Factors Associated with Acceptance of Vaccination Against Human Papillomavirus in eThekwini District of South Africa

Background: South Africa launched a school-based human papillomavirus (HPV) vac-cination programme in 2014 and has achieved national coverage of more than 80%. However, there is subnational variation in coverage, with eThekwini District in the prov-ince of KwaZulu-Natal having the lowest coverage at 40%. Knowing factors associated with vaccine acceptance in this district would inform tailored strategies to improve cov-erage, which could be extrapolated to similar settings. We thus conducted this cross-sectional study to assess factors associated with HPV vaccine acceptance in eThekwini District. Methods: We used stratified random sampling to select caregivers of children aged 9-14 years in the district. We interviewed participants in April-May 2023, and employed modified Poisson regression models to assess factors associated with HPV vaccine acceptance. Results: Of 793 individuals contacted, 713 (89.9%) participated. They were mostly women (86.1%) and had mean age of 42.6 ± 11.6 years and secondary or lower education (83.8%). Most participants knew about the HPV vaccination programme (86.0%) and accepted HPV vaccination (93.5%). The latter includes 42.9% who already vaccinated their daughters and 50.6% who were willing to allow their daughters to be vaccinated. A negligible proportion was either undecided (2.1%) or unwilling (4.4%) to accept HPV vaccination. Knowledge of the programme (adjusted prevalence ratio [aPR] 1.16; 95% confidence inter-val [CI] 1.06-1.28) and confidence in vaccine safety (aPR 1.14; 95% CI 1.08-1.19) were in-dependent predictors of HPV vaccine acceptance. Conclusion: Our findings highlight the critical role of provision of information and education about the benefits and safety of HPV vaccination.