Pragmatic RE-AIM evaluation of the Train-the-Trainer Vaccine Champions Program in Vietnam

Background and objectiveVietnam had increasing rates of zero-dose children and sub-optimal COVID-19 vaccine booster coverage in 2022. With the Vietnamese Ministry of Health, we co-designed, implemented and evaluated a vaccine education and communication program for health workers and community leaders to improve trust, knowledge, communication skills and intention to vaccinate for routine childhood and COVID-19 vaccines. MethodThe Train-the-Trainer Vaccine Champions program was piloted in 2022 and deployed in 2023 in three low-coverage provinces. Master Trainers trained Provincial Trainers (healthcare workers and communication experts), who trained community leaders and other health workers as Champions to deliver community vaccine education sessions. Using mixed methods and the RE-AIM framework, we evaluated reach, effectiveness, adoption, implementation, and maintenance. Primary effectiveness outcomes included trust in vaccines and the healthcare system, vaccine knowledge, communication self-efficacy, satisfaction, and community respondents intention to vaccinate. Secondary outcomes included changes in Provincial level coverage pre- and 6-months post-intervention. ResultsThe program trained 56 Provincial Trainers (47% female), 286 Vaccine Champions (46% female), and reached 4027 community attendees. Communication self-efficacy and trust in vaccines and the health system increased significantly among Provincial Trainers and Vaccine Champions post-training but change in knowledge was minimal. Participants reported high satisfaction with sessions and materials and 86% of community respondents reported increased intention to vaccinate. Champions continue to run education sessions and promote other health programs with the Ministry of Health. ConclusionsIn Vietnam, a multi-level Vaccine Champions program that trained healthcare workers and community leaders to promote routine childhood and COVID-19 vaccination increased participant trust in vaccines and the health system, self-efficacy, and community intention to vaccinate. The program has potential to reduce healthcare workforce burden and has ongoing government support. Hybrid implementation-effectiveness trials are needed to determine impact on vaccine coverage and cost-effectiveness, alongside implementation outcomes, to guide scalability.