Evidence map›Paper›PMID 41856140›Full record

ArticleThe Lancet. Global health2026

Population impact of South Africa's human papillomavirus (HPV) vaccination programme on HPV prevalence in adolescent girls with and without HIV: a repeat cross-sectional study.

Dorothy A Machalek, Dorothy C Nyemba, Danielle Travill, Kathy Petoumenos, Zizipho Z A Mbulawa, Ishana Naidoo, Feni M M Motshwane, Lesley Bamford, Helen Rees, John M Kaldor and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Dorothy A MachalekKirby Institute, University of New South Wales, Sydney, NSW, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, VIC, Australia.
Dorothy C NyembaWits RHI, University of the Witwatersrand, Johannesburg, South Africa.
Danielle TravillWits RHI, University of the Witwatersrand, Johannesburg, South Africa.
Kathy PetoumenosKirby Institute, University of New South Wales, Sydney, NSW, Australia.
Zizipho Z A MbulawaWalter Sisulu University, National Health Laboratory Service, Mthatha, South Africa.
Ishana NaidooWits RHI, University of the Witwatersrand, Johannesburg, South Africa.
Feni M M MotshwaneNational Department of Health, Pretoria, South Africa.
Lesley BamfordNational Department of Health, Pretoria, South Africa; Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa.
Helen ReesWits RHI, University of the Witwatersrand, Johannesburg, South Africa.
John M KaldorKirby Institute, University of New South Wales, Sydney, NSW, Australia.
Sinead Delany-MoretlweWits RHI, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: sdelany@wrhi.ac.za.
HOPE study group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundA school-based human papillomavirus (HPV) vaccination programme providing protection against types 16 and 18 of HPV was introduced in South Africa in 2014 for Grade 4 girls (aged ≥9 years), achieving 87% coverage among learners with at least one of the two recommended doses. We evaluated the programme's impact on HPV prevalence among adolescent girls in a setting of high HIV prevalence.

methodsIn this repeat cross-sectional study, girls aged 17-18 years were invited from 15 primary health-care clinics in four provinces (Free State, Gauteng, Mpumalanga, and North West) of South Africa to provide a self-collected vaginal sample for HPV testing (AnyPlex II HPV28, Seegene, Seoul, South Korea). A survey done from June 19 to Dec 11, 2019, estimated baseline (pre-vaccine) HPV prevalence. A repeat survey done from Feb 16 to Dec 6, 2023, estimated HPV prevalence in a group eligible for the vaccination programme (post-vaccine). Vaccination status was assessed through district registers and self-reported data. The primary outcome was the impact of the HPV vaccination programme, measured as the relative reduction in HPV prevalence between the two birth cohorts using generalised linear regression (estimating adjusted prevalence ratios), overall and by HIV status.

findingsOf 2470 participants enrolled, 819 girls were recruited for the pre-vaccine survey (248 living with HIV) and 1538 for the post-vaccine survey (295 living with HIV). Prevalence of HPV vaccine types HPV-16 and HPV-18 declined by 83%, from 21·6% (177 of 819 participants) in the pre-vaccine group to 3·2% (49 of 1538 participants) in the post-vaccine group (adjusted prevalence ratio 0·17, 95% CI 0·12-0·24; p<0·0001). A similar reduction was observed among those living with HIV, with prevalence decreasing from 29·4% (73 of 248 participants) in the pre-vaccine group to 4·4% (13 of 295 participants) in the post-vaccine group (adjusted prevalence ratio 0·18, 95% CI 0·10-0·32; p<0·0001). No significant reductions were noted for other HPV types, except HPV-31 and HPV-45, which is consistent with cross-protection.

interpretationIn this large-scale evaluation of South Africa's two-dose HPV vaccination programme, we observed impacts similar to those seen with three-dose programmes in high-income settings, including equivalent impacts among adolescent girls living with HIV. These findings underscore the substantial population-level benefits of high-coverage routine HPV vaccination in a high-HIV-burden setting.

fundingAustralian National Health and Medical Research Council and the Gates Foundation.

Indexed as

HIV InfectionsImmunization ProgramsPapillomavirus InfectionsPapillomavirus VaccinesAdolescentCross-Sectional StudiesFemaleHumansPrevalenceSouth AfricaPapillomavirus Vaccines

Identifiers

PMID41856140
PMCPMC13000116

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.