{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:01:08Z","timestamp":1785427268522,"version":"3.56.0"},"reference-count":62,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["66243"],"award-info":[{"award-number":["66243"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"award":["66243"],"award-info":[{"award-number":["66243"]}],"id":[{"id":"https:\/\/ror.org\/054225q67","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Greif, Inc."},{"DOI":"10.13039\/100004334","name":"Merck & Co., Inc.","doi-asserted-by":"publisher","award":["APA-21-147717"],"award-info":[{"award-number":["APA-21-147717"]}],"id":[{"id":"10.13039\/100004334","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Merck Sharp & Dohme"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: India accounts for one-fifth of global cervical cancer deaths, yet Human Papillomavirus (HPV) vaccination coverage remains low despite the World Health Organization (WHO) recommendations to initiate vaccination at age 9. With the national HPV vaccination campaign in 2026 and its approval for integration into India\u2019s Universal Immunization Programme (UIP), strengthening physician knowledge, beliefs, and confidence in recommending the vaccine is critical. Methods: In 2023, the American Cancer Society and Cancer Foundation of India catalyzed two national medical societies, the Federation of Obstetric and Gynaecological Societies of India and the Indian Academy of Pediatrics, to educate physicians on HPV vaccination using a train-the-trainer (ToT) model. A mixed-methods evaluation, using the RE-AIM Framework, included pre- and post-training surveys assessing changes in knowledge, beliefs, confidence, and intent, as well as monthly engagement surveys and project reports analyzed using descriptive and inferential statistics. A fidelity assessment evaluated consistency of training delivery. Twenty in-depth interviews explored physician reactions and implementation of learnings, analyzed using a rapid approach. Results: A total of 18,206 physicians were trained. The post-training respondent group demonstrated higher HPV vaccination knowledge scores and more favorable responses in confidence, beliefs, and intent than the pre-training respondent group. The fidelity assessment demonstrated consistent delivery overall, with some variability in role play facilitation. Interviews highlighted increased physician confidence, peer knowledge sharing, and community engagement following the training. Medical societies reported strong program adoption and plans for continued efforts. Conclusions: A ToT physician training cascaded through medical societies is a feasible strategy to prepare physicians to recommend the HPV vaccine and address parental concerns at scale.<\/jats:p>","DOI":"10.3390\/vaccines14080654","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:47:41Z","timestamp":1785145661000},"page":"654","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Building Physician Capacity for HPV Vaccine Uptake in India: Mixed-Methods Implementation Outcomes of a Train-the-Trainer Model Using RE-AIM"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0808-247X","authenticated-orcid":false,"given":"Ashleigh","family":"Flowers","sequence":"first","affiliation":[{"name":"American Cancer Society, 270 Peachtree St NW, Suite 1300, Atlanta, GA 30303, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1894-7932","authenticated-orcid":false,"given":"Shaylen","family":"Foley","sequence":"additional","affiliation":[{"name":"American Cancer Society, 270 Peachtree St NW, Suite 1300, Atlanta, GA 30303, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati","family":"Saxena","sequence":"additional","affiliation":[{"name":"Independent Researcher, New Delhi 110021, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sutapa","family":"Biswas","sequence":"additional","affiliation":[{"name":"Cancer Foundation of India, 47\/2D Selimpur Road, Kolkata 700031, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Ganeshkumar","sequence":"additional","affiliation":[{"name":"Federation of Obstetric and Gynaecological Societies of India, Trade World, C-5,6,7,9,12,13, 1st Floor D-Wing Entrance, Kamala City, Senapati Bapat Marg, Lower Parel (W), Mumbai 400013, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Purna","family":"Kurkure","sequence":"additional","affiliation":[{"name":"Indian