Factors Associated with Acceptance of Vaccination Against Human Papillomavirus in eThekwini District of South Africa.

South Africa launched a school-based human papillomavirus (HPV) vaccination programme in 2014 and has achieved a national coverage of more than 80%. However, there is subnational variation in coverage, with eThekwini District in the province of KwaZulu-Natal having the lowest coverage at 40%. Knowledge of the factors associated with vaccine acceptance in this district would inform tailored strategies to improve coverage, which could be extrapolated to similar settings. We conducted this cross-sectional study to assess the factors associated with HPV vaccine acceptance in eThekwini District. We used stratified random sampling to select caregivers of children aged 9-14 years in the district. We interviewed participants in April-May 2023 and employed bivariate and multivariate logistic regression models to assess the factors associated with HPV vaccine acceptance. Of 793 individuals contacted, 713 (89.9%) participated. Most were women (86.1%) and had a mean age of 42.6 ± 11.6 years and secondary or lower education (83.8%). Most participants knew about the HPV vaccination programme (86.0%) and accepted HPV vaccination (93.5%). The latter includes 42.9% who had already vaccinated their daughters and 50.6% who were willing to allow their daughters to be vaccinated. A negligible proportion was either undecided (2.1%) or unwilling (4.4%) to accept HPV vaccination. Awareness of the programme (adjusted odds ratio [aOR] 5.22; 95% confidence interval [95%CI] 2.01-13.56), confidence in vaccine safety (aOR 19.69; 95%CI 5.86-66.15), and endorsement by religious leaders (aOR 5.06; 95%CI 1.56-16.45) were independent predictors of vaccine acceptance. Our findings highlight the critical role of the provision of information and education about the benefits and safety of HPV vaccination.