Navigating the Divide – Demographic and Individual Predictors of Low HPV Vaccine Uptake in Rural Uganda

Background: Despite the critical role of Human Papillomavirus (HPV) vaccination in preventing cervical cancer, adolescent girls in many Ugandan districts, including Rukiga, exhibit persistently low completion rates for the two-dose series. This study aimed to identify demographic and individual-level factors associated with the low uptake of the HPV vaccination series among adolescent girls in Rukiga District, Uganda. Methods: A cross-sectional study employing mixed methodologies was conducted with 292 adolescent girls and their caregivers in Rukiga District between September and November 2022. Multivariate logistic regression was utilized to identify demographic, individual health and community determinants of completing the two-dose HPV vaccine regimen. Qualitative data were gathered through in-depth interviews with 11 health workers and 10 Village Health Team members to explore individual-level, health system and community barriers to vaccine uptake from the perspective of implementers. Results: The study found that only 27.49% of eligible girls completed the two-dose HPV vaccination series. Caregivers' gender was a significant predictor of uptake, with girls cared for by mothers having greater odds of completion (AOR = 1.70, 95% CI: 1.05-2.74, p = 0.030). Caregivers without formal education (AOR = 0.19, 95% CI: 0.05-0.74, p = 0.033) and peasant farmers (AOR = 0.49, p = 0.013) were less likely to vaccinate their daughters. Key individual barriers included change of residence (AOR = 0.50, p = 0.001) and school absenteeism/dropout (AOR = 0.73, p = 0.037), both significantly reducing uptake. Qualitative findings highlighted additional individual challenges such as misunderstanding regarding vaccine safety, insufficient health worker training, vaccine stockouts, long clinic wait times, and widespread community mistrust of government health initiatives. Conclusion: The low completion of the HPV vaccine series in Rukiga District is substantially influenced by identifiable demographic characteristics, particularly caregiver education and relationship to the child, and critical individual-level barriers such as mobility and school attendance. Targeted interventions are needed to empower mothers, enhance health literacy among less-educated and peasant caregivers, and implement flexible vaccination strategies to reach mobile and out-of-school adolescents.