Moucheraud Corrina, Kalande Pericles, Chibaka Symon, Phiri Khumbo, Makwaya Amos, Duah Maame, Li Mei, Liu Muxin, Hoffman Risa M, Phiri Sam
School of Global Public Health, New York University, New York, USA.
Implementation Science Department, Partners in Hope, Lilongwe, Malawi.
Hum Vaccin Immunother. 2025 Dec;21(1):2485651. doi: 10.1080/21645515.2025.2485651. Epub 2025 Apr 3.
Uptake of the human papillomavirus (HPV) vaccine is suboptimal globally. Effective interventions are needed to meet the global goal of vaccinating 90% of girls against HPV, and this requires a robust understanding of barriers to vaccine uptake. Using a household survey in three communities of Malawi with parents/guardians of girls aged 9-13 years, we collected and analyzed data about intervention-amenable factors hypothesized to be associated with girls' HPV vaccination status. The 299 parent/guardian respondents provided information on 382 girls aged 9-13 years, of whom 39.0% ( = 149) had received ≥ 1 dose of the HPV vaccine. More than half of parents/guardians were concerned about the HPV vaccine's safety. Greater HPV vaccine hesitancy was associated with having an unvaccinated daughter in adjusted multilevel models (aOR 0.69 [95% CI 0.50-0.93]). Higher odds of being vaccinated were found among daughters of respondents with greater knowledge about the HPV vaccine and who knew someone who had cervical cancer. Speaking with more people about cervical cancer/HPV vaccination, and perceiving that other parents are vaccinating their daughters against HPV, were strongly associated with daughters' HPV vaccination status (aOR 2.03 [95% CI 1.59-2.62] and 3.68 [95% CI 1.97-7.18, respectively). Most parents/guardians had not experienced, or did not anticipate experiencing, challenges accessing HPV vaccination services, but those who did also had daughters with lower odds of vaccination. Interventions that leverage social networks and norms, increase confidence in the vaccine's safety, and work to improve access to HPV vaccination services, may increase coverage of the HPV vaccine in Malawi.
全球人乳头瘤病毒（HPV）疫苗的接种率未达理想水平。需要采取有效的干预措施来实现为90%的女孩接种HPV疫苗的全球目标，而这需要深入了解疫苗接种的障碍。我们在马拉维的三个社区对9至13岁女孩的父母/监护人进行了一项家庭调查，收集并分析了与女孩HPV疫苗接种状况相关的、可通过干预解决的因素的数据。299名父母/监护人受访者提供了382名9至13岁女孩的信息，其中39.0%（n = 149）已接种≥1剂HPV疫苗。超过一半的父母/监护人担心HPV疫苗的安全性。在调整后的多水平模型中，对HPV疫苗的犹豫程度越高，其女儿未接种疫苗的可能性越大（调整优势比为0.69[95%置信区间0.50 - 0.93]）。对HPV疫苗了解较多且认识宫颈癌患者的受访者的女儿接种疫苗的几率更高。与更多人谈论宫颈癌/HPV疫苗接种，以及认为其他父母正在为女儿接种HPV疫苗，与女儿的HPV疫苗接种状况密切相关（调整优势比分别为2.03[95%置信区间1.59 - 2.62]和3.68[95%置信区间1.97 - 7.18]）。大多数父母/监护人没有经历过，也没有预计会遇到获得HPV疫苗接种服务的挑战，但那些遇到过挑战的父母，其女儿接种疫苗的几率也较低。利用社交网络和规范、增强对疫苗安全性的信心以及努力改善HPV疫苗接种服务可及性的干预措施，可能会提高马拉维HPV疫苗的接种覆盖率。
