Primary caregivers' acceptance of gendered human papillomavirus (HPV) vaccination across The Gambia

Human papillomavirus (HPV) is one of the most common sexually transmitted infections associated with cervical cancer. In The Gambia, it is estimated that 770,927 women aged 15 years and above are at risk of cervical cancer with approximately 286 new cases being diagnosed annually. Despite the effectiveness of the HPV vaccine, uptake has remained low since its introduction in 2019. This qualitative study explored the potential impact of age (adults versus adolescents versus infants) and gender (boys and girls versus girls only) on caregivers' acceptance of the HPV vaccine. Understanding caregivers' reasons for acceptance and refusal can help HPV vaccine programme managers to address issues that may prevent uptake. 23 qualitative in-depth interviews and 10 focus group discussions with a total of 83 caregivers were conducted in urban and rural settlements located across five regions of the Gambia (West Coast, North Bank, Lower River, Central River and Upper River). Male and female caregivers aged 18 and above were recruited through convenience and snowball sampling. NVivo 14 qualitative data analysis software was used for data management and thematic analysis. Knowledge of HPV, cervical cancer, and the HPV vaccine was scarce. Participants highlighted the need for greater sensitisation on HPV and the vaccine. Despite this, all participants accepted the HPV vaccine regardless of the age or gender of the individual receiving the vaccine. Motives for vaccine acceptance included ensuring the wellbeing of their children and trust in healthcare workers. Vaccine hesitancy was prompted by a lack of sensitisation and fear of infertility. HPV vaccine acceptance is high across the different regions although there is a need for widespread sensitisation. Such findings can inform the implementation of future vaccination programmes to improve sensitization messaging, plan for effective vaccination rollout and subsequently increase uptake and coverage of HPV vaccines. • There is limited research on HPV vaccination knowledge and acceptance in sub-Saharan Africa, especially in The Gambia. • There is an overarching acceptance of HPV vaccines despite limited knowledge of HPV, HPV vaccines and cervical cancer. • Three key recommendations are proposed including the need to address knowledge gaps through community sensitization. • Future vaccination programmes should improve sensitization messaging to ensure effective vaccination rollout.