{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:58:29Z","timestamp":1790423909849,"version":"4.1.0"},"posted":{"date-parts":[[2026,9,23]]},"group-title":"Sexual and Reproductive Health","reference-count":46,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess the knowledge, willingness and barriers to human papillomavirus (HPV) vaccination among caregivers of adolescent girls living with HIV in Sierra Leone.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This cross-sectional study examined HPV vaccine knowledge, willingness, and barriers among 249 caregivers of adolescent girls living with HIV in Sierra Leone. Data were collected through structured questionnaires at public tertiary hospitals and high-volume HIV clinics, and associations were assessed using chi-square tests, logistic regression, and Kruskal-Wallis analyses.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Only 32.1% (80\/249) of caregivers had heard of HPV, with even fewer aware of its link to cervical cancer (24.4%, 60\/246) or prevention methods of cervical cancer (31.9%, 79\/248). Misconceptions were prevalent; 16.3% (36\/221) erroneously linked oral contraceptives to cervical cancer, and 61.1% (44\/72) of caregivers unwilling to vaccinate cited distrust in vaccine efficacy. While tertiary-educated caregivers exhibited the highest level of knowledge (45.5%, p &lt; 0.001), their willingness to vaccinate (50%, 33\/66) was comparable to that of less-educated groups, highlighting a knowledge-action gap. Structural barriers dominated, with 66.1% (154\/233) citing unawareness of the vaccine and 10.3% (24\/233) missing school-based vaccination days. Relationship dynamics significantly influenced willingness: extended family members showed the highest willingness (69.4%, p = 0.029), whereas grandparents were least willing (31%, 9\/29). Although systemic gaps such as disrupted vaccination services, vaccine supplies and cold chain limited uptake, healthcare workers emerged as the most effective information source (rank sum = 889.5, p = 0.039).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The study highlights the need for culturally tailored education to dispel myths and community-driven strategies engaging trusted actors like healthcare workers and extended families. This study justifies the need for integration of HPV vaccination and cervical cancer screening into HIV care services.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.21.26363609","type":"posted-content","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:50:17Z","timestamp":1790189417000},"source":"Crossref","is-referenced-by-count":0,"title":["Caregiver knowledge and Attitudes toward Human Papillomavirus Vaccination among adolescent girls living with HIV in Sierra Leone: A health facility-based cross-sectional study"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1595-4742","authenticated-orcid":false,"given":"Darlinda F","family":"Jiba","sequence":"first","affiliation":[{"name":"Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone"},{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"},{"name":"Infectious Disease Research Network, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7772-1111","authenticated-orcid":false,"given":"Mamadu","family":"Baldeh","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia"},{"name":"Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Turay","sequence":"additional","affiliation":[{"name":"Public Health Department, University of Makeni, Makeni, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saidu","family":"Kanu","sequence":"additional","affiliation":[{"name":"Faculty of Agriculture and Food Sciences, University of Makeni, Makeni, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda N","family":"Kamara","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"},{"name":"Infectious Disease Research Network, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynda M. L","family":"Farma","sequence":"additional","affiliation":[{"name":"National Child Health Programme, Ministry of Health, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umu","family":"Barrie","sequence":"additional","affiliation":[{"name":"Infectious Disease Research Network, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waheed O","family":"Awonuga","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary M","family":"Baio","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Sesay","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"},{"name":"Infectious Disease Research Network, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Shehab","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaline","family":"Sinnah","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enanga S","family":"Namanga","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"},{"name":"Infectious Disease Research Network, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phildys M D","family":"Johnson","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulaiman","family":"Lakoh","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone"},{"name":"Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone"},{"name":"Infectious Disease Research Network, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4194-8725","authenticated-orcid":false,"given":"J. Andrew","family":"Dykens","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Illinois Chicago, Chicago, Illinois, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026092604050825000_2026.09.21.26363609v1.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2026092604050825000_2026.09.21.26363609v1.2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-16-0858"},{"key":"2026092604050825000_2026.09.21.26363609v1.3","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1002\/ijgo.13879","article-title":"Worldwide initiatives to eliminate cervical cancer","volume":"155","year":"2021","journal-title":"Int J Gynecol Obstet"},{"key":"2026092604050825000_2026.09.21.26363609v1.4","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdr015"},{"issue":"50","key":"2026092604050825000_2026.09.21.26363609v1.5","doi-asserted-by":"crossref","first-page":"8026","DOI":"10.1016\/j.vaccine.2010.08.090","article-title":"Examining attitudes and knowledge about HPV and cervical cancer risk among female clinic attendees in Johannesburg, South Africa","volume":"28","year":"2010","journal-title":"Vaccine"},{"key":"2026092604050825000_2026.09.21.26363609v1.6","unstructured":"Centers for Disease Control and Prevention. STD Facts: Human Papillomavirus (HPV). Available online: https:\/\/www.cdc.gov\/std\/hpv\/stdfact-hpv.htm (accessed on 12 February 2025)."