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Impact of HPV Vaccination Services on HPV Vaccine Completion among Adolescent Girls in Nigeria

Abstract

Human papillomavirus (HPV) infection is an important public health concern because persistent infection with high-risk HPV types is a major cause of cervical cancer. Cervical cancer remains a significant health burden among women in Nigeria, while vaccination against HPV provides an important opportunity for primary prevention. HPV vaccination during adolescence can protect against HPV infection before exposure and contributes to long-term cervical cancer prevention. However, achieving high vaccination coverage depends not only on initial vaccine uptake but also on completion of the recommended vaccination schedule where multiple doses are indicated. Factors such as limited availability of vaccination services, inadequate awareness among adolescents and parents, concerns about vaccine safety, cost, geographical barriers, missed vaccination appointments, inadequate follow-up, and weak reminder systems may affect HPV vaccine completion. Strengthening accessible and well-organized HPV vaccination services may therefore improve completion of the recommended vaccination schedule among adolescent girls. Against this background, this study investigates the impact of HPV vaccination services on HPV vaccine completion among adolescent girls in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Andersen's Behavioral Model of Health Services Use. The Health Belief Model explains how adolescent girls' and their parents' perceptions of HPV infection susceptibility, cervical cancer severity, perceived benefits of vaccination, perceived barriers, and cues to action may influence HPV vaccination behaviour. The Social Ecological Model emphasizes the interaction between individual, family, school, community, healthcare-system, and policy factors in determining vaccination access and completion. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need factors, with accessible HPV vaccination services serving as an important enabling factor. Collectively, these theoretical perspectives provide a suitable framework for explaining how HPV vaccination services may influence vaccine completion among adolescent girls in Nigeria. The study will adopt a quantitative quasi-experimental or prospective cohort research design. The study population will comprise adolescent girls eligible for HPV vaccination and their parents or primary caregivers in selected communities, schools, primary healthcare centres, hospitals, and vaccination sites across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, schools, healthcare facilities, vaccination sites, and eligible adolescent girls. HPV vaccination services will be assessed using indicators such as availability of HPV vaccines, accessibility of vaccination sites, frequency of vaccination sessions, school-based vaccination activities, community outreach, trained vaccination personnel, vaccine supply continuity, vaccination counselling, parental education, adolescent education, appointment scheduling, reminder and recall systems, documentation, follow-up, and referral arrangements. HPV vaccine completion will be assessed using indicators such as receipt of the required vaccine dose or doses according to the applicable national schedule, timely receipt of subsequent doses where multiple doses are recommended, completion within the recommended interval, availability of documented vaccination records, missed vaccination appointments, delayed doses, and reasons for incomplete vaccination. Data will be collected using structured questionnaires, school vaccination registers, immunization registers, vaccination cards, electronic immunization records where available, healthcare facility records, parental interviews, adolescent interviews, and programme monitoring documents. Descriptive statistics will be used to summarize participants' demographic characteristics, vaccination service exposure, initial HPV vaccine uptake, and completion patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of HPV vaccination services on vaccine completion. Where a quasi-experimental design is adopted, vaccine completion before and after implementation of enhanced vaccination services may be compared, or completion among adolescent girls receiving structured vaccination support may be compared with those receiving routine vaccination services. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that accessible and well-organized HPV vaccination services have a significant positive impact on HPV vaccine completion among adolescent girls in Nigeria. Adolescent girls who have access to reliable vaccination services, appropriate counselling, reminder systems, school-based vaccination activities, and consistent vaccine supplies are expected to demonstrate higher completion rates than girls with limited access to such services. School and community outreach may reduce geographical and transportation barriers, while parental and adolescent education may improve understanding of HPV infection, cervical cancer prevention, and the benefits of completing vaccination. Reminder and follow-up systems may reduce missed appointments and improve timely receipt of subsequent doses where applicable. However, vaccine stock-outs, inadequate healthcare personnel, parental concerns, misinformation, fear of vaccination, poor documentation, missed appointments, geographical barriers, and weak follow-up systems may reduce completion. The study therefore expects accessible, adequately supplied, adolescent-friendly, and well-coordinated HPV vaccination services to contribute significantly to improved HPV vaccine completion among adolescent girls in Nigeria. The study is expected to contribute to the literature on HPV vaccination services, HPV vaccine completion, adolescent immunization, cervical cancer prevention, vaccine uptake, school-based vaccination, community outreach vaccination, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, National Cancer Control Programme, state ministries of health and education, primary healthcare facilities, schools, immunization programme managers, healthcare workers, parents, community leaders, development partners, and policymakers regarding strategies for strengthening HPV vaccination. The study will also provide evidence-based recommendations for improving HPV vaccine availability, expanding school- and community-based vaccination services, strengthening parental and adolescent education, implementing effective reminder and recall systems, improving vaccination documentation and follow-up, training healthcare workers, addressing vaccine misinformation and concerns, and integrating HPV vaccination into sustainable adolescent health and immunization programmes across Nigeria.

Keywords: HPV vaccination services, HPV vaccine completion, human papillomavirus, adolescent girls, cervical cancer prevention, adolescent immunization, vaccine completion, school-based vaccination, community vaccination, Nigeria, public health.