South Africa launched a mass COVID-19 vaccination campaign in May 2021, targeting 40 million adults. Understanding predictors of COVID-19 vaccine intentions was required to achieve this goal. We conducted a population-based survey in June–July 2021 using the WHO Behavioral and Social Drivers (BeSD) of COVID-19 Vaccination tool to determine predictors of vaccine hesitancy, defined as intention to refuse or uncertainty whether to accept COVID-19 vaccination. There were 1193 participants, mean age 39 (standard deviation 15) years, and 53% women, of whom 58% trusted information provided by healthcare workers and 32% were vaccine hesitant. Independent predictors of vaccine hesitancy included concerns about side effects (odds ratio (OR) 11.41; 95% confidence interval (CI) 3.5–50.80), lack of access to the online vaccine registration platform (OR 4.75; CI 2.15–10.37), distrust of government (OR 3.0; CI 1.33–6.77), belief in conspiracy theories (OR 3.01; CI 1.32–6.77), having no monthly income (OR 1.84; CI 1.12–3.07), and depending on someone else to make vaccination decision (OR 2.47; CI 1.06–5.77). We identified modifiable predictors of vaccine hesitancy at the start of South Africa’s COVID-19 vaccination rollout. These factors should be addressed by different stakeholders involved in the national immunization program through tailored communication and other effective strategies that increase vaccine literacy, reach low-income households, and engender confidence in government.

Background Human papillomavirus (HPV) vaccination among children and adolescents is crucial for the prevention of HPV-related diseases later in life. However, HPV vaccination uptake remains suboptimal in this population. This protocol outlines a comprehensive review that aims to evaluate the effectiveness of interventions targeting parents and parent-adolescent dyads in improving HPV vaccination uptake among children and adolescents aged 9-18 years. Objective The objective of this study is to assess the impact of parent-directed and parent-adolescent dyad interventions on HPV vaccination uptake in children and adolescents aged 9-18 years. Specific objectives include reviewing existing literature on parent-oriented and parent-adolescent dyad interventions, assessing vaccination uptake, identifying influencing factors, and providing evidence-based recommendations for intervention development and implementation. Methods A systematic review will be conducted, encompassing literature published up to the present day. Various databases will be searched for relevant studies on parent-focused and parent-adolescent dyad interventions aimed at improving HPV vaccination uptake. Data extraction and analysis will be performed to assess the proportion of children and adolescents receiving HPV vaccination following interventions, factors influencing vaccination uptake, and completion rates of the recommended vaccine series. Results The review findings will be analyzed using appropriate statistical methods, including meta-analysis to estimate the overall effect size of interventions. Subgroup and sensitivity analyses will be conducted to explore heterogeneity and assess the robustness of the results. Conclusion This protocol outlines a comprehensive review that will contribute to the current understanding of the effectiveness of parent-oriented and parent-adolescent dyad interventions in improving HPV vaccination uptake among children and adolescents. The findings will inform the development and implementation of targeted interventions to address barriers and improve vaccination coverage, ultimately reducing the burden of HPV-related diseases.

Background: South Africa launched a school-based human papillomavirus (HPV) vaccination programme in 2014 and has achieved a national coverage of more than 80%. However, there is subnational variation in coverage, with eThekwini District in the province of KwaZulu-Natal having the lowest coverage at 40%. Knowledge of the factors associated with vaccine acceptance in this district would inform tailored strategies to improve coverage, which could be extrapolated to similar settings. We conducted this cross-sectional study to assess the factors associated with HPV vaccine acceptance in eThekwini District. Methods: We used stratified random sampling to select caregivers of children aged 9–14 years in the district. We interviewed participants in April–May 2023 and employed bivariate and multivariate logistic regression models to assess the factors associated with HPV vaccine acceptance. Results: Of 793 individuals contacted, 713 (89.9%) participated. Most were women (86.1%) and had a mean age of 42.6 ± 11.6 years and secondary or lower education (83.8%). Most participants knew about the HPV vaccination programme (86.0%) and accepted HPV vaccination (93.5%). The latter includes 42.9% who had already vaccinated their daughters and 50.6% who were willing to allow their daughters to be vaccinated. A negligible proportion was either undecided (2.1%) or unwilling (4.4%) to accept HPV vaccination. Awareness of the programme (adjusted odds ratio [aOR] 5.22; 95% confidence interval [95%CI] 2.01–13.56), confidence in vaccine safety (aOR 19.69; 95%CI 5.86–66.15), and endorsement by religious leaders (aOR 5.06; 95%CI 1.56–16.45) were independent predictors of vaccine acceptance. Conclusions: Our findings highlight the critical role of the provision of information and education about the benefits and safety of HPV vaccination.

