Knowledge and acceptability of male HPV vaccination among young people and community stakeholders in northwest Tanzania: social sciences in the Add-Vacc trial
Susan A. Kelly & Shelley Lees et al. · 2025-11-27
Human papillomavirus (HPV) and related diseases are global health concerns affecting both males and females. Tanzania introduced two-dose HPV vaccination for 14-year old girls in 2018. The Add-Vacc trial in rural northwest Tanzania is evaluating the impact of adding one-time, single-dose HPV vaccination for 14-18-year-old boys to the national programme for girls on HPV population prevalence. As this is the first time HPV vaccination has been offered to adolescent males in Tanzania, acceptability of boys' HPV vaccination among adolescents and community stakeholders was assessed. Qualitative data were collected between July 2023-May 2024 through: 1) rapid ethnography; 2) rumours tracking using an electronic tool piloted during the study; 3) in-depth interviews with in- and out-of-school boys who accepted or declined vaccination; 4) key informant interviews with vaccination stakeholders including parents, teachers, health workers, and community leaders; and 5) focus group discussions with stakeholders and vaccination-age boys and girls. Data were coded using Nvivo12 and analysed thematically. Messaging on HPV-related complications beyond cervical cancer motivated parental and adolescent support for vaccinating both boys and girls. Framing male HPV vaccination as a gender equity issue and highlighting the economic burden of illness emerged as important themes. Participants emphasised the need for trusted, locally recognised messengers to convey information. Parents and peers were key influencers for adolescents, while health workers and religious/community leaders influenced parents. Some parents and adolescents who initially declined vaccination reported they later accepted it after having time to reflect and seeing vaccinated boys experienced no adverse effects. Single-dose HPV vaccination of males was generally acceptable across all study groups. Ongoing, dynamic community engagement and open dialogue about the full spectrum of HPV-related sequalae and HPV vaccination for both genders are essential to building trust and improving understanding and acceptability of HPV vaccination targeting boys and girls in this Tanzanian context.
Susan A. Kelly, John Changalucha, Donati Malibwa, Victoria L. Ewing, Gabriel Mkungu, Derick Deogratias, Ramadhan Hashim, Margaret Stanley, Charles Lacey, Richard Hayes, Saidi Kapiga, Kathy Baisley, Deborah Watson-Jones, Shelley Lees