Integrated service delivery to improve adolescent health and human papillomavirus (HPV) vaccination in Lao PDR: a quasi-experimental mixed-methods study - study protocol.
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INTRODUCTION: The Lao People's Democratic Republic (PDR) faces the significant public health challenges of high cervical cancer incidence and suboptimal human papillomavirus (HPV) vaccine coverage alongside broader adolescent health concerns such as high adolescent pregnancy rates and inadequate sexual and reproductive health (SRH) literacy. This study protocol outlines an approach to address these interconnected issues comprehensively by evaluating an integrated service delivery model. METHODS AND ANALYSIS: This study employed a quasi-experimental design with mixed methods to assess the impact of an integrated service package comprising HPV vaccination and improved adolescent health services in two districts of Louangnamtha province in Lao PDR. The study population included girls aged 10-13 years for HPV vaccination and boys and girls aged 10-13 years for other adolescent health services. The intervention district received this integrated service package delivered through school-based, facility-based and outreach approaches. The comparison district continued with its standard HPV vaccination and routine adolescent health service delivery, which does not include the additional refresher training, comprehensive sexuality education or dedicated SRH outreach services provided in the intervention district.The intervention period was 7 months, from November 2024 to May 2025. Quantitative data on HPV vaccine uptake, SRH knowledge and attitudes and utilisation of adolescent health services were collected at baseline, midline (at 3 months) and endline (at 7 months). Qualitative data on barriers and facilitators to implementation, provider workload and capacity, and stakeholder perceptions were collected through in-depth interviews and focus group discussions with adolescents, caregivers, healthcare providers, educators, community leaders and policymakers at endline. ETHICS AND DISSEMINATION: Ethical approval for the study has been received from the University of Health Sciences Research Ethics Committee in Laos (ID: 833/REC, dated 4 September 2024). Informed consent was obtained from all participants or their legal guardians. Findings will be disseminated through academic publications, policy briefs, workshops and community engagement activities to inform policies and practices in Lao PDR and contribute to the global knowledge base on integrated service delivery models. TRIAL REGISTRATION NUMBER: NCT06650956.