Barriers and strategies to enhance HPV vaccine uptake in adolescents living with HIV and their guardians in Lilongwe, Malawi

Female Adolescents Infected with HIV are at higher risk for Human Papillomavirus -related cancers later in life, making them a priority for HPV vaccination. Since HPV-related cancers typically develop after adolescence, HPV vaccination before exposure to HPV infection is most effective. Increasing vaccination rates in this group is key to reducing the risk of cervical cancer incidence. The Global Action strategy to eliminate cervical cancer requires achieving 90% national coverage and 80% district coverage for HPV vaccination. However, the uptake of HPV vaccine in Malawi has been slow, with an uptake of less than 73%. This study explored the barriers of HPV vaccine uptake and identified strategies to improve vaccination rates among female adolescents infected with HIV in Lilongwe, Malawi. This qualitative phenomenological study employed two focus group discussions and 12 in-depth interviews with female Adolescents infected with HIV, healthcare workers and caregivers respectively. Study participants were sampled from Mitundu Community Hospital and Area 18 Urban Health Centre in April 2022. Female Adolescents infected with HIV were sampled through teen clubs. Thirty participants were enrolled using quota sampling. Recorded interviews were transcribed verbatim and translated into English for analysis. The data were analysed using a thematic approach. The barriers to the uptake of the HPV vaccine were negative attitudes towards the HPV vaccine and misconceptions about the vaccine due to inadequate or incorrect HPV vaccine information, lack of adequate HPV vaccine information, and shortage of HPV vaccine. Strategies for improving the uptake of HPV vaccines include raising awareness and sensitization about HPV, resource availability, and advocating for other HPV vaccine delivery modes, such as the integration of HPV-related interventions in teen clubs to enhance vaccine uptake. Overall, teen club clinic days were proposed as the best days to identify unvaccinated female adolescents and recommend the HPV vaccine. Teen clubs should be well positioned to fill the gap in previously lost opportunities for vaccine administration and empower female adolescents infected with HIV by endorsing the HPV vaccine. Further research should explore the feasibility and readiness of administering the HPV vaccination in teen club clinics.