Understanding vaccination hesitancy and evaluating single dose and gender-neutral vaccination for improving uptake of HPV vaccines in West and East Africa.

Cervical cancer, caused by human papillomavirus (HPV), is almost entirely preventable through prophylactic HPV vaccination. Many countries have yet to implement HPV vaccination programmes or are struggling to achieve high vaccine coverage. This presents a major challenge for meeting the World Health Organisation (WHO) cervical cancer elimination target, with 90% of 15 year-old girls being vaccinated against HPV by 2030. Originally licenced as multidose vaccines, WHO has recently recommended that countries can offer a single HPV vaccine dose to 9-20 year olds. The IMPROVE-HPV consortium, a partnership of research institutions in Tanzania, Nigeria, UK and Spain, will investigate barriers to HPV vaccine uptake and the impact and acceptability of new HPV vaccine delivery strategies to improve vaccine coverage and effectiveness and reduce hesitancy. The consortium builds on previous successful collaborations in HPV epidemiology and vaccine research and qualitative research on barriers and facilitators to vaccine uptake. Tanzania has a multidose HPV vaccination programme in girls but will change to a single dose regimen in 2024. A gender-neutral HPV vaccination strategy is currently being implemented in Tanzania as part of a large cluster-randomised trial. Nigeria is one of the first countries to introduce national HPV vaccination with a single dose. Using these opportunities, IMPROVE-HPV will evaluate vaccine effectiveness, uptake and the factors affecting acceptability of (1) HPV two-dose vaccination delivery in females, (2) introducing or changing to a single dose vaccine regimen (3) gender-neutral HPV vaccination, and will also (4) investigate factors influencing vaccine hesitancy, community engagement and perceptions of HPV vaccines. The workplan directly addresses effectiveness and uptake of different HPV vaccine deployment strategies through phase IV/implementation research and will inform policy decision making in sub-Saharan Africa for HPV vaccination programmes.