MULTILEVEL DETERMINANTS OF HUMAN PAPILLOMAVIRUS VACCINE ACCEPTANCE AND UPTAKE, AND CERVICAL CANCER SCREENING UPTAKE, AMONG WOMEN ATTENDING TERTIARY HEALTHCARE FACILITIES IN NASARAWA STATE, NIGERIA: A CROSS-SECTIONAL STUDY

Abstract

Nigeria introduced the human papillomavirus (HPV) vaccine into its national routine immunization programme in October 2023, yet population-level data on vaccine acceptance, actual uptake, and cervical cancer screening remain limited, particularly in north-central Nigeria. This study examined the prevalence and multilevel determinants of HPV vaccine acceptance, vaccine uptake, and cervical cancer screening uptake among women attending tertiary healthcare facilities in Nasarawa State, Nigeria. A facility-based cross-sectional study was conducted among 431 women aged 15–49 years attending two tertiary healthcare facilities (Federal Medical Centre, Keffi, and Federal University Teaching Hospital, Lafia), recruited via multistage sampling with systematic random selection within clinics. Data were collected using a structured, interviewer-administered, validated questionnaire (content validity index ≥0.80; knowledge-scale Cronbach’s α = 0.89) covering sociodemographic characteristics, knowledge, attitudes, and multilevel determinants of HPV vaccine acceptance/uptake and cervical cancer screening. Multilevel mixed-effects logistic regression, accounting for clustering within facilities, was used to identify determinants at individual, interpersonal/community, and organizational levels, guided by the Socio-Ecological Model. Awareness of HPV infection (66.4%) and of cervical cancer screening (71.2%) was moderate, but only 40.1% correctly identified girls aged 9–14 years as the recommended HPV vaccination target group. Mean composite knowledge score was 67.8 ± 14.9 (28.3% classified as having good knowledge). HPV vaccine acceptance was high (78.4% willing if offered), but actual uptake was low (17.2%), and only 6.8% of vaccinated respondents had completed the full three-dose schedule. Cervical cancer screening uptake was similarly low (27.6%). In multilevel models, tertiary education (adjusted odds ratio [AOR] 5.61, 95% confidence interval [CI] 2.76–11.39), good HPV knowledge (AOR 4.88, 95% CI 2.76–8.61), spousal support (AOR 3.68, 95% CI 2.22–6.08), and direct healthcare provider recommendation (AOR 5.28, 95% CI 3.11–8.95) were among the strongest independent predictors of preventive service utilization; the organizational-level model showed the best fit (Nagelkerke R² = 0.614, area under the curve [AUC] = 0.921). A substantial intention-behaviour gap exists between HPV vaccine acceptance and actual uptake among women attending tertiary facilities in Nasarawa State, mirrored by low cervical cancer screening uptake. Education, knowledge, spousal/family support, and — most strongly — healthcare provider recommendation and service integration were the dominant predictors of preventive service utilization, pointing to provider-level intervention as a high-yield entry point for closing this gap.