From Awareness to Action Study: Improving Human Papillomavirus Knowledge, Screening and Vaccine Uptake Among Mother-Adolescent Pairs in the HOMINY Study in Nigeria: A Longitudinal Study.
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INTRODUCTION: Persistent cervical infection with high-risk human papillomavirus (HPV) in women is a leading cause of cervical cancer, and its co-infection among people living with HIV increases the risk of other HPV-associated cancers, including oropharyngeal and anogenital cancers. In sub-Saharan Africa, awareness of HPV is limited, screening and vaccine adoption are critically low, undermining efforts towards sexually transmitted infection (STI) elimination. METHODS: From Awareness to ACTion (FACT) study assessed HPV knowledge, screening and vaccine uptake among adolescent-mother pairs participating in the HOMINY (HPV, Human Immunodeficiency Virus, and Oral Microbiota Interplay in Nigerian Youths) prospective cohort study. Participants were enrolled, including adolescents aged 9-18 years (N = 636) and mothers aged 29-59 years (N = 385). FACT was conducted at the University of Benin Teaching Hospital, Nigeria, between April 2024 and July 2025, with adolescents and mothers grouped by HIV serostatus. In line with the national immunization programme protecting girls in Nigeria, sensitization programmes were integrated into the research study to promote awareness and adoption of screening and vaccination practices. Knowledge and attitudes regarding HPV and its vaccination benefits were assessed through thematic discussions, interactive sessions and questionnaires administered over the study period. RESULTS: HPV awareness was initially low, particularly among adolescents, but increased following sensitization, rising from 34.5% to 64.4% among mothers and from 1.4% to 19.0% among adolescents. Vaccination uptake rose from 0% to 5.4% (p < 0.0001) in adolescents aged 9-14 years. Among adolescents with perinatally acquired HIV, uptake increased from 1.9% to 4% over time (p = 0.003), and the proportion of mothers who underwent HPV-related screening increased from 38.7% pre-sensitization to 52.4% 12-month post-sensitization (p < 0.0001). Barriers to the adoption of preventive services included misconceptions, healthcare provider gaps, myths, misinformation, mistrust, scepticism and limited access. CONCLUSIONS: HPV awareness programmes significantly improved knowledge, vaccination uptake and screening practices in this vulnerable population. As part of comprehensive STI elimination strategies, integrating HPV education and vaccination initiatives into HIV care and research will enhance prevention and address significant barriers. Lessons from a unique programmatic science framework provide critical insights for scaling vaccine delivery, and the design of future vaccine programmes.