Submission ID 131624
| Issue/Objective | Despite the availability of effective Human papillomavirus (HPV) vaccines, global progress toward HPV prevention remains uneven. Significant disparities persist across geographic regions and country income levels, particularly affecting populations in Africa, South Asia, and low- and middle-income countries (LMICs). Understanding these inequities is critical to addressing upstream determinants of health and informing equitable global health strategies. This study aimed to quantify differences in knowledge, attitudes, and practices (KAP) toward HPV and its vaccine across regions and income levels. |
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| Methodology/Approach | A systematic review and meta-analysis of 590 studies was conducted, including participants aged ≥16 years across diverse global settings. Databases were searched up to January 2025. Outcomes included HPV knowledge, attitudes, prevention practices, and vaccine uptake. Subgroup analyses were performed by WHO region, country income level (high-income countries [HICs] vs LMICs), age, and sex using random-effects models. |
| Results | We included 590 studies representing over 2.7 million participants across 105 countries. Pooled HPV knowledge was 61.7% (95% CI: 58.4-65.0), vaccine awareness 63.7% (60.3-67.0), and vaccine uptake 20.9% (18.1-23.8). Geographic disparities were marked across all outcomes. HPV knowledge ranged from 70.6% in the Americas and 64.0% in Europe to 37.8% in Africa. Vaccine awareness was highest in the Americas (66.5%) and Western Pacific (63.2%), and lowest in Africa (26.3%). Vaccine uptake was highest in the Americas (31.3%) and lowest in South-East Asia (6.4%), with Africa similarly low. Screening coverage ranged from 65.9% in the Americas to 12.3% in Africa. Notably, willingness to vaccinate was highest in the Western Pacific (74.7%) and Africa (64.3%) regions where uptake was lowest. Income-level disparities were equally stark: uptake was four-fold higher in HICs (28.7%, 24.1-33.5) than LMICs (6.7%, 2.8-12.1), with vaccine awareness only 29.2% in LMICs. Leading barriers were cost (38.6%), safety concerns (32.2%), and lack of provider recommendation (30.6%). |
| Discussion/Conclusion | Global inequities in HPV prevention are strongly shaped by geographic and economic disparities. While HICs face implementation and awareness challenges, LMICs are constrained by structural barriers including access, affordability, and policy limitations. Addressing these inequities requires region-specific and income-sensitive strategies, including expanding vaccine access in LMICs and strengthening education and provider engagement in HICs. |
| Presenters and Affiliations | Naharin Sultana Anni McMaster University Lawrence Mbuagbaw McMaster University Zain Chagla McMaster University Elizabeth Alvarez McMaster University |
