Bridging Fragmented Systems: Integrated Approaches to HPV Vaccination for People Living with HIV in Eastern and Southern Africa

Background/Objectives: Eastern and Southern Africa (ESA) carries the world’s heaviest combined burden of HIV and cervical cancer. People living with HIV (PLHIV) face higher HPV acquisition, reduced clearance, and accelerated progression to cervical cancer, and WHO recommends a two- or three-dose HPV vaccination schedule for this group regardless of age or antiretroviral therapy (ART) status. Multi-dose completion among PLHIV nonetheless remains largely unmonitored. This Review examines how to close the HPV vaccination gap for women and girls living with HIV by integrating immunisation and HIV service delivery. Methods: We conducted a narrative synthesis of peer-reviewed evidence, mathematical modelling, and country implementation experience from high HIV-burden settings, anchored by primary data from a WHO Regional Office for Africa sub-regional workshop convened in Cape Town in November 2025 with immunisation and HIV programmes from five ESA countries (Eswatini, Malawi, South Africa, Tanzania, and Zimbabwe), modellers, youth advocates, and global partners. Results: Regional HPV vaccination coverage more than doubled between 2019 and 2024, but only one of the five countries examined can currently monitor coverage by HIV status. Four cross-cutting barriers emerge: delivery platforms are misaligned with the population at risk; data systems cannot follow individuals across services; confidentiality and stigma disrupt dose completion; and policies lack operational translation. An integration approach built around four axes (policy and eligibility, service platforms, data systems, and financing) can close the gap without creating parallel infrastructure. Conclusions: While the evidence draws principally on ESA, the framework is transferable to other settings. Closing the equity gap for PLHIV will depend on aligning existing programmes to operationalise integration and prevent cervical cancer in this group.