Academy of Pediatrics, Kamdhenu Business Bay, 5th Floor, Plot No. 51, Sector 1, Juinagar East, Nerul, Navi Mumbai 400706, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Upendra","family":"Kinjawadekar","sequence":"additional","affiliation":[{"name":"Indian Academy of Pediatrics, Kamdhenu Business Bay, 5th Floor, Plot No. 51, Sector 1, Juinagar East, Nerul, Navi Mumbai 400706, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Comstock","sequence":"additional","affiliation":[{"name":"American Cancer Society, 270 Peachtree St NW, Suite 1300, Atlanta, GA 30303, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"DaSilva Batista","sequence":"additional","affiliation":[{"name":"American Cancer Society, 270 Peachtree St NW, Suite 1300, Atlanta, GA 30303, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meenu","family":"Anand","sequence":"additional","affiliation":[{"name":"American Cancer Society, 270 Peachtree St NW, Suite 1300, Atlanta, GA 30303, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"International Agency for Research on Cancer (IARC) (2024, September 20). India Fact Sheet. Available online: https:\/\/gco.iarc.who.int\/media\/globocan\/factsheets\/populations\/356-india-fact-sheet.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e191","DOI":"10.1016\/S2214-109X(19)30482-6","article-title":"Estimates of Incidence and Mortality of Cervical Cancer in 2018: A Worldwide Analysis","volume":"8","author":"Arbyn","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100233","DOI":"10.1016\/j.gloepi.2025.100233","article-title":"Cervical Cancer Burden in India: A Descriptive Epidemiological Study and Policy Insights","volume":"10","author":"Singh","year":"2025","journal-title":"Glob. Epidemiol."},{"key":"ref_5","unstructured":"Centers for Disease Control and Prevention (CDC) (2024, September 13). Reasons to Get Vaccinated, Available online: https:\/\/www.cdc.gov\/hpv\/vaccines\/reasons-to-get.html."},{"key":"ref_6","unstructured":"World Health Organization (WHO) (2024, September 13). Cervical Cancer, Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cervical-cancer."},{"key":"ref_7","unstructured":"World Health Organization (WHO) (2024, September 20). Human Papillomavirus (HPV), Available online: https:\/\/www.who.int\/teams\/immunization-vaccines-and-biologicals\/diseases\/human-papillomavirus-vaccines-(HPV)."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Noreen, K., Naeem Khalid, S., Murad, M.A., Baig, M., and Khan, S.A. (2024). Uptake and Determinants of HPV Vaccination in South Asia: A Systematic Review and Meta-Analysis. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1453704"},{"key":"ref_9","unstructured":"World Health Organization (WHO) (2024, September 27). Cervical Cancer Elimination Initiative, Available online: https:\/\/www.who.int\/initiatives\/cervical-cancer-elimination-initiative."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1111\/ajco.13962","article-title":"Cost-Effectiveness Analysis of Human Papillomavirus Vaccines for the Prevention of Cervical Cancer in India","volume":"20","author":"Arora","year":"2024","journal-title":"Asia Pac. J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3253","DOI":"10.1002\/cncr.30734","article-title":"Cost-Effectiveness of Human Papillomavirus Vaccination for Adolescent Girls in Punjab State: Implications for India\u2019s Universal Immunization Program","volume":"123","author":"Prinja","year":"2017","journal-title":"Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100228","DOI":"10.1016\/j.jvacx.2022.100228","article-title":"Awareness, Perceptions, and Choices of Physicians Pertaining to Human Papillomavirus (HPV) Vaccination in India: A Formative Research Study","volume":"12","author":"Kataria","year":"2022","journal-title":"Vaccine X"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4103\/0971-5851.96961","article-title":"Cervical Cancer in India and HPV Vaccination","volume":"33","author":"Kaarthigeyan","year":"2012","journal-title":"Indian J. Med. Paediatr. