Strengthened HPV vaccination among adolescents living with HIV, - Findings of a Pilot QI project in Kampala Metropolitan, Uganda.

introductionRecent reports from Kampala indicate low uptake and completion of the human papillomavirus (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 experiences at two urban HIV treatment centres the Joint Clinical Research Centre (JCRC) and Mildmay Uganda in Kampala, Uganda.

methodsThis was a descriptive cross-sectional mixed methods study employing both qualitative 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 adolescent girls and 32 key informant interviews (KIIs) with focal health workers (Paediatricians, nurses, counsellors) at the two centres were conducted.

resultsOverall, 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.

conclusionIn these two urban HIV care and treatment centres, vaccination against HPV among eligible adolescents is way lower than recommended 90 percent. Adolescent girls living 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.