Abstract:
Recent reports from Kampala indicate low uptake and completion of the human pap-
illomavirus (HPV) vaccine among adolescents, especially amongst those living with
HIV. However, the drivers of this low uptake are poorly understood. This study aimed
to determine the current HPV vaccine coverage; assess the knowledge, attitude and
practices influencing HPV vaccine uptake among adolescent girls living with HIV; and
pilot an HPV vaccination program while documenting lessons learned and experi-
ences at two urban HIV treatment centres the Joint Clinical Research Centre (JCRC)
and Mildmay Uganda in Kampala, Uganda.
Methods
This was a descriptive cross-sectional mixed methods study employing both qual-
itative and quantitative data collection methods, carried out between 03/12/2024–
30/08/2025, among adolescent girls living with HIV in Kampala, Uganda. A total
of 371 were enrolled, of which 182 from JCRC and 189 from Mild May Uganda.
At enrolment, 11 adolescents declined consent to participate. Quantitative data on
knowledge of HPV and HPV vaccination was collected through interviews, with any additional demographic data being obtained from medical records at the treatment
centres. Qualitative data included four focused group discussions (FGDs) of adoles-
cent girls and 32 key informant interviews (KIIs) with focal health workers (Paediatri-
cians, nurses, counsellors) at the two centres were conducted.
Results
Overall, 138/371 (37%) of the adolescents reported having heard about the HPV
vaccine, while 233/371 (63%) had not. At enrolment, only 51 out of 371 (14%)
participants had initiated vaccination. Among those who initiated vaccination,
51% had received only the first dose. By the end of the study, 342/371 (92%) of
adolescents had completed the recommended two doses of the HPV vaccine. This
study focused on increasing vaccine uptake amongst the HIV positive adolescents
at the two centres. Most adolescents with a good level of knowledge about HPV
or those attending school reported to have initiated vaccination. Identified barriers
to vaccine uptake included inadequate knowledge about HPV and the benefits of
vaccination; limited availability of HPV vaccines, and the absence of routine HPV
immunisation programs within HIV treatment centres or programs specifically
targeting adolescents living with HIV.
Conclusion
In these two urban HIV care and treatment centres, vaccination against HPV among
eligible adolescents is way lower than recommended 90 percent. Adolescent girls liv-
ing with HIV demonstrated low levels of knowledge about the HPV vaccine and poor
access to vaccination services, despite being receptive to vaccination. This study
showed that HPV vaccine uptake can be substantially improved within HIV care and
treatment centers by reducing barriers to HPV vaccination uptake when the vaccines
are made readily available and accessible, either in existing HIV care and treatment
centres or in the new integrated care centres in areas where government programs
have moved to implement HIV care integration into mainstream medical services