The introduction of human papillomavirus (HPV) vaccination programs is a significant achievement in preventing cervical cancer and other HPV-related illnesses. This study aimed to explore healthcare workers (HCWs) and caregivers (CGs) knowledge, perceptions and experiences surrounding the school-based HPV immunization program in eThekwini District, KwaZulu-Natal Province, South Africa. CGs refer to parents or other individuals responsible for making vaccination decisions for eligible girls. A qualitative study design was employed that incorporated in-depth, semi-structured interviews with 20 CGs and 20 HCWs from different areas of eThekwini District who are involved in a school-based HPV immunization program. The study was informed by the World Health Organization's Measuring Behavioral and Social Drivers of Vaccination (BeSD) approach. The BeSD resources include qualitative tools for conducting in-depth interviews that informed our interview guide. Thematic analysis was used to analyze interviews that were recorded, transcribed, and translated. HCWs indicated a thorough understanding of HPV and the vaccine's benefits, but CGs' knowledge varied, with some having misconceptions about the vaccine. HCWs largely praised the school-based HPV immunization program initiative but noted practical difficulties. CGs' perceptions varied from supportive to doubtful, depending on the information they received. Common impediments highlighted included a lack of information, cultural and religious beliefs and communication breakdowns. The study established that factors such as culture, information, and interpersonal experiences influence the knowledge, acceptance, and uptake of the HPV vaccine. The findings are anticipated to guide development of tailored interventions to increase HPV vaccination coverage in South Africa.

Background: South Africa launched a school-based human papillomavirus (HPV) vac-cination programme in 2014 and has achieved national coverage of more than 80%. However, there is subnational variation in coverage, with eThekwini District in the prov-ince of KwaZulu-Natal having the lowest coverage at 40%. Knowing factors associated with vaccine acceptance in this district would inform tailored strategies to improve cov-erage, which could be extrapolated to similar settings. We thus conducted this cross-sectional study to assess factors associated with HPV vaccine acceptance in eThekwini District. Methods: We used stratified random sampling to select caregivers of children aged 9-14 years in the district. We interviewed participants in April-May 2023, and employed modified Poisson regression models to assess factors associated with HPV vaccine acceptance. Results: Of 793 individuals contacted, 713 (89.9%) participated. They were mostly women (86.1%) and had mean age of 42.6 ± 11.6 years and secondary or lower education (83.8%). Most participants knew about the HPV vaccination programme (86.0%) and accepted HPV vaccination (93.5%). The latter includes 42.9% who already vaccinated their daughters and 50.6% who were willing to allow their daughters to be vaccinated. A negligible proportion was either undecided (2.1%) or unwilling (4.4%) to accept HPV vaccination. Knowledge of the programme (adjusted prevalence ratio [aPR] 1.16; 95% confidence inter-val [CI] 1.06-1.28) and confidence in vaccine safety (aPR 1.14; 95% CI 1.08-1.19) were in-dependent predictors of HPV vaccine acceptance. Conclusion: Our findings highlight the critical role of provision of information and education about the benefits and safety of HPV vaccination.

Introduction The human papillomavirus (HPV) vaccine is pivotal in preventing HPVrelated cancers, yet vaccine uptake rates vary significantly. This study assesses the efficacy of parent-adolescent dyad and parent-centered interventions on enhancing HPV vaccine uptake across different doses and over time.