Abstract
Girls living with HIV (GLHIV) or vulnerable to HIV have a higher risk of HPV infection and cervical cancer as they age. We determined acceptability and vaccination uptake after integrating HPV vaccination into HIV prevention and treatment services for girls in Mozambique and Zimbabwe. Methods: Pre-integration and integration HPV vaccination information were abstracted from routine records of girls aged 9–14 years offered HPV vaccine through HIV services in 54 health facilities (HFs) and surrounding communities between February and December 2025. Caregivers participated in quantitative surveys about vaccine perceptions and integration model experiences in a subset of 16 HFs. Results: In total, 6377 records of girls (median age: 11 years) were abstracted. Among the vaccine recipients, 63 (3.0%) girls received vaccine pre-integration and 2019 (97.0%) post-integration in Mozambique and 743 (17.3%) pre-integration and 3541 (82.7%) post-integration in Zimbabwe. Among GLHIV, 95.8% and 69.6% received a first HPV vaccine in Zimbabwe and Mozambique, respectively. Full vaccination with two doses occurred in 49.1% of eligible girls in Mozambique and 73.9% in Zimbabwe. Overall, 461 (67.8%) caregivers had heard of the HPV vaccine and 85.9% of cervical cancer, 99.6% were satisfied with vaccination in integration settings, and 78.6% preferred facility-based vaccination models. Conclusions: We demonstrated that HPV/HIV service integration was an effective strategy to increase HPV vaccine uptake among young girls at increased risk of HPV and cervical cancer. We found high vaccine and model acceptability and awareness of cervical cancer among caregivers. Optimization of this approach requires better integrated tools and model adaptations to fit the needs of girls and health systems.
