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Cited by 30Cervical Cancer and HPV ResearchVaccine Coverage and HesitancyWomen's cancer prevention and management

Improving HPV vaccination uptake among adolescents in low resource settings: Sociocultural and socioeconomic barriers and facilitators

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Xu, Mia, Choi, Jasmin, Capasso, Ariadna, DiClemente, Ralph·2024·Adolescent Health, Medicine and Therapeutics
DOI 10.2147/ahmt.s394119PMC PMC11296371
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Abstract

Background: Lower- and middle-income countries (LMICs) are disproportionately impacted by human papillomavirus (HPV) and would benefit from implementing the HPV vaccine. In the context of competing health priorities, utilizing scarce domestic infrastructure and human resources for HPV vaccination remains challenging for many LMICs. Given the high benefits of the HPV vaccine, the World Health Organization (WHO) is now encouraging for all countries, particularly LMICs, to introduce HPV vaccines into their routine immunization programs. Understanding the barriers and facilitators to HPV adolescent vaccine programs in LMICs may help strengthen how LMICs implement HPV vaccine programs, in turn, increasing HPV vaccine acceptance, uptake, and coverage. Objective: To identify and assess barriers and facilitators to implementing adolescent HPV vaccination programs in LMICs. Methods: This study comprised a review of literature assessing adolescent HPV vaccination in LMICs published after 2020 from a sociocultural perspective. Results: Overall, the findings showed that LMICs should prioritize increasing HPV vaccine availability and HPV vaccine knowledge, particularly focusing on cancer prevention, as knowledge reduces misinformation and increases vaccine acceptance. Evidence suggests that factors promoting HPV vaccine uptake include fostering low vaccine hesitancy, integrating HPV vaccination as a primary school routine vaccination, and vaccinating both genders. A one-dose HPV vaccine may enable many LMICs to increase vaccine acceptance, uptake, and coverage while controlling financial, infrastructure, and human resource costs. Conclusion: As HPV is one of the leading causes of death in many LMICs, implementing the HPV vaccine may be highly beneficial. Cohesive national HPV vaccine buy-in and understanding the success and challenges of prior LMIC HPV vaccine implementation is crucial to developing effective, efficient, and sustainable HPV vaccination programs.

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  • Physicians in rural and semi-urban India remain under-utilized for HPV vaccination, a challenge echoed in other LMICs.

    “However, physicians in rural and semi-urban India remain under-utilized, a challenge echoed in other LMICs49,53.”

    From Barriers to HPV vaccination among adolescent girls in India: A scoping review (2026) · cites this paper as [49]

    The Results (Cost-Benefit Perception and Attitudes; page unavailable) say that adolescents use health services minimally in most LMICs and often lack a primary care doctor or nurse. This supports a broader LMIC access challenge, but the paper does not establish that physicians are under-utilized for HPV vaccination in rural or semi-urban India. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • In China and Turkey, parental understanding does not necessarily convert into HPV vaccine adoption unless combined with affordability and trustworthy healthcare communication.

    “Similar issues have been identified in countries such as China and Turkey, where parental understanding does not necessarily convert into vaccine adoption unless combined with affordability and trustworthy healthcare communication49,50.”

    From Barriers to HPV vaccination among adolescent girls in India: A scoping review (2026) · cites this paper as [49]

    The Discussion (page not provided) links affordability, community knowledge and vaccine acceptance, while the Results section on caregivers links trustworthy healthcare communication to consent. These passages support the general point that understanding alone may not ensure uptake, but they do not establish it for parents in China and Turkey. Turkey appears in a reference to nursing students, not in a finding about parental vaccine adoption. (LLM, conf=0.85)

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Cited by

Sorted by citations

Authors
Xu, M., Choi, J., Capasso, A., & DiClemente, R.
Affiliations
  • New York University (US)
  • Health Resources in Action (US)
Corresponding author
Xu, Mia
ORCID
Venue
Adolescent Health, Medicine and Therapeutics
Publisher
Informa UK Limited
Published
2024-07
Volume
Volume 15
Pages
73-82
ISSN
1179-318X (ISSN-L)
DOI
10.2147/ahmt.s394119
PMC
PMC11296371
OpenAlex
W4401064562
Cited by
30
References
3
Citations by year
2026: 10 · 2025: 20
FWCI
1.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Adolescent Health Medicine and Therapeutics (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords
HPV vaccination, adolescent vaccination, vaccine uptake, resource-limited settings, socio-cultural barriers, socioeconomic barriers, vaccine hesitancy, HPV vaccine knowledge, school-based vaccination, cervical cancer prevention, vaccine misinformation

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