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e637","DOI":"10.1016\/S1470-2045(19)30531-5","article-title":"Current Status of Human Papillomavirus Vaccination in India\u2019s Cervical Cancer Prevention Efforts","volume":"20","author":"Sankaranarayanan","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1016\/S1470-2045(22)00567-8","article-title":"HPV Vaccination in South Asia: New Progress, Old Challenges","volume":"23","author":"Oncology","year":"2022","journal-title":"Lancet Oncol."},{"key":"ref_16","unstructured":"India Today (2024, September 27). Cervical Cancer: HPV Vaccines Available, Cost and Age Groups. Available online: https:\/\/www.indiatoday.in\/health\/story\/poonam-pandey-dies-of-cervical-cancer-hpv-vaccines-available-cost-and-age-groups-2497080-2024-02-03."},{"key":"ref_17","unstructured":"Gavi, the Vaccine Alliance (2025, December 12). India Resolves to Reduce Cervical Cancer by Vaccinating Girls. Available online: https:\/\/www.gavi.org\/vaccineswork\/india-resolves-reduce-cervical-cancer-vaccinating-girls."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chellapandian, P., Myneni, S., Ravikumar, D., Padmanaban, P., James, K.M., Kunasekaran, V.M., Manickaraj, R.G.J., Puthota Arokiasamy, C., Sivagananam, P., and Balu, P. (2021). Knowledge on Cervical Cancer and Perceived Barriers to the Uptake of HPV Vaccination among Health Professionals. BMC Womens Health, 21.","DOI":"10.1186\/s12905-021-01205-8"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Krokidi, E., Rao, A.P., Ambrosino, E., and Thomas, P.P.M. (2023). The Impact of Health Education Interventions on HPV Vaccination Uptake, Awareness, and Acceptance among People under 30 Years Old in India: A Literature Review with Systematic Search. Front. Reprod. Health, 5.","DOI":"10.3389\/frph.2023.1151179"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.1016\/j.vaccine.2021.03.049","article-title":"Parents\u2019 Knowledge, Beliefs, Acceptance and Uptake of the HPV Vaccine in Members of The Association of Southeast Asian Nations (ASEAN): A Systematic Review of Quantitative and Qualitative Studies","volume":"39","author":"Wijayanti","year":"2021","journal-title":"Vaccine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"A17","DOI":"10.1016\/j.vaccine.2021.07.024","article-title":"Human Papillomavirus (HPV) Vaccine Introduction in Sikkim State: Best Practices from the First Statewide Multiple-Age Cohort HPV Vaccine Introduction in India\u20132018\u20132019","volume":"40","author":"Ahmed","year":"2022","journal-title":"Vaccine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.1016\/S1470-2045(23)00118-3","article-title":"India Rolls out HPV Vaccination","volume":"24","author":"Burki","year":"2023","journal-title":"Lancet Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/S1470-2045(26)00128-2","article-title":"India Introduces Human Papillomavirus Vaccination","volume":"27","author":"Sharma","year":"2026","journal-title":"Lancet Oncol."},{"key":"ref_24","unstructured":"Gavi, the Vaccine Alliance (2026, May 01). India, Home to 25% of the World\u2019s Cervical Cancer Deaths, Launches Nationwide HPV Vaccination. Available online: https:\/\/www.gavi.org\/vaccineswork\/india-home-25-worlds-cervical-cancer-victims-launches-nationwide-hpv-vaccination."},{"key":"ref_25","unstructured":"Press Information Bureau (PIB), Government of India (2026, May 22). Prime Minister to Launch Nationwide HPV Vaccination Drive for 14-Year-Old Girls from Ajmer Tomorrow, Available online: https:\/\/www.pib.gov.in\/PressReleasePage.aspx?PRID=2233632."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1080\/07399332.2012.740115","article-title":"Acceptability of HPV Vaccine Implementation among Parents in India","volume":"35","author":"Paul","year":"2014","journal-title":"Health Care Women Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"966","DOI":"10.4269\/ajtmh.20-1650","article-title":"Challenges to Human Papillomavirus Vaccine Acceptability among Women in South India: An Exploratory Study","volume":"105","author":"Shah","year":"2021","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ypmed.2014.04.002","article-title":"Human Papillomavirus Vaccine Acceptability among Parents of Adolescent Girls: Obstacles and Challenges in Mysore, India","volume":"64","author":"Madhivanan","year":"2014","journal-title":"Prev. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"106554","DOI":"10.1016\/j.ypmed.2021.106554","article-title":"Provider Communication and HPV Vaccine Uptake: A Meta-Analysis and Systematic Review","volume":"148","author":"Oh","year":"2021","journal-title":"Prev. