Barriers, Facilitators, and Implementation Strategies for Reaching ≥90% HPV Vaccine Coverage in Girls Aged 9–14 Years in Nigeria: A Comprehensive Literature Review Aligned with WHO Guidelines
Joyce O Ederhion, Edesiri Oghwegha, Daniel O Okeke, Innocent Okoacha, Abel S Anegbe, Olivia K Muoka, Ugochukwu Obi-Nwafor and Allen C Omo-Ogboi*
ABSTRACT
Cervical cancer remains a leading cause of cancer morbidity and mortality among women in Nigeria, with an estimated 12,312 new cases and 7,599 deaths in 2024. The WHO Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem sets a target of 90% HPV vaccination coverage of girls by age 15. Nigeria introduced its national single-dose HPV vaccination program in October 2023 for girls aged 9–14 years using schooland community-based approaches. By late 2024, more than 12 million girls had been vaccinated, yet coverage remains below the 90% target. This comprehensive literature review synthesizes current evidence on barriers, facilitators, and implementation strategies in the Nigerian context. Uptake in
individual studies ranged from 23.4% to 57.2%, while national cumulative figures exceeded 12 million girls.
Key barriers included low awareness, misconceptions about infertility and promiscuity, safety fears, cultural and religious attitudes, and logistical challenges. Facilitators included campaign exposure (adjusted odds ratio 6.87), school-based delivery, free vaccine provision, and engagement of female or younger caregivers. Effective strategies comprised multi-component communication, engagement with religious and community leaders, human-centered design, and mHealth interventions (adjusted odds ratio: 3.05). Achieving ≥90% coverage requires sustained, equity-focused, multi-level strategies fully aligned withthe WHO Global Strategy.
