What Shapes HPV Vaccine Uptake Among Adolescent Girls from Urban Slums in Dhaka, Bangladesh: A Qualitative Study Using the WHO Behavioral and Social Drivers (BeSD) Framework

Background: Human papillomavirus (HPV) is the leading cause of cervical cancer and the vaccine is the key preventive measure. In 2023, Bangladesh launched a school-based HPV vaccination campaign for girls aged 10-14 years. However, vaccine uptake among this group in urban settings remains suboptimal. This study explored adolescent girls (aged 10-14 years) understanding attitude, and motivation towards the vaccine, as well as the practical challenges impacting on vaccine uptake. Methods: From April to June 2024, a qualitative study was undertaken in two urban slums in Dhaka, Bangladesh. Through a combination of convenience and snowball sampling, we conducted 15 in-depth interviews and one focus group discussion using the World Health Organizations Behavioral and Social Drivers (BeSD) tool. Interviews were conducted in the native Bengali language, audio recorded, and transcribed verbatim. Framework analysis was performed to emerge key themes and generate study findings. Results: A total of 26 girls with a mean age of 12.65 (SD: 1.23) participated in the study. While some participants believed that the HPV vaccine could reduce the infection during menstruation or prevent childbirth-related complications, there was uncertainty regarding the appropriate age for vaccination. Concerns were raised about menstrual irregularities, infertility, and the potential negative impact on marital prospects. Students spoke about being subjected to inappropriate jokes from their male peers. Male guardians were identified as the key decision makers and were perceived to be against the need for this vaccine. Operational barriers including inaccessible digital registration, limited information about the vaccine, and lack of systematic follow-up constrained the participation in the school-based HPV campaign. Conclusions: Adolescents in urban slums faced multi-layered barriers, including knowledge gaps, cultural barriers, and accessibility challenges to HPV vaccination. Strengthening adolescent-friendly communication, engaging parents, teachers and male students, simplifying registration, adequate vaccine supply and ensuring supportive school-based vaccination processes are critical to improving equitable coverage and acceptance.