HPV vaccination policies and implementation for adolescents in low- and middle-income countries: a scoping review

This scoping review mapped adolescent HPV vaccination policies across 84 low- and middle-income countries (LMICs) with national HPV immunization programs and synthesized implementation evidence through July 2025. Focusing on adolescents aged 9-14 years, we identified policy convergence in target age, school-based delivery, and free vaccination provision, alongside divergence in gender eligibility, vaccine type, and funding mechanisms across income levels. Nearly half of LMICs have adopted single-dose schedules, reflecting a clear trend toward dosing simplification. Despite these policy advances, only 9.8% of countries achieved the WHO 90% complete vaccination target among females by age 15. Coverage analysis suggested that school-based programs maintained more stable performance over time than health facility-based approaches. Implementation evidence identified four facilitating factors, while barriers varied by income level. School-based programs complemented by mixed delivery approaches and single-dose schedules may offer a promising pathway toward the 2030 cervical cancer elimination goals.