Improving HPV Vaccine Uptake Among Girls Aged 9–14 Years in Akwa Ibom State, Nigeria: A Community-Participatory Pre/Post-Intervention Study

Abstract Background Cervical cancer remains a leading cause of cancer-related mortality among women in Nigeria, where Human Papillomavirus (HPV) vaccine uptake has historically been among the lowest in sub-Saharan Africa. Despite the introduction of the HPV vaccine into Nigeria's National Immunisation Programme in 2023, uptake remains suboptimal. This study evaluated the effect of a community-participatory, multi-channel sensitisation intervention on HPV vaccine uptake, awareness, and knowledge among caregivers of girls aged 9–14 years in Akwa Ibom State, Nigeria. Methods A pre/post-intervention study was conducted across six communities in three local government areas representing urban, semi-urban, and rural settings. Independent cross-sectional surveys were administered to caregivers of eligible girls before (n = 331, January 2025) and after (n = 355, June 2025) a fourteen-week community sensitisation intervention delivered through five channels: churches, schools, primary healthcare facilities, community sound announcers, and physical materials. All materials were co-designed with community stakeholders. Descriptive statistics, chi-square and Mann-Whitney U tests, and multivariable logistic regression were used for analysis. Statistical significance was set at p < 0.05. Results HPV vaccine uptake increased from 7.3% (95% CI: 4.5%–10.0%) to 50.4% (95% CI: 45.2%–55.6%), an absolute increase of 43.1 percentage points. HPV vaccine awareness rose from 15.1% to 65.4% (p < 0.001). Among HPV-aware respondents, good HPV knowledge increased from 63.9% to 84.3% (p = 0.019), though vaccine-specific knowledge remained predominantly poor across both phases (4.0% vs. 6.9%, p = 0.749). Willingness to vaccinate among unvaccinated caregivers was high and unchanged (87.0% vs. 87.5%, p = 0.979). Routine facility records corroborated survey findings, showing a 276% increase in mean monthly doses administered. HPV vaccine awareness was the strongest independent predictor of uptake in both phases (pre-intervention aOR 9.88, 95% CI: 2.07–47.46; post-intervention aOR 16.59, 95% CI: 6.98–39.46). Conclusions A community co-designed, multi-channel sensitisation intervention was associated with a substantial increase in HPV vaccine uptake within six months. Limited awareness rather than vaccine hesitancy was the primary barrier in this setting. Sustaining these gains requires parallel investment in vaccine supply-chain resilience alongside community sensitisation, and future interventions should prioritise strengthening vaccine-specific knowledge to support informed and durable vaccination uptake. Trial registration Pan African Clinical Trials Registry (PACTR), PACTR202609683563072, [07 September, 2026]. Retrospectively registered.