girls received HPV vaccination. eVIN documented 24,897 vaccine doses utilized, giving an absolute difference of 379 doses (1.5%) between administrative vaccination records and eVIN utilization. CHC Faridpur achieved complete implementation, with 152 of 152 planned sessions conducted, 2,478 beneficiaries vaccinated, and zero difference between beneficiary records and eVIN utilization.

Conclusion: The Bareilly implementation demonstrates that large-scale HPV vaccination can be integrated within routine immunization infrastructure through strong leadership, detailed microplanning, intersectoral collaboration, supportive supervision, and digital vaccine logistics monitoring. The operational experience may inform implementation in similar districts.

References

World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva: World Health Organization. 2020.

World Health Organization. Human papillomavirus (HPV) and cervical cancer. Geneva: World Health Organization. 2024.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2021;71(3):209-49.

Bruni L, Saura-Lazaro A, Montoliu A, Brotons M, Alemany L, Diallo MS, et al. HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010–2019. Prev Med. 2021;144:106399.

Varghese T, Ramesh RM, Dhinagar MJ, Gnanaselvam NA, Kompithra RZ, Varughese DT, et al. Universal immunization programme in India: A review of childhood vaccine updates over the last decade (2014-2024). IJID Regions. 2026;4:100957.

Rajwar E, Pundir P, Parsekar SS, D’Souza SR, Nayak BS, Noronha JA, et al. The utilization of systematic review evidence in formulating India’s National Health Programme guidelines between 2007 and 2021. Health Pol Plan. 2023;38(4):435-53.

Singh K, Verma A, Lakshminarayan M. India’s efforts to achieve 1.5 billion COVID-19 vaccinations: a narrative review. Osong Publ Health Res Pers. 2022;13(5):316.

Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2016;25(12):986–92.

Drolet M, Bénard É, Pérez N, Brisson M. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet. 2019;394(197):497–509.

Garland SM, Kjaer SK, Muñoz N, Block SL, Brown DR, DiNubile MJ, et al. Impact and effectiveness of the quadrivalent human papillomavirus vaccine: a systematic review of 10 years of real-world experience. Clin Infect Dis. 2016;63(4):519–27.

Luthra K, Zimmermann Jin A, Vasudevan P, Kirk K, Marzetta C, Privor-Dumm L. Assessing vaccine introduction and uptake timelines in Gavi-supported countries: are introduction timelines accelerating across vaccine delivery platforms. BMJ Global Health. 2021;6(5):5032.

World Health Organization. Immunization Agenda 2030: A Global Strategy to Leave No One Behind. Geneva: WHO. 2021.

Gurnani V, Dhalaria P, Chatterjee S, Singh P, Agrahari K, Kashyap S, et al. Return on investment of the electronic vaccine intelligence network in India. Human Vacc Immunotherap. 2022;18(1):2289.

Sankaranarayanan R, Basu P, Kaur P, Bhaskar R, Singh GB, Denzongpa P, et al. Current status of human papillomavirus vaccination in India's cervical cancer prevention efforts. Lancet Oncol. 2019;20(11):637-44.

Sung H, Filho AM, Laversanne M, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2024: GLOBOCAN estimates of incidence and mortality worldwide for 34 cancers in 186 countries. Cancer J Clin. 2026;76(4):70090.

World Health Organization. Reproductive health, world health organization. chronic diseases, health promotion. comprehensive cervical cancer control: a guide to essential practice. World Health Organization. 2006.

Jain N, Bahl D, Mehta R, Bassi S, Sharma K, Arora M. Progress and challenges in implementing adolescent and school health programmes in India: a rapid review. BMJ. 2022;12(5):47435.

Workowski KA, Berman SM. Centers for disease control and prevention sexually transmitted disease treatment guidelines. Clinical Infect Dis. 2011;53(3):59-63.

World Health Organization. Guide to introducing HPV vaccine into national immunization programmes. World Health Organization. 2016.

Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(124):575-90.