Cervical cancer prevention knowledge attitudes and practices among Tunisian obstetrics and gynecology residents before HPV vaccine introduction: A cross-sectional study

Prior to the introduction of the HPV vaccination program in Tunisia in February 2025, this study assessed cervical cancer screening knowledge, attitudes and practices among Tunisian obstetrics and gynecology residents and identified factors influencing their screening performance. An analytical cross-sectional study was conducted between March and June 2024 among residents nationwide. Data were collected using an anonymous online questionnaire based on WHO recommendations and international guidelines for cervical cancer screening and HPV vaccination. A total of 271 residents participated. Knowledge remained suboptimal with more than half of participants classified as having a low level of knowledge. Higher knowledge scores were associated with female gender, advanced residency year, training in university hospitals, participation in screening campaigns and specific training in cervical cancer screening. Conventional Pap smear remained the most recommended screening method (57.6%) whereas only 34.7% recommended HPV testing for women aged ≥ 30 years. Nearly 60% were unaware of HPV vaccines available in Tunisia. Attitudes were generally favorable, with 90% supporting HPV vaccination and 85% recommending continued screening after vaccination. Major perceived barriers included lack of patient information, cultural taboos and limited access to care. Strengthening training and targeted educational programs may improve screening practices and support cervical cancer prevention in Tunisia.