Navigating the divide - demographic and individual predictors of low HPV vaccine uptake in rural Uganda

Cervical cancer remains a leading cause of cancer-related mortality among women in low- and middle-income countries, with sub-Saharan Africa bearing a disproportionate burden. Although Human papillomavirus (HPV) vaccination is an effective preventive strategy, completion of the recommended two-dose schedule remains suboptimal in many rural settings in Uganda. This study assessed demographic and individual-level predictors of low HPV vaccine uptake among adolescent girls in Rukiga District.

A cross-sectional mixed-methods study was conducted between September and November 2022 among 292 caregivers of adolescent girls aged 9-14 years in Rukiga District. Quantitative data were analyzed using multivariable logistic regression to identify factors associated with completion of the HPV vaccination series. Qualitative data were collected through in-depth interviews with 11 health workers and 10 Village Health Team members and analyzed thematically to explore contextual barriers to vaccine uptake.

Completion of the two-dose HPV vaccination series was low (23.49%). Maternal caregiving was positively associated with vaccine completion (AOR = 1.70, 95% CI: 1.05-2.75, p = 0.030). In contrast, lack of formal education (AOR = 0.19, p = 0.033), primary education (AOR = 0.50, p = 0.007), and peasant occupation (AOR = 0.49, p = 0.013) among caregivers were associated with lower uptake. Individual factors such as residential mobility (AOR = 0.50, p = 0.001) and school absenteeism or dropout (AOR = 0.73, p = 0.037) significantly reduced the likelihood of completing vaccination. Qualitative findings revealed key barriers including misconceptions about vaccine safety, school-based delivery limitations, frequent mobility, health system constraints (e.g., stockouts, understaffing), and community mistrust.

HPV vaccine uptake in Rukiga District remains low and is influenced by caregiver education, maternal involvement, socioeconomic status, and adolescent mobility and school attendance. Addressing these barriers requires targeted community health education, strengthening school and outreach vaccination strategies, and improving health system capacity. Tailored interventions focusing on less-educated caregivers and hard-to-reach adolescents are critical to improving vaccine completion and reducing the burden of cervical cancer.