School-based HPV vaccination program implementation in municipalities of the São Paulo State, Brazil, from 2015 to 2018.

4vHPV vaccine was introduced into the Brazilian National Immunization Program in 2014, with vaccination at schools and healthcare facilities. Data on HPV vaccination program implementation in Brazil are scarce. This cross-sectional, exploratory study aimed to get a better understanding of the HPV vaccination actions and barriers to implement the school-based vaccination in municipalities of the São Paulo State, from 2015 to 2018, from the point of view of people who were responsible for conducting the actions. In November 2018, a questionnaire was sent to the state's regional surveillance groups to be answered by people responsible for the vaccination actions in the municipalities. The questionnaire consisted of six open questions on HPV vaccination actions taken by the municipalities, from 2015 to 2018, including whether the school-based vaccination had been implemented or not, a program description, the barriers to implement it, how the program was evaluated, and the municipality plans regarding HPV vaccination program in the following years. 233 (36.1%) of the 645 municipalities answered the questionnaire. Most of them implemented both education or vaccination actions at schools. Reported barriers were health human resources shortage, education staff concerns on vaccination within schools, and students' and parents' unfamiliarity with HPV vaccination. Raising awareness on HPV infection and prevention among students and parents, ensuring appropriate human resources, and building a partnership between the health and education sectors are critical to have a successful school-based program.