Sohail Agha

HPV vaccine uptake among adolescent girls in Nigeria: The complex role of caregivers’ education

Introduction Cervical cancer remains a leading cause of cancer-related deaths among women in low- and middle-income countries (LMICs), with sub-Saharan Africa (SSA) bearing a disproportionate burden of the disease. Human papillomavirus (HPV) vaccination offers a critical intervention, yet uptake remains suboptimal due to vaccine hesitancy, misinformation, and socio-economic disparities. This study examines factors associated with HPV vaccine uptake among adolescent girls whose caregivers use social media. Methods We conducted a cross-sectional survey in October and November 2024 among 4,830 caregivers of adolescent girls 9–17 in Abuja, Nasarawa, and Adamawa states. Participants were recruited via advertisements on Facebook and Instagram. Data on adolescents’ HPV vaccination was collected from caregivers. Caregiver also provided data on their own education, motivation, ability, and exposure to HPV vaccine messaging. Multivariate logistic regression was used to identify predictors of vaccine uptake, adjusting for socio-demographic factors, motivation, and ability. Results The HPV vaccination rate among adolescent girls 9–17 was 53.9%. Caregivers with no formal education had higher exposure to HPV campaign messaging than caregivers with Higher National Diploma (HND) or Bachelor’s (BSc) education (95.3% vs 53.8%, p < 0.001). The least educated caregivers were also more likely to report a three times higher odds ratio of HPV vaccination compared to caregivers with Higher National Diploma (adjusted odds ratio [aOR] = 3.01, 95% CI: 1.52–5.93). Exposure to HPV vaccine messaging was associated with a seven times higher odds ratio of HPV vaccine uptake (aOR = 6.87, 95% CI: 6.20–7.61). Motivation and ability were positively associated with HPV vaccination. Regional differences were observed, with Nasarawa demonstrating higher a vaccination rate than Abuja and Adamawa. Conclusion Exposure to HPV vaccine messages is higher among less educated compared to more educated caregivers. Moreover, the impact of advertising exposure on vaccine uptake is stronger among less educated caregivers. Educational disparities in campaign exposure and campaign effects highlight the need for strategies to increase campaign reach to more educated caregivers and to ensure that HPV messages resonate with them. Our findings suggest that existing campaigns may need to be restructured to more effectively reach educated and skeptical audiences.

Cost-effectiveness of a behavioral insights-informed digital campaign to increase HPV vaccination in Bangladesh

Digital platforms like social media are increasingly used to promote vaccine uptake in low- and middle-income countries (LMICs), yet limited evidence exists on their economic value. This study estimates the cost-effectiveness of a behavioral insights-informed social media campaign designed to increase HPV vaccine uptake among adolescent girls ages 9-14 in Bangladesh. A static cost-effectiveness analysis was conducted from the health system perspective. Inputs included campaign delivery costs, vaccine procurement and distribution, and treatment costs averted through cervical cancer prevention. Disability-adjusted life years (DALYs) averted per vaccinated girl were modeled using global burden-of-disease parameters. Effectiveness estimates were drawn from a quasi-experimental evaluation of the campaign, which reported a 9.5 percentage-point increase in vaccine uptake in one study arm and a 5.3 percentage-point increase in another, relative to a control group. These findings were preceded by a posttest study in Dhaka Division, which showed a strong association between campaign exposure and vaccination behavior. The incremental cost per vaccinated girl was $6.02, and the cost per DALY averted - i.e. the Incremental Cost-Effectiveness Ratio (ICER) - was $39.57. This falls well below established cost-effectiveness thresholds, including 40% of GDP per capita, commonly applied in LMICs. The findings suggest that digital campaigns guided by behavioral insights can represent a highly cost-effective approach to addressing persistent immunization coverage gaps. These results support the integration of such strategies into national immunization programs, particularly in contexts where traditional outreach methods may face financial constraints.