HPV vaccine awareness, perceptions, uptake, and school-based information channels during Nigeria’s national rollout: a cross-sectional study among adolescent girls in rural Oyo State

BACKGROUND: Nigeria introduced the human papillomavirus (HPV) vaccine into its national routine immunisation programme in October 2023, using a phased delivery strategy that included school- and community-based platforms. Evidence remains limited on how adolescent girls in rural communities understand HPV vaccination during active rollout. This study assessed awareness, knowledge, perceptions, self-reported HPV vaccine uptake, and willingness to receive the vaccine among adolescent girls in rural Oyo State during the Phase-2 national rollout. METHODS: We conducted a school-based cross-sectional survey among 441 in-school adolescent girls recruited from 12 public and private secondary schools across three rural local government areas of Oyo State between 26 May and 19 June 2024. Structured questionnaires measured knowledge of cervical cancer, HPV, and HPV vaccination, as well as perceptions, beliefs, and self-reported vaccination status. Multivariable binary logistic regression was used to identify factors associated with HPV vaccine uptake and willingness to be vaccinated. RESULTS: Awareness of cervical cancer (26.1%), HPV (28.8%), and HPV vaccination (29.0%) was low. Schools were the most frequently reported source of information on cervical cancer and HPV among those who had heard of them. Forty-one participants (9.3%) self-reported having received the HPV vaccine. In adjusted analysis, favourable vaccine perception was strongly associated with self-reported uptake (AOR = 11.00; 95% CI: 3.53-34.25; p < 0.001), although this estimate should be interpreted cautiously because the vaccinated subgroup was small. Among unvaccinated participants, lack of information (49.3%), low perceived risk (20.3%), and concerns about side effects (16.0%) were the most frequently reported reasons for non-vaccination. Definite willingness to be vaccinated was associated with favourable vaccine perception (AOR = 6.24; 95% CI: 3.16-12.33; p < 0.001). CONCLUSIONS: During Nigeria's HPV vaccine rollout, self-reported uptake among adolescent girls in rural Oyo State was low and was associated more consistently with favourable vaccine perceptions than with knowledge measures alone. The findings suggest the potential value of strengthening school-based communication, providing adolescent-appropriate information, and considering parent/guardian engagement as part of rural HPV vaccination implementation. Because the study was cross-sectional and vaccination status was primarily self-reported, findings should be interpreted as associations rather than causal effects.