Improving human papillomavirus vaccine uptake in low- and middle-income countries: a narrative review of implementation and education strategies

Abstract Human papillomavirus (HPV) vaccination is a safe and cost-effective strategy for preventing cervical cancer, yet uptake remains low worldwide, particularly in low- and middle-income countries (LMICs). Numerous interventional studies in LMICs have attempted to improve vaccine uptake or knowledge, with mixed success. In this narrative review, we synthesize the evidence on implementation and education strategies and highlight best practices to guide future vaccination efforts. School-based vaccination programs have the strongest evidence for achieving high coverage, but alternative approaches are required to reach out-of-school youth and high-risk adult populations. While access to the HPV vaccine remains the most critical determinant of uptake, coupling this with education and awareness campaigns is essential to drive uptake. The most effective educational strategies are culturally adapted and grounded in learning theory. Overall, the evidence suggests that simply providing the HPV vaccine along with culturally relevant education will lead to broad vaccine acceptance across most populations. Future research should prioritize rigorous evaluation of unique educational and implementation strategies, such as mother-daughter approaches or culture-specific educational formats, with a focus on quantifying the impact these strategies have on endline vaccination status and not surrogate outcomes. Such studies will advance the evidence base, strengthen HPV vaccination strategies, and help reduce the global burden of HPV-associated cancers.