Multi-level determinants of HPV vaccine uptake in Sub-Saharan Africa: Socio-cultural, structural, and systemic perspectives

Background: Human papillomavirus (HPV) is a leading cause of cervical cancer and related diseases, placing a disproportionate burden on women in Sub-Saharan Africa (SSA). Despite the availability of highly effective vaccines, uptake across the region remains markedly low.Research Design: This study is a systematic review examining the socio-cultural, structural, and systemic factors that shape HPV vaccination uptake in SSA.Methods: Guided by the Population, Exposure, Outcome (PEO) framework and the Socio-Ecological Model, evidence was synthesized from 12 qualitative, quantitative, and mixed-methods studies identified through peer-reviewed databases and grey literature. Thematic analysis was applied to extract determinants influencing vaccine uptake.Findings: Persistent barriers included misinformation linking vaccination to infertility and side effects, spiritual and cultural concerns, low parental education, weak health infrastructure, and inconsistent vaccine supply. Conversely, uptake was facilitated by strong government leadership, school-based vaccination programs, the involvement of trusted community figures, and transparent public health campaigns. Rwanda emerged as a success case where political commitment and integrated strategies significantly boosted coverage.Conclusion: HPV vaccine uptake in SSA is mediated by interconnected cultural narratives, health system capacity, and institutional trust. Improving coverage requires multi-level interventions that integrate community-based education, expanded delivery strategies, and sustained political and policy commitment.