Intervention-amenable factors associated with lack of HPV vaccination in Kenya: Results from a large national phone survey

Background: Coverage of human papillomavirus (HPV) vaccination remains suboptimal in many countries, but the determinants are not well-understood particularly in low- and middle-income countries. We undertook a random digit dialed phone survey across Kenya between July-October 2022, with parents/caregivers of preadolescent girls, to identify intervention-amenable factors associated with respondents' daughter's HPV vaccination status. Methods: Informed by the World Health Organization Behavioral and Social Drivers of Vaccination framework, we collected information about respondents' knowledge about and hesitancy toward HPV vaccine, perceived risk of cervical cancer, social norms around HPV vaccination, trust in institutions, and access to HPV vaccination services. Results: 1416 parents/caregivers completed the survey (97.4 % of those eligible), of whom 38.2 % said that ageeligible girl(s) in their household had received any doses of the HPV vaccine. Knowledge/perceptions: In multivariable models adjusted for sociodemographic characteristics, respondents with less HPV vaccine hesitancy and fewer concerns about safety were more likely to have vaccinated daughter(s), as were those with greater knowledge about HPV vaccine and knowing someone who had died from cervical cancer. Social norms: Having spoken with others about HPV vaccination, although reported by less than half of respondents, and believing that other parents have vaccinated their daughters were associated with having vaccinated daughter(s). Respondents with more trust in information about HPV vaccination from health systems, and with higher trust in institutions, had greater odds of having vaccinated daughter(s). Access: One-fifth of respondents had experienced, or anticipated experiencing, challenges accessing HPV vaccination services, and these respondents had approximately half the odds of having a vaccinated daughter compared to their counterparts. Conclusions: Promising areas for intervention include: targeted messaging about safety of the HPV vaccine, increasing parents'/caregivers' knowledge about the vaccine, and leveraging trusted messengers including health workers, faith leaders, and peer parents/caregivers.