From Awareness to ACTion Study: Improving Human Papillomavirus Knowledge, Screening, and Vaccine Uptake in Adolescent-Mother Pairs in the HOMINY study in Nigeria

Introduction: Persistent infection with high-risk Human Papillomavirus (hr-HPV) in women is a leading cause of cervical cancer, and its co-infection among people living with HIV (PLHIV) increases the risk of HPV-associated cancer, including oropharyngeal and anogenital cancers. In sub-Saharan Africa, awareness of HPV is limited, screening and vaccine adoption are critically low, undermining efforts toward sexually transmitted infection (STI) elimination. Methods: ouths) prospective cohort study. Participants were enrolled, including adolescents aged 9-18 years (N=636) and mothers aged 29-59 years (N=385). FACT was conducted at the University of Benin Teaching Hospital, Nigeria, with adolescent participants grouped as perinatally acquired HIV, HIV-exposed without acquisition and HIV-unexposed, and mothers by HIV serostatus. In line with the national immunisation programme protecting girls in Nigeria, sensitisation programmes were integrated into the research study to promote awareness and adoption of screening and vaccination practices. Knowledge and attitudes regarding HPV and its vaccination benefits were assessed through thematic discussions, field notes, interactive sessions, and questionnaires administered over the study period. Results: At baseline, HPV awareness was low, with 34.5% of mothers and 1.4% of adolescents being aware of HPV. Post-sensitisation, awareness increased significantly to 64.4% and 19% in mothers and adolescents, respectively. Vaccination uptake rose from 0% to 3.4% in adolescents, and the proportion of mothers who underwent HPV-related screening (Visual Inspection with Acetic Acid and/or Papanicolaou test) increased from 38.7 % at baseline to 52.4 % after a year (p < 0.0001). Barriers to the adoption of preventive services included misconceptions, healthcare provider gaps, myths, misinformation, mistrust, skepticism, and limited access. Conclusions: HPV awareness programmes significantly improved knowledge, vaccination uptake, and screening practices in this vulnerable population. As part of comprehensive STI elimination strategies, integrating HPV education and vaccination initiatives into HIV care and research will enhance prevention and address significant barriers. Lessons from a unique programmatic science framework provide critical insights for scaling vaccine delivery, and the design of future vaccine programmes.