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.vaccine.2016.01.023","article-title":"Provider Communication and HPV Vaccination: The Impact of Recommendation Quality","volume":"34","author":"Gilkey","year":"2016","journal-title":"Vaccine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1007\/s13187-016-0999-0","article-title":"Knowledge and Attitudes Towards Human Papillomavirus (HPV) Among Academic and Community Physicians in Mangalore, India","volume":"32","author":"Canon","year":"2017","journal-title":"J. Cancer Educ."},{"key":"ref_32","first-page":"e66284","article-title":"A Cross-Sectional Observational Study Analyzing the Knowledge, Attitude, and Practice of Young Female Nursing Officers and Female Doctors About the Human Papillomavirus Vaccine","volume":"16","author":"Mandal","year":"2024","journal-title":"Cureus"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1016\/j.vaccine.2019.01.032","article-title":"Acceptability of Human Papillomavirus Vaccination among Medical Students in Mangalore, India","volume":"37","author":"Padmanabha","year":"2019","journal-title":"Vaccine"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Mavundza, E.J., Iwu-Jaja, C.J., Wiyeh, A.B., Gausi, B., Abdullahi, L.H., Halle-Ekane, G., and Wiysonge, C.S. (2021). A Systematic Review of Interventions to Improve HPV Vaccination Coverage. Vaccines, 9.","DOI":"10.3390\/vaccines9070687"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e2022058029","DOI":"10.1542\/peds.2022-058029","article-title":"Provider-Based HPV Vaccine Promotion Interventions: A Meta-Analysis","volume":"151","author":"Wu","year":"2023","journal-title":"Pediatrics"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the Public Health Impact of Health Promotion Interventions: The RE-AIM Framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am. J. Public Health"},{"key":"ref_37","unstructured":"Prevent Global HPV Cancers (2025, December 12). Cervical Cancer Prevention Through HPV Vaccination. Available online: https:\/\/preventglobalhpvcancers.org\/wp-content\/uploads\/2023\/02\/ACS-Action-Guide-India-06.1.pdf."},{"key":"ref_38","unstructured":"Prevent Global HPV Cancers (2025, December 12). Overcoming Barriers to HPV Vaccination Among Physicians in India: Final Research Report. Available online: https:\/\/preventglobalhpvcancers.org\/wp-content\/uploads\/2023\/03\/Overcoming-Barriers-to-HPV-Vaccination-Among-Physicians-in-India-Final-Research-Report.pdf."},{"key":"ref_39","unstructured":"Prevent Global HPV Cancers (2025, December 12). Resources. Available online: https:\/\/preventglobalhpvcancers.org\/resources\/."},{"key":"ref_40","unstructured":"SurveyMonkey Inc (2025, December 12). SurveyMonkey: The World\u2019s Most Popular Survey Platform. Available online: https:\/\/www.surveymonkey.com\/."},{"key":"ref_41","unstructured":"Google Workspace (2025, December 12). Google Forms: Online Form Builder. Available online: https:\/\/workspace.google.com\/products\/forms\/."},{"key":"ref_42","unstructured":"Google (2025, December 12). Google Docs. Available online: https:\/\/docs.google.com\/document\/u\/0\/."},{"key":"ref_43","unstructured":"StataCorp LLC (2025, December 12). Statistical Software for Data Science. Available online: https:\/\/www.stata.com\/."},{"key":"ref_44","unstructured":"Rev (2025, December 12). Artificial Intelligence Content. Available online: https:\/\/www.rev.com\/category\/artificial-intelligence."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3731","DOI":"10.1016\/j.vaccine.2021.05.038","article-title":"HPV Vaccine Communication Training in Healthcare Systems: Evaluating a Train-the-Trainer Model","volume":"39","author":"Brewer","year":"2021","journal-title":"Vaccine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1016\/j.vaccine.2023.10.064","article-title":"Identifying Key Challenges and Optimizing Approaches for Training of Health Care Professionals for HPV Vaccination Programmes","volume":"42","author":"Waheed","year":"2024","journal-title":"Vaccine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.pvr.2017.09.001","article-title":"Human Papillomavirus (HPV) Vaccine Coverage Achievements in Low and Middle-Income Countries 2007\u20132016","volume":"4","author":"Gallagher","year":"2017","journal-title":"Papillomavirus Res."