Bridging the Service Gap – Health Facility Challenges in HPV Vaccine Uptake in Rural Uganda

Background: Cervical cancer, largely preventable through HPV vaccination, remains a significant public health burden in Uganda. Despite national immunization efforts, low completion rates for the two-dose HPV vaccine series persist, particularly in rural districts like Rukiga. This study aimed to investigate health facility-related factors contributing to 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 Multivariate logistic regression was utilized to identify health facility-level determinants of completing the two-dose HPV vaccine regimen. Additionally, qualitative data were gathered through in-depth interviews with 12 health workers and 10 Village Health Team members to explore operational and service delivery barriers to vaccine uptake. Results: The study found that only 27.49% of eligible girls completed the two-dose HPV vaccination series. Significant health facility-related barriers included vaccine shortages and inadequate cold chain infrastructure (AOR = 1.75, 95% CI: 1.04-2.93, p = 0.004) and understaffing of healthcare workers (AOR = 1.97, 95% CI: 1.05-3.68, p = 0.006). Limited knowledge among health workers regarding the HPV vaccination schedule (AOR = 0.94, 95% CI: 0.70-1.24, p = 0.043) and the lack of clear government programs targeting out-of-school girls (AOR = 0.97, 95% CI: 0.73-1.29, p = 0.035) also contributed to reduced uptake. Qualitative findings further highlighted issues such as poor records management, inadequate community engagement by facilities, transportation challenges for vaccine delivery, and low staff motivation due to lack of incentives. Conclusion: Health facility limitations, particularly concerning vaccine supply, human resources, and operational efficiency, are critical impediments to completing the HPV vaccine series in Rukiga District. Addressing these systemic weaknesses through investments in cold chain infrastructure, increased staffing, enhanced health worker training, and robust outreach strategies is essential to improve vaccine coverage and reduce the burden of cervical cancer.