Integrating HPV vaccination into ART clinics: perspectives from an ethnographic study with girls aged 9-14 years in Ndola District, Zambia.
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People living with HIV are more likely to have persistent HPV infections, increasing the risk of developing HPV-related cancers (e.g., cervical cancer). The HPV vaccination offers protection against such cancers. However, administering the HPV vaccination according to the recommended schedule for adolescents who are living with HIV holds challenges. ART clinics may provide opportune locations in places with high burden of HIV. In our 5-year study in Ndola District, Zambia, we are identifying and testing strategies to support HPV vaccination integration in ART clinics across three geographical settings (rural, peri-urban, urban). Adolescents' experiences and perspectives are integral to such integration. As such, we carried out ethnographic and participatory research with girls in the study sites, including through participant-observation of vaccination campaigns and participatory "playshops" where 93 girls offered insights through a focus group game, mapping good and bad vaccination sites, and role-playing clinic-based vaccination. The girls identified that ART clinics were ideal sites, but only for adolescents who are living with HIV and if certain conditions are met - safety, privacy, discretion, respect, autonomy. Their insights are informing integration strategies and hold broader lessons to be applied to HPV vaccination in other clinical departments and school- and community-based campaigns.