Awareness, Acceptance, and Associated Factors of Human Papillomavirus Vaccination Among Parents/Guardians of Adolescent Girls in Burundi: A Community-Based Cross- Sectional Study

Abstract Background: Cervical cancer remains a major public health challenge in sub-Saharan Africa. In Burundi, it is the most common cancer among women. As the country prepares to introduce human papillomavirus (HPV) vaccination into the national immunization program, evidence on parental awareness and acceptance is essential. Methods: A community-based cross-sectional study was conducted from November to December 2024 in six health districts of Burundi. Using a two-stage cluster sampling technique, 562 parents/guardians of girls aged 9–14 years were interviewed using a structured questionnaire. Descriptive statistics and logistic regression analyses were performed to identify factors associated with HPV vaccine acceptance. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: Overall HPV vaccine acceptance was 96.1%. Awareness of cervical cancer was reported by 77.4% of respondents, while only 19.9% had heard of HPV. In multivariable analysis, lack of knowledge that HPV is sexually transmitted (AOR = 0.16; 95% CI: 0.01–0.95; p = 0.045) and unwillingness to pay for a Pap smear test (AOR = 0.22; 95% CI: 0.06–0.66; p = 0.006) were independently associated with lower acceptance. Sociodemographic and school-related factors were not significant after adjustment. The model demonstrated strong discriminative ability (AUC = 0.87). Conclusions: Parental acceptance of HPV vaccination in Burundi is exceptionally high despite substantial knowledge gaps. Targeted education through trusted channels is critical to ensure sustained vaccine uptake during national rollout.