Integrating HPV vaccination into ART clinics: perspectives from an ethnographic study with girls aged 9–14 years in Ndola District, Zambia
AIDS Care
Authors: Jean Hunleth, Tasha Ngalande, Diana Mwanza, Petronella Singogo, Lindsey Kaufman, Thembekile Shato, Comfort Asante, Ana Baumann, Aliness Dombola, Sam Miti, Michelle Silver, Gershom Chongwe & Kevin Kapungu
This study examined adolescent girls’ perspectives on integrating human papillomavirus (HPV) vaccination into antiretroviral therapy (ART) clinics in Ndola District, Zambia. People living with HIV have an increased risk of persistent HPV infection and HPV-related cancers, making HPV vaccination an important component of comprehensive HIV care. However, ensuring that adolescents living with HIV receive HPV vaccination according to recommended schedules can be challenging. The study explored whether ART clinics could provide an accessible and acceptable setting for delivering HPV vaccination while considering adolescents’ experiences and preferences.
As part of a five-year study evaluating strategies for integrating HPV vaccination into ART clinics across rural, peri-urban, and urban settings in Ndola District, researchers conducted ethnographic and participatory research with girls aged 9–14 years. The research included participant observation of vaccination campaigns and participatory “playshops,” during which 93 girls shared their perspectives through focus-group activities, mapping exercises, and role-playing scenarios involving vaccination in clinical settings. This approach allowed researchers to examine not only whether girls supported clinic-based vaccination, but also what characteristics made vaccination settings feel acceptable and trustworthy.
Participants generally viewed ART clinics as appropriate locations for HPV vaccination, particularly for adolescents already receiving HIV care. However, their acceptance depended on several important conditions. Girls emphasized the need for safety, privacy, discretion, respect, and autonomy. Privacy and discretion were particularly important because receiving services at an ART clinic could potentially reveal an adolescent’s HIV status to peers or community members. Participants also highlighted the importance of being treated respectfully and having agency in decisions surrounding vaccination.
The findings demonstrate that successful integration of HPV vaccination into HIV care requires more than simply adding vaccination services to existing clinics. Adolescents’ concerns about confidentiality, stigma, and the clinical environment must be incorporated into implementation strategies. The authors suggest that these insights can inform HPV vaccination programs not only in ART clinics but also in other healthcare, school-based, and community settings. Centering adolescents’ experiences and preferences may help create vaccination services that are accessible, acceptable, and responsive to the needs of young people living with HIV.