},{"key":"ref_48","unstructured":"Gilkey, M.B. (2026, January 26). HPV Vaccination Strategies and a Case for Optimism in Uncertain Times. Presented at the 2nd Annual NC HPV Vaccination Stakeholders Meeting, Chapel Hill, NC, USA."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"6700","DOI":"10.1016\/j.vaccine.2016.10.042","article-title":"Vaccine Hesitancy and Healthcare Providers","volume":"34","author":"Paterson","year":"2016","journal-title":"Vaccine"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2402122","DOI":"10.1080\/21645515.2024.2402122","article-title":"Healthcare Worker Practices for HPV Vaccine Recommendation: A Systematic Review and Meta-Analysis","volume":"20","author":"Bakare","year":"2024","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Fu, Y., He, Y., Wang, Z., and Sun, J. (2025). Strategies, Barriers, and Facilitators for Healthcare Professionals to Recommend HPV Vaccination: A Systematic Review. Vaccines, 13.","DOI":"10.3390\/vaccines13040402"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1158\/1055-9965.EPI-21-0733","article-title":"Disparities in Healthcare Providers\u2019 Recommendation of HPV Vaccination for US Adolescents: A Systematic Review","volume":"30","author":"Kong","year":"2021","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1080\/21645515.2020.1852871","article-title":"A Brief Educational Intervention Can Improve Nursing Students\u2019 Knowledge of the Human Papillomavirus Vaccine and Readiness to Counsel","volume":"17","author":"Berenson","year":"2021","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1080\/21645515.2019.1692558","article-title":"An Educational Intervention to Improve Attitudes Regarding HPV Vaccination and Comfort with Counseling among US Medical Students","volume":"16","author":"Berenson","year":"2019","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3156","DOI":"10.1016\/j.vaccine.2023.03.062","article-title":"A Systematic Review of Pre-Service Training on Vaccination and Immunization","volume":"41","author":"Tchoualeu","year":"2023","journal-title":"Vaccine"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1016\/j.acap.2021.01.017","article-title":"What Works to Increase Vaccination Uptake","volume":"21","author":"Brewer","year":"2021","journal-title":"Acad. Pediatr."},{"key":"ref_57","unstructured":"Federation of Obstetric and Gynaecological Societies of India (2024). A Guide Book for Master Trainers: Preventing Cervical Cancer Through HPV Vaccination in India, FOGSI."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/s41572-021-00279-w","article-title":"Overcoming Vaccine Hesitancy in Low-Income and Middle-Income Regions","volume":"7","author":"Simas","year":"2021","journal-title":"Nat. Rev. Dis. Primer"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"126833","DOI":"10.1016\/j.vaccine.2025.126833","article-title":"Realist Review of Low- to Upper-Middle-Income Country Experiences on Integration of HPV Vaccination with Other Adolescent Health Services","volume":"50","author":"Jennings","year":"2025","journal-title":"Vaccine"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3811","DOI":"10.1016\/j.vaccine.2013.06.016","article-title":"Human Papillomavirus (HPV) Vaccine Implementation in Low and Middle-Income Countries (LMICs): Health System Experiences and Prospects","volume":"31","author":"Wigle","year":"2013","journal-title":"Vaccine"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Khalid, S.N., and Khan, J.S. (2025). HPV Vaccine Introduction in Pakistan: A Strategic Opportunity for Multisectoral Alliance. Lancet Reg. Health-Southeast Asia, 42.","DOI":"10.1016\/j.lansea.2025.100688"},{"key":"ref_62","first-page":"e73459","article-title":"Confronting Vaccine Hesitancy in India: A Vital Call for Unified Action","volume":"16","author":"Paul","year":"2024","journal-title":"Cureus"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/8\/654\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:20:06Z","timestamp":1785212406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/8\/654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":62,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["vaccines14080654"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14080654","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,25]]}}}