},{"issue":"5","key":"2026092604050825000_2026.09.21.26363609v1.7","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.ajog.2012.11.013","article-title":"A systematic review of randomized trials assessing human papillomavirus testing in cervical cancer screening","volume":"208","year":"2013","journal-title":"Am J Obstet Gynecol"},{"key":"2026092604050825000_2026.09.21.26363609v1.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.07.055"},{"key":"2026092604050825000_2026.09.21.26363609v1.9","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(20)30459-9"},{"key":"2026092604050825000_2026.09.21.26363609v1.10","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.28891"},{"key":"2026092604050825000_2026.09.21.26363609v1.11","first-page":"300","article-title":"Use of 9-valent human papillomavirus (HPV) vaccine: Updated HPV vaccination recommendations of the advisory committee on immunization practices","volume":"64","year":"2015","journal-title":"MMWR Morb. Mortal. Wkly. Rep"},{"key":"2026092604050825000_2026.09.21.26363609v1.12","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.pvr.2017.06.002","article-title":"HPV vaccination of immunocompromised hosts","volume":"4","year":"2017","journal-title":"Papillomavirus Res"},{"key":"2026092604050825000_2026.09.21.26363609v1.13","doi-asserted-by":"publisher","DOI":"10.1186\/s12866-020-01759-x"},{"key":"2026092604050825000_2026.09.21.26363609v1.14","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1112513"},{"key":"2026092604050825000_2026.09.21.26363609v1.15","unstructured":"Organization WH . WHO guidance note: comprehensive cervical cancer prevention and control: a healthier future for girls and women. 2013."},{"key":"2026092604050825000_2026.09.21.26363609v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30068-4"},{"issue":"7","key":"2026092604050825000_2026.09.21.26363609v1.17","doi-asserted-by":"crossref","first-page":"e453","DOI":"10.1016\/S2214-109X(16)30099-7","article-title":"Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis","volume":"4","year":"2016","journal-title":"Lancet Glob Health"},{"key":"2026092604050825000_2026.09.21.26363609v1.18","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines10081198"},{"key":"2026092604050825000_2026.09.21.26363609v1.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2016.08.042"},{"key":"2026092604050825000_2026.09.21.26363609v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(23)00305-4"},{"key":"2026092604050825000_2026.09.21.26363609v1.21","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines10081185"},{"key":"2026092604050825000_2026.09.21.26363609v1.22","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12060665"},{"key":"2026092604050825000_2026.09.21.26363609v1.23","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/8586459"},{"key":"2026092604050825000_2026.09.21.26363609v1.24","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-024-01913-y"},{"key":"2026092604050825000_2026.09.21.26363609v1.25","doi-asserted-by":"publisher","DOI":"10.1363\/4119115"},{"key":"2026092604050825000_2026.09.21.26363609v1.26","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-09849-1"},{"key":"2026092604050825000_2026.09.21.26363609v1.27","doi-asserted-by":"publisher","DOI":"10.3389\/frph.2022.960089"},{"key":"2026092604050825000_2026.09.21.26363609v1.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2013.06.016"},{"key":"2026092604050825000_2026.09.21.26363609v1.29","first-page":"1735","article-title":"Addressing HPV vaccine hesitancy: unveiling concerns and building trust\u2019 perspectives of adolescent girls and parents in Kisumu County, Kenya","volume":"18","year":"2024","journal-title":"ecancer"},{"key":"2026092604050825000_2026.09.21.26363609v1.30","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-15842-1"},{"key":"2026092604050825000_2026.09.21.26363609v1.31","first-page":"30","article-title":"The health belief model","volume":"2","year":"2015","journal-title":"Predicting Health Behaviour: Res Pract Social Cognition Models"},{"key":"2026092604050825000_2026.09.21.26363609v1.32","first-page":"45","article-title":"The health belief model","volume":"4","year":"2008","journal-title":"Health Behav Health Education: Theory Res Pract"},{"issue":"1","key":"2026092604050825000_2026.09.21.26363609v1.33","first-page":"1","article-title":"Application of the health belief model (HBM) in HIV prevention: a literature review","volume":"1","year":"2015","journal-title":"Cent Afr J Public Health"},{"key":"2026092604050825000_2026.09.21.26363609v1.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2018.12.042"},{"key":"2026092604050825000_2026.09.21.26363609v1.35","first-page":"46","article-title":"Towards a Strategy for Reducing Missed Opportunities for Vaccination in Malawi: Implications of a Qualitative Health Facility Assessment","volume":"7","year":"2018","journal-title":"J Immunol Sci"},{"key":"2026092604050825000_2026.09.21.26363609v1.36","doi-asserted-by":"publisher","DOI":"10.19088\/SSHAP.2024.011"},{"key":"2026092604050825000_2026.09.21.26363609v1.37","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-17534-2"},{"key":"2026092604050825000_2026.09.21.26363609v1.38","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.097253"},{"key":"2026092604050825000_2026.09.21.26363609v1.39","unstructured":"HPV vaccine delivery through a controlled temperature chain: a guide for decision-makers and implementers. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO."},{"key":"2026092604050825000_2026.09.21.26363609v1.40","unstructured":"The Use of Real Time Monitoring Approaches and Tools for Immunization Campaigns: Good Practices and Lessons Learned New York: United Nations Children\u2019s Fund (UNICEF), 2021."},{"key":"2026092604050825000_2026.09.21.26363609v1.41","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines12080847"},{"key":"2026092604050825000_2026.09.21.26363609v1.42","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.998234"},{"key":"2026092604050825000_2026.09.21.26363609v1.43","unstructured":"Jalloh MF , Sengeh P , Ibrahim N , Kulkarni S , Sesay T , Eboh V , et al. Association of community engagement with vaccination confidence and uptake: a cross-sectional survey in Sierra Leone, 2019."},{"key":"2026092604050825000_2026.09.21.26363609v1.44","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-026-05065-x"},{"key":"2026092604050825000_2026.09.21.26363609v1.45","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-026-27139-0"},{"key":"2026092604050825000_2026.09.21.26363609v1.46","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-026-29324-7"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.09.21.26363609","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:05:21Z","timestamp":1790420721000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.09.21.26363609"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":46,"URL":"https:\/\/doi.org\/10.64898\/2026.09.21.26363609","relation":{},"subject":[],"published":{"date-parts":[[2026,9,23]]},"subtype":"preprint"}}