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HPV vaccine awareness and uptake among women attending cervical screening in health-resource-limited areas of China: A multicenter cross-sectional study
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X I Jia*X
Xi’ao Da*J
J F Shi*R
Rufei DuanY
Yuqian Zhao*Z
Zhifang Li*R
Ruimei FengC
Chunxia Yang*T
Tai Zhang*H
Hongyun Zhang*J
Junling Wang*S
S. S. Hu*Y
YouLin Qiao* DOI：10.1080/21645515.2026.2644020.png)
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Abstract
En 中文
Evidence shows HPV vaccination reduces infection, precancer and cervical cancer, yet coverage in health-resource-limited of China remains uncertain. We assessed awareness, uptake and correlates among women attending cervical screening, and examined associations with screening outcomes. We conducted a cross-sectional study in eight county sites in 2023–2024 among women aged 35–64 y. A standardized questionnaire captured sociodemographic factors, awareness and vaccination. Cervical samples were tested for hrHPV. Outcomes were awareness, vaccination, hrHPV, HPV16/18 and CIN2+. Associations were estimated using modified Poisson models with site fixed effects and HC3 robust errors. Adjusted prevalence ratios (aPRs) and covariate-standardized marginal estimates were reported. We included 93,027 unique participants. Awareness was 45.15% and vaccination 6.73%. hrHPV prevalence was 11.38% and CIN2+ detection was 0.70%. In 2024 versus 2023, awareness was lower (40.66% vs 51.34%) while vaccination was higher (7.61% vs 5.53%; aPR 1.25, 95% CI 1.18–1.32). Awareness and uptake declined with age; coverage was 23.23% at ages 35–39 and 0.29% at ages 60–64. Urban residence and higher education were associated with uptake (urban aPR 1.19, 95% CI 1.11–1.27; bachelor’s or higher aPR 1.73, 95% CI 1.58–1.90). The age-by-year interaction was significant, with standardized gains concentrated at ages 35–49. Vaccination was associated with lower HPV16/18 infection (aPR 0.66, 95% CI 0.52–0.85) but not with overall hrHPV or CIN2+. HPV vaccine awareness and uptake were low among women aged 35–64 y in health-resource-limited areas, with strong age, educational and urban–rural gradients and marked site heterogeneity. Uptake increased in 2024, mainly at ages 35–49, and vaccination was associated with a lower prevalence of HPV16/18 infection.
Keywords:
Human papillomavirus vaccine
vaccination coverage
vaccine awareness
cervical cancer screening
health-resource-limited areas
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