Human papillomavirus (HPV) vaccine uptake and its associated factors among adolescent girls in Kathmandu District, Nepal: A cross-sectional study

HPV causes over 95% of cervical cancer globally. In Nepal, cervical cancer is the second most common cancer with a crude incidence of 14.2 per 100,000 women, and HPV vaccination for 14-year-old girls began nationwide in 2023. This study assessed HPV vaccine uptake and its associated factors among adolescent girls in Kathmandu district. A cross-sectional study was conducted using multistage cluster random sampling. From 770 schools across eight municipalities where the vaccine available, 142 were selected, with ten 14-15-year-old girls each school. Data were collected using a supervised self-administered questionnaire. HPV vaccine uptake was defined as receipt of two doses within six months. Factors associated with uptake were analysed using Poisson regression with generalized estimating equations, accounting for clustering and sample weights. The prevalence of HPV vaccine uptake was 12.74% (CI: 7.2-21.4). Girls attending private schools had lower uptake than those in public schools (APR: 0.05; CI: 0.02-0.13), while 15-year-old girls had higher uptake than 14-year-olds (APR: 2.28; CI: 1.49-3.50). Lower uptake was observed among girls whose fathers were daily wage labour (APR: 0.59; CI: 0.39-0.90), self-employed (APR: 0.59; CI: 0.39-0.90), or employed abroad (APR: 0.65; CI: 0.43-0.97), whereas higher uptake was noted among girls whose mothers were employed in government jobs (APR: 2.70; CI: 1.55-4.69), private jobs (APR: 2.15; CI: 1.11-4.14), or abroad (APR: 2.58; CI: 1.31-3.86). Good knowledge of HPV infection (APR: 1.88; CI: 1.13-3.15) and good or moderate knowledge of the HPV vaccine (APR: 2.73; CI: 1.33-5.60 and APR: 2.02; CI: 1.07-3.82) were also associated with higher uptake. In conclusion uptake was higher among public school students, older adolescents, and those with working mothers or good HPV knowledge, highlighting the need for targeted interventions to improve awareness, school-based education, and access to vaccination services.