Knowledge, perceptions, uptake, and determinants of HPV vaccination, and preferred delivery strategies among out-of-school girls in Masaka, Uganda

Cervical cancer is a leading cause of cancer-related mortality among women in sub-Saharan Africa, and accounts for 80% of female cancer cases in Uganda. The Human Papillomavirus (HPV) vaccine prevents cervical cancer but is mainly administered to school-going girls aged 9-15 y, potentially excluding out-of-school girls. This study assessed knowledge, perceptions, uptake, and preferred delivery strategies among out-of-school girls aged 9-20 y in inland and fishing communities in Masaka, Uganda. Between August and October 2024, we surveyed 428 girls (214 per community) using structured questionnaires. Descriptive statistics summarized participant characteristics, and logistic regression identified factors associated with uptake. The median age was 17 y (IQR: 15-19). Nearly one-fifth (19.9%) were married or cohabiting, and 62.4% had ever had sex. Less than half (44.2%) reported prior knowledge of the HPV vaccine, though most recognized its importance (73.4%) and safety (72.2%). Uptake remained low: 29.9% had received at least one dose, and 12.9% had completed two doses. Prior awareness strongly predicted uptake (aOR = 7.82; 95% CI: 4.67-13.44), with higher uptake in fishing communities (aOR = 2.21; 95% CI: 1.30-3.84). Lower uptake was associated with being out of school for 6-10 y (aOR = 0.24; 95% CI: 0.14-0.40) and prior sexual experience (aOR = 0.51; 95% CI: 0.27-0.96). Among unvaccinated girls, 91.2% expressed willingness to receive the vaccine. Preferred strategies included community outreaches (57.7%), health facility approaches (53.3%), and door-to-door delivery (29.2%). Uptake among out-of-school girls was low despite high willingness, underscoring the need for targeted interventions in high-risk settings.