Human papillomavirus vaccine coverage surveys in low- and middle-income countries: current efforts and future considerations for very young adolescents.

With the recent accelerated rollout of the human papillomavirus (HPV) vaccine in low- and middle-income countries (LMICs), there is a growing need for high-quality vaccination coverage measurement. Vaccine coverage surveys are a key avenue for collecting coverage data, but little is known about the current state of HPV vaccination coverage surveys of very young adolescents (VYAs)-those 10-14 years of age-in LMICs and methodological considerations for these efforts. Through an analysis of peer-reviewed and grey literature and a series of expert discussions, we identify promising approaches for these coverage surveys, such as when to sample from schools versus households and how to reduce recall bias. We also draw attention to the significant methodological gaps, such as a lack of research comparing the validity of vaccination status self-report by the VYA to a caregiver's report. Next, we describe the status of coverage surveys, finding that most LMICs with the HPV vaccine included in their national programme have not conducted a nationally representative HPV vaccination coverage survey. We also describe four existing multi-country survey efforts that include HPV vaccination coverage questions. Finally, we discuss promising approaches to strengthen survey measurement of HPV vaccination coverage among VYAs. Our findings lay the groundwork for stakeholders to expand HPV vaccination coverage measurement for VYAs in LMICs, a necessary component for reducing global HPV and cervical cancer burdens.