Human papillomavirus vaccine uptake among adolescent girls living with HIV in Côte d’Ivoire: A national cross-sectional survey

BACKGROUND: Human papillomavirus (HPV) vaccination programs are scaling-up in low-and-middle-income countries, targeting girls aged 9 to 14, usually through a school-based approach. However, specific data on adolescent girls living with HIV (AGLHIV) are lacking. We estimated the HPV vaccine uptake and its determinants among AGLHIV in Côte d'Ivoire. METHODS: A nationally representative survey was conducted within HIV pediatric facilities from July 2024 to February 2025 through a mixed-method approach. Participating facilities were selected through a hybrid sampling combining the inclusion of the largest pediatric HIV facilities and a random sample of integrated HIV facilities. Vaccine uptake was documented from immunization records, and questionnaires to AGLHIV. A logistic regression analysis was used to assess factors associated with HPV vaccine uptake. In-depth interviews were conducted with AGLHIV, parents/guardians, and healthcare workers (HCW) to assess barriers to HPV vaccine uptake. RESULTS: Overall, 659 AGLHIV (median age 15 years [IQR: 13-17]) were included across 15 HIV facilities. Among participants, 97 (14.7%) received at least one dose of HPV vaccine. Reported barriers to vaccination included: lack of information about the vaccine (85.4%), parents' refusal (8.9%) and fear of adverse events (5.7%). Identifying HPV as a risk factor for cervical cancer (adjusted Odds Ratio (aOR) = 4.02 [95% CI: 1.87-8.62], having ever attended a focus group on sexual education (aOR = 1.79 [95% CI: 1.07-2.99] and receiving care outside of Abidjan (aOR = 3.07 [95% CI: 1.88-5.01]) were independently associated with vaccine uptake. In-depth interviews highlighted a lack of information, stigma, parental influence, and a lack of vaccine proposition by HCW as barriers to HPV vaccination. CONCLUSION: The HPV vaccine uptake was low among AGLHIV in Côte d'Ivoire. Person-centered interventions combining school- and facility-based approaches, with dedicate monitoring tools, are urgently needed to achieve the WHO 90% HPV vaccination coverage among AGLHIV.