Early implementation and contextual determinants of the human papillomavirus vaccine rollout and uptake in Nigeria: a...

In 2023, Nigeria introduced the Human Papillomavirus (HPV) vaccine into routine immunization to reduce the high burden of cervical cancer. However, limited evidence exists regarding early vaccine availability, uptake, and the contextual factors influencing implementation across health facilities.

This study employed a sequential explanatory mixed-methods design (quan + QUAL) across five Nigerian states (Oyo, Jigawa, Kano, Lagos, and Rivers). Data collectors conducted monthly visits to assess HPV vaccine availability and reviewed the facility register to assess HPV vaccine uptake. Subsequently, in-depth interviews were conducted with healthcare workers to explore contextual determinants of vaccine delivery and acceptance. Qualitative data were analyzed using reflexive thematic analysis and reported in accordance with COREQ guidelines.

Overall, 13 of the 52 (25%) facilities included in this study did not record a single HPV vaccine availability and uptake throughout the entire 4 months period. HPV vaccine availability varied substantially across states and facilities, with only 8/17 facilities in Oyo reporting availability compared to 6/11 in Jigawa across all 4 months. Uptake also varied widely, ranging from 0 to 308 doses per facility over the 4 months, with higher uptake observed in parts of Rivers State. Qualitative themes supported these findings, demonstrating that HPV vaccine uptake evolved as communities increasingly understood its relevance through local narratives, trusted health worker endorsement, and peer influence. Despite a structured rollout, frontline preparedness and vaccine uptake were shaped by variability in training, outreach-driven delivery, trust in healthcare workers and community influencers, as well as sociocultural barriers, misconceptions, and household power dynamics.

Overall, our study reinforces that improving HPV vaccine coverage requires more than expanding stock; it demands reliable access, responsive service delivery models, and socially grounded communication strategies that foster community legitimacy. Addressing both structural constraints and contextual determinants will be essential to prevent HPV vaccination from remaining concentrated in a few facilities and instead embed it as a routine, equitable public health intervention.