TL;DR
Although mandates alone are unlikely to achieve national HPV vaccination targets, they may serve as an important component of comprehensive state efforts to increase uptake and prevent HPV-related cancers.
HPV vaccination uptake among adolescent girls in Lesotho was far behind the WHO 2030 target, and a comprehensive sexual health education programme that includes information on STIs and HPV can improve vaccination uptake, especially in districts with low uptake.
In the context of catch-up vaccination extended up to 26 years, targeted university-based interventions could improve vaccination coverage in this insular territory.
HPV knowledge, HPV vaccine knowledge and beliefs, and vaccine hesitancy were all independently associated with vaccination status, and participants with stronger positive HPV vaccine beliefs and lower vaccine hesitancy had significantly greater odds of reporting HPV vaccination.
Strengthening public confidence, primary care capacity, school-based delivery, and digital monitoring may help close immunization gaps and accelerate progress toward cervical cancer elimination.
In SSA primary care, routine initiation of HPV vaccination via prescription appears constrained mainly by missed opportunities and organizational friction rather than clinician opposition, with additive effects when combining levers.
Findings demonstrate variation in simultaneous vaccination patterns, suggesting that flexibility in the recommended adolescent vaccination schedule allows for different approaches to vaccination across clinical settings and family preferences while maintaining adherence to the recommended schedule.
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