HPV Infection in Sub-Saharan Africa: Circulating Genotypes, Vaccination Strategies (Single-Dose Versus Two-Dose), and Implications of HIV Co-Infection

Cervical cancer is a major cause of morbidity and mortality among women in sub-Saharan Africa, where vaccination coverage remains below the World Health Or-ganization target of 90% of girls fully vaccinated by 15 years of age. This narrative review synthesizes evidence on HPV genotype distribution, single-dose versus two-dose vac-cination, and the implications of HIV co-infection. Although HPV16 and HPV18 remain the predominant oncogenic types, HPV35, HPV52, HPV45, HPV33, and HPV58 are re-ported frequently in sub-Saharan African populations. Consequently, some high-risk infections fall outside bivalent and quadrivalent vaccine coverage, and some detected types remain outside nonavalent vaccine coverage. Randomized trials in Tanzania and Kenya demonstrate durable single-dose immunogenicity through 60 months and vac-cine efficacy above 98% against persistent vaccine-type infection through 54 months, respectively. The ESCUDDO trial in Costa Rica provides a direct five-year randomized comparison showing noninferiority of one dose to two doses. Equivalent single-dose efficacy and durability evidence for people living with HIV remains unavailable. These findings support expanded single-dose vaccination in immunocompetent populations alongside multidose pathways for people living with HIV, genotype-specific surveil-lance, and continued cervical screening.