Knowledge, attitude, and associated factors toward human papillomavirus vaccination among female secondary school students in Nifas Silk Lafto Sub-City, Addis Ababa, Ethiopia: Multicenter cross-sectional study.

Background: Human papillomavirus (HPV) infection is among the most common sexually transmitted infections worldwide and a leading cause of cervical cancer, which claims the life of one woman every minute globally. HPV vaccination is a proven, effective strategy to prevent cervical cancer. Despite vaccine availability, few studies have assessed awareness and perceptions among female secondary school students, a key target group for early vaccination. Addressing this gap is essential for designing interventions to improve vaccine acceptance and coverage. Objectives: This study aimed to assess knowledge and attitudes toward the HPV vaccine and identify associated factors among female secondary school students in Nifas Silk Lafto Sub-City, Addis Ababa, Ethiopia. Methods: Institutional-based cross-sectional study was conducted from May 10 to 20, 2023, in Nifas Silk Lafto Sub-City. Stratified sampling was used to select study participants. A total of 635 students were selected using a simple random sampling technique. Data were collected using structured self-administered questionnaires. The data were entered into EpiData version 4.6 and analyzed with SPSS version 25. Descriptive statistics (such as frequency, percentage, and means) were used to summarize the data, while binary and multivariable logistic regression analyses were performed to identify factors associated with the outcome variables. Adjusted odds ratios with 95% confidence intervals (CI) and p-value <0.05 were used to determine statistical significance. Results: A total of 616 students participated, with a response rate of 97%. Of the respondents, 55.5% had good knowledge and 58.6% had positive attitudes toward the HPV vaccine. Age between 18-20 years (AOR = 2.579, 95% CI = 1.446-4.598, p<0.001) and prior awareness of the HPV vaccine (AOR = 10.441, 95% CI = 6.530-16.694, p<0.001) were significantly associated with good knowledge. Factors significantly associated with a positive attitude included prior awareness of the HPV vaccine (AOR = 0.368, 95% CI = 0.239-0.567, p<0.001), receiving information from healthcare providers (AOR = 2.434, 95% CI = 1.055-5.615, p = 0.037), and knowledge about the HPV vaccine (AOR = 1.464, 95% CI = 1.000-2.144, p = 0.05). Conclusions: Overall knowledge and attitudes toward the HPV vaccine were low compared to other studies. Age and prior awareness of the HPV vaccine were significantly associated with knowledge. Additionally, prior awareness, source of information and knowledge significantly influenced attitudes toward the HPV vaccine. Therefore, targeted health education programs are recommended to improve awareness and attitudes among female secondary school students.