Factors that influence the uptake and delivery of HPV vaccines in migrants: a systematic review

BACKGROUND: Migrants are known to be an under-immunised group for many routine vaccinations. We did a global systematic review to explore and assess factors that influence uptake of vaccines for human papillomavirus (HPV) infection, using the WHO-endorsed Behavioural and Social Driver of Vaccination Framework (BeSD). METHODS: Using PRISMA guidelines, 3,075 records were found from 7 databases (2006-2023), with no exclusions based on country or language. After title/abstract screening and full-text review, data were extracted for thematic analysis using BeSD (4 domains for vaccine behavioural change) and qualitative synthesis. RESULTS: We included 104 studies from 16 countries: two thirds from the US, 25% from Europe, and only 2% from LMICs. The majority focused on vaccine eligibility and/or parents; 10% looked at providers’ views; 2% involved wider stakeholders, and most research focused on females. Migrant sub-groups reported diverse views and experiences about HPV vaccines. Many examined vaccine initiation and identified low awareness/knowledge of HPV/HPV vaccine. “What people think/feel” domain: barriers such as concerns on vaccine safety, cultural belief, lack of information, vaccine unnecessary; mixed view on vaccine benefit. “Social process”: doctor recommendation and information via providers/peers was influential but depended on framing and migrant characteristics. “Motivation” domain was understudied. “Practical issues” that impact uptake included cost, mobility, accessibility, and language. CONCLUSIONS: Culturally sensitive education to address misconception and enhance importance of HPV vaccines were considered important, alaongside practical efforts to address mobility (mHealth), proactive vaccine behaviour and strong provider recommendation. A comprehensive strategy along the BeSD pathway, using a multipronged approach, would be valuable, and may be further enhanced by exploring wider macro-level factors. KEY MESSAGES: • Special efforts will be needed to engage mobile groups in HPV vaccination, with further research needed in LMICs. • Culturally sensitive education to address misconception and enhance importance of HPV vaccines were considered important.