Human Papillomavirus Vaccine Hesitancy and Uptake Among Adolescent Girls Living with HIV in Sierra Leone: A Call for Integration of Cervical Cancer Services.
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Human papillomavirus (HPV) vaccination is critical for preventing cervical cancer among women living with HIV. Yet, uptake among adolescent girls needed to prevent cervical cancer remains understudied in low-income countries. This cross-sectional study examined HPV vaccination rates among adolescent girls (aged 10-18 years), sociodemographic predictors and perceptions related to HPV vaccination among their caregivers. A total of 249 caregivers of these adolescents, all attending antiretroviral therapy clinics in Sierra Leone, were included. This cross-sectional study assessed HPV vaccination rates among adolescent girls with HIV. We collected data using structured surveys and employed logistic regression models to identify factors associated with vaccine initiation (≥ 1 dose). Only 13.3% (n = 33/249) of adolescents had received the HPV vaccine, with significant disparities by age: older adolescents (18 years) had higher uptake (27.8%, 10/36) compared to younger peers (10-13 years) (5.3%, 5/94). Caregiver relationship strongly predicted vaccination: extended family caregivers had 1.84-fold higher odds of initiating vaccination than grandparents (adjusted OR = 1.84, 95% CI:1.09-3.12, p = 0.022). Misconceptions were prevalent: 16.8% (n = 41/243) of caregivers believed HPV vaccination promotes premarital sex, and 4.5% (n = 11/243) feared infertility, with none in the latter group vaccinating their child. Despite 80.7% (n = 196/243) expressing intent to vaccinate, only 6.6% (n = 13/196) had done so, highlighting a critical intention-action gap. Structural barriers, such as inconsistent access and cultural myths, likely mediate low uptake. These findings underscore the need for multifaceted interventions, including community-led education to dispel myths, integration of HPV vaccination into HIV care platforms, and targeted engagement of extended family decision-makers.