Human Papillomavirus Vaccine Hesitancy and Uptake Among Adolescent Girls Living with HIV in Sierra Leone: A Call for Integration of Cervical Cancer Services.

Human papillomavirus (HPV) vaccination is critical for preventing cervical cancer among women living with HIV. Yet, uptake among adolescent girls needed to prevent cervical cancer remains understudied in low-income countries. This cross-sectional study examined HPV vaccination rates among adolescent girls (aged 10-18 years), sociodemographic predictors and perceptions related to HPV vaccination among their caregivers. A total of 249 caregivers of these adolescents, all attending antiretroviral therapy clinics in Sierra Leone, were included. This cross-sectional study assessed HPV vaccination rates among adolescent girls with HIV. We collected data using structured surveys and employed logistic regression models to identify factors associated with vaccine initiation (≥ 1 dose). Only 13.3% (n = 33/249) of adolescents had received the HPV vaccine, with significant disparities by age: older adolescents (18 years) had higher uptake (27.8%, 10/36) compared to younger peers (10-13 years) (5.3%, 5/94). Caregiver relationship strongly predicted vaccination: extended family caregivers had 1.84-fold higher odds of initiating vaccination than grandparents (adjusted OR = 1.84, 95% CI:1.09-3.12, p = 0.022). Misconceptions were prevalent: 16.8% (n = 41/243) of caregivers believed HPV vaccination promotes premarital sex, and 4.5% (n = 11/243) feared infertility, with none in the latter group vaccinating their child. Despite 80.7% (n = 196/243) expressing intent to vaccinate, only 6.6% (n = 13/196) had done so, highlighting a critical intention-action gap. Structural barriers, such as inconsistent access and cultural myths, likely mediate low uptake. These findings underscore the need for multifaceted interventions, including community-led education to dispel myths, integration of HPV vaccination into HIV care platforms, and targeted engagement of extended family decision-makers.