Post-campaign evaluation of the 2025 national human papillomavirus multi-age cohort vaccination campaign in Sierra Leone: a cross-sectional study of coverage, awareness and caregiver attitudes in selected districts

The introduction of the Human Papillomavirus (HPV) vaccine for girls aged 10 years in Sierra Leone facilitated the rollout of the national Multi-Age Cohort (MAC) campaign in 2025. This study assessed HPV campaign awareness, vaccination coverage, knowledge, attitudes, barriers to vaccination, and factors associated with vaccine uptake among primary caregivers during the MAC campaign. We conducted a community-based cross-sectional study after the 2025 HPV MAC vaccination campaign in 10 purposively selected districts across all 5 administrative regions of Sierra Leone. This study included 2,253 caregivers of girls aged 11–18 years. We verified vaccination status during the interview against vaccination cards. We purposively sampled districts and collected data using a structured questionnaire administered via mobile data collection tools. We assessed knowledge only among caregivers of vaccinated girls ( n = 2,097). We used modified Poisson regression with cluster-robust standard errors as the primary analysis model to identify independent factors associated with vaccination status. Vaccination coverage was 94.8% (2,097/2,213, 95% CI: 93.2–96.1) in the evaluated districts. Composite knowledge among caregivers of vaccinated girls was 61% (1,280/2,097), 57.3% recognised cervical cancer prevention, and 46.0% knew the HPV vaccine is a single dose. Overall, attitudes toward the HPV vaccination and MAC campaign rollout were positive (mean attitude score 4.0/5.0). The post-campaign attitude score (adjusted PR: 1.060; 95% CI: 1.033–1.088, p < 0.001), campaign awareness (adjusted PR: 1.057; 95% CI: 1.013–1.102, p = 0.011), and girl attending school (adjusted PR: 1.193; 95% CI: 1.080–1.318, p < 0.001) were independently associated with vaccination status. Education level was not associated after cluster-robust correction (adjusted PR: 1.005, p = 0.477). Non-uptake was associated with access constraints, time limitations, and safety concerns. The coverage and uptake of the HPV vaccine were high in the surveyed districts. This was associated with increased awareness, post-campaign attitude score, and school attendance. The findings highlight the role of community-based health workers and nurses as central personnel in reaching girls beyond clinics and schools. These findings provide programmatic learning evidence from selected districts to inform planning the transition from campaign to routine immunisation.