{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:07:36Z","timestamp":1788977256981,"version":"build-2803163510"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-046461"],"award-info":[{"award-number":["INV-046461"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-057603"],"award-info":[{"award-number":["INV-057603"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"JSI","award":["30142"],"award-info":[{"award-number":["30142"]}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    Cameroon introduced the human papilloma virus vaccine (HPVV) into the routine immunization schedule in October 2020. By the end of 2022, coverage remained low. To increase coverage, Cameroon switched to a country-wide, gender-neutral vaccination (GNV) approach in 2023, coupled with a revamped delivery strategy of Community Dialogues (CDs) and Periodic Intensification of Routine Immunization (PIRIs) activities in selected health districts (HDs). We assessed the impact of these programmatic changes, notably the GNV approach, on HPVV coverage. This retrospective, cross-sectional study measured the effect of GNV and CDs+PIRIs on HPVV coverage among 9-year-old girls in Cameroon (2022\u20132023). Data on HPV vaccination from all 203 HDs were extracted from DHIS2, and coveragecalculated at the HD level based on the estimated population eligible of 9-year-old girls. Descriptive statistics and multiple regression models were employed to assess the impact of GNV on vaccination coverage, while adjusting for CDs+PIRIs, baseline (2022) coverage, region, urban\/rural status. In 2023, of the 203 HDs, 115 (56.7%) conducted GNV only and 74 (36.5%) implemented GNV &amp; CDs+PIRIs. Among age-eligible girls, there was an overall increase in HPV vaccination coverage, with coverage rising 39.2 percentage points from 2022 to 2023. Following multiple linear regression, there was a significant association between percentage point increase in HPVV coverage in HDs with GNV &amp; CDs+PIRIs, compared to those with no GNV and no CDs+PIRIs in the adjusted model (\u03b2:44.5, 95%CI: 29.4, 59.6,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Furthermore, there was a significant association between increase in HPVV coverage in HDs with GNV only compared to those with no GNV or no CDs+PIRIs in the adjusted model (\u03b2:15.5, 95%CI: 1.23, 29.8\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Overall, the GNV approach was associated with an increase in HPVV coverage for girls, with greater magnitude and predicted precision when implemented alongside CDs+PIRIs.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0006349","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:28:30Z","timestamp":1788974910000},"page":"e0006349","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the impact of a gender-neutral approach to HPV vaccination on vaccination coverage for nine-year-old girls in Cameroon: A retrospective, cross-sectional study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4804-7919","authenticated-orcid":true,"given":"Bridget C.","family":"Griffith","sequence":"first","affiliation":[{"name":"Analytics and Implementation Research Team, Clinton Health Access Initiative","place":["Boston, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shariffatou","family":"Iliassu","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative","place":["Tsinga Sous-Prefecture, Yaound\u00e9, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9738-4543","authenticated-orcid":true,"given":"Clarence","family":"Mbanga","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative","place":["Tsinga Sous-Prefecture, Yaound\u00e9, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Budzi Michael","family":"Ngenge","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative","place":["Tsinga Sous-Prefecture, Yaound\u00e9, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1757-8414","authenticated-orcid":true,"given":"Sonali","family":"Patel","sequence":"additional","affiliation":[{"name":"Global Vaccines Delivery Team, Clinton Health Access Initiative","place":["Boston, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0297-9721","authenticated-orcid":true,"given":"Justin C.","family":"Graves","sequence":"additional","affiliation":[{"name":"Analytics and Implementation Research Team, Clinton Health Access Initiative","place":["Boston, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navpreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Global Vaccines Delivery Team, Clinton Health Access Initiative","place":["Boston, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0687-9928","authenticated-orcid":true,"given":"Shalom","family":"Ndoula","sequence":"additional","affiliation":[{"name":"Expanded Program on Immunization, Messa","place":["Yaound\u00e9, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5008-1414","authenticated-orcid":true,"given":"Andreas Ateke","family":"Njoh","sequence":"additional","affiliation":[{"name":"Expanded Program on Immunization, Messa","place":["Yaound\u00e9, Cameroon"]},{"name":"School of Global Health and Bioethics, Euclid University","place":["Bangui, Central African Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efouba","family":"Gisele","sequence":"additional","affiliation":[{"name":"Expanded Program on Immunization, Messa","place":["Yaound\u00e9, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shadrack","family":"Mngemane","sequence":"additional","affiliation":[{"name":"Global Vaccines Delivery Team, Clinton Health Access