DOI: 10.4103/mgmj.mgmj_73_26 ISSN: 2347-7946

HPV vaccination initiation in Indian children: a systematic review with secondary synthesis of published meta-analyses and qualitative caregiver evidence

Shiv Prakash Sharma, Neha Sharma
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Abstract

Background:

India accounts for nearly one-quarter of the global burden of cervical cancer, yet uptake of the human papillomavirus (HPV) vaccine remains critically low. This mixed-methods systematic review, including a secondary synthesis of published meta-analyses, aimed to estimate caregiver-reported HPV vaccination initiation in Indian children and to synthesize qualitative evidence on barriers and facilitators to vaccine uptake.

Materials and Methods:

We searched PubMed, Scopus, DOAJ, Google Scholar, IndMed, Shodhganga, and the Cochrane Library from inception through April 2026. Observational and qualitative studies reporting caregiver-initiated HPV vaccine uptake (first dose) in India were included. Quantitative pooled estimates were drawn from a previously published high-quality systematic review and meta-analysis, and additional eligible primary studies were narratively synthesized. Qualitative evidence was synthesized using thematic analysis. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools and the Mixed-Methods Appraisal Tool.

Results:

Eleven studies, including nine primary studies ( n = 4336) and two systematic reviews, met the inclusion criteria. The published pooled estimate of HPV vaccine coverage in India was 4% (95% confidence interval [CI]: 2%–7%; I 2 = 96%). Pooled caregiver knowledge of HPV vaccination was 22% (95% CI: 14%–31%; I 2 = 99.5%), and the pooled proportion of caregivers with a positive attitude toward HPV vaccination was 45% (95% CI: 33%–57%; I 2 = 100%). Among the primary studies, one reported an actual vaccine uptake of only 0.6%, whereas caregiver willingness to vaccinate ranged from 61% to 91.5% in the remaining studies. The qualitative synthesis identified six major themes influencing vaccine uptake: limited awareness, sociocultural stigma, financial constraints, healthcare provider recommendation, school-based vaccine delivery, and trust in government healthcare services.

Conclusion:

The available pooled evidence indicates that HPV vaccine coverage in India remains extremely low despite moderate caregiver willingness and generally favorable attitudes toward vaccination. Addressing deficiencies in awareness, accessibility, affordability, and vaccine delivery systems is essential to improve HPV vaccine initiation and support the successful implementation of the national HPV vaccination program.

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