Initiative","place":["Boston, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tosin","family":"Ajayi","sequence":"additional","affiliation":[{"name":"Global Vaccines Delivery Team, Clinton Health Access Initiative","place":["Boston, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laure-Anais","family":"Zultak","sequence":"additional","affiliation":[{"name":"Global Vaccines Delivery Team, Clinton Health Access Initiative","place":["Boston, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yauba","family":"Saidu","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative","place":["Tsinga Sous-Prefecture, Yaound\u00e9, Cameroon"]},{"name":"Institute for Global Health, University of Siena","place":["Siena, Italy"]},{"name":"College of Public Health & Health Professions, University of Florida","place":["Gainesville, Florida, United States of America"],"department":["Department of Environmental and Global Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"11","key":"pgph.0006349.ref001","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/OLQ.0000000000000193","article-title":"The estimated lifetime probability of acquiring human papillomavirus in the United States","volume":"41","author":"HW Chesson","year":"2014","journal-title":"Sex Transm Dis"},{"key":"pgph.0006349.ref002","article-title":"Global burden of human papillomavirus and related diseases","author":"D Forman","year":"2012","journal-title":"Vaccine"},{"key":"pgph.0006349.ref003","unstructured":"World Health Organization (WHO)\/Organisation mondiale de la Sant\u00e9 (OMS). Cervical cancer 2024. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cervical-cancer"},{"issue":"4","key":"pgph.0006349.ref004","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/S1470-2045(09)70096-8","article-title":"A review of human carcinogens--Part B: biological agents","volume":"10","author":"V Bouvard","year":"2009","journal-title":"Lancet Oncol"},{"key":"pgph.0006349.ref005","volume-title":"Global strategy to accelerate the elimination of cervical cancer as a public health problem","author":"World Health Organization (WHO)","year":"2020"},{"issue":"50","key":"pgph.0006349.ref006","first-page":"645","article-title":"Weekly Epidemiological Record","volume":"97","author":"World Health Organization (WHO), Organisation mondiale de la Sant\u00e9 (OMS)","year":"2022","journal-title":"Wkly Epidemiol Rec"},{"key":"pgph.0006349.ref007","doi-asserted-by":"crossref","DOI":"10.1016\/j.acap.2017.09.014","article-title":"Ten Years of Human Papillomavirus Vaccination in the United States","volume":"18","author":"LE Markowitz","year":"2018","journal-title":"Acad Pediatr"},{"issue":"5","key":"pgph.0006349.ref008","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1188\/06.CJON.559-560","article-title":"Gardasil: Introducing the new human papillomavirus vaccine","volume":"10","author":"MR McLemore","year":"2006","journal-title":"Clin J Oncol Nurs"},{"key":"pgph.0006349.ref009","unstructured":"PATH. 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Databases. https:\/\/ins-cameroun.cm\/en\/format\/data\/2024"},{"issue":"1","key":"pgph.0006349.ref026","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13031-022-00461-1","article-title":"Impact of periodic intensification of routine immunization within an armed conflict setting and COVID-19 outbreak in Cameroon in 2020","volume":"16","author":"AA Njoh","year":"2022","journal-title":"Confl Health"},{"key":"pgph.0006349.ref027","doi-asserted-by":"crossref","first-page":"128002","DOI":"10.1016\/j.vaccine.2025.128002","article-title":"Knowledge and acceptability of male HPV vaccination among young people and community stakeholders in northwest Tanzania: social sciences in the Add-Vacc trial","volume":"69","author":"SA Kelly","year":"2026","journal-title":"Vaccine"},{"issue":"11","key":"pgph.0006349.ref028","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1016\/j.chom.2023.10.001","article-title":"Ecological diversity profiles of non-vaccine-targeted HPVs after gender-based community vaccination efforts","volume":"31","author":"VN Pimenoff","year":"2023","journal-title":"Cell Host Microbe"},{"key":"pgph.0006349.ref029","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h2016","article-title":"Direct benefit of vaccinating boys along with girls against oncogenic human papillomavirus: bayesian evidence synthesis","volume":"350","author":"JA Bogaards","year":"2015","journal-title":"BMJ"},{"issue":"1","key":"pgph.0006349.ref030","doi-asserted-by":"crossref","first-page":"2480404","DOI":"10.1080\/21645515.2025.2480404","article-title":"Strategically striving to be more inclusive: A recommendation for gender-neutral human-papillomavirus vaccine policies","volume":"21","author":"MJ Xu","year":"2025","journal-title":"Hum Vaccin Immunother"},{"issue":"46","key":"pgph.0006349.ref031","doi-asserted-by":"crossref","first-page":"8443","DOI":"10.1016\/j.vaccine.2011.07.096","article-title":"The cost-effectiveness of male HPV vaccination in the United States","volume":"29","author":"HW Chesson","year":"2011","journal-title":"Vaccine"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006349","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:28:37Z","timestamp":1788974917000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006349"}},"subtitle":[],"editor":[{"given":"Edina","family":"Amponsah-Dacosta","sequence":"first","affiliation":[{"name":"University of Cape Town","place":["SOUTH AFRICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006349","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}