Gender inequities regarding the HPV vaccination coverage in high-income countries: a systematic review and meta-analysis

Abstract Objective This systematic review aimed to systematically map the evidence and identify the knowledge gaps in the universal HPV vaccine coverage in high income countries. Methods An electronic search of the PubMed/MEDLINE, Scopus, Google Scholar, and official websites was carried out for articles reporting the HPV vaccination coverage in high income countries. The data was analysed systematically based on the updated Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The meta-analysis component was modified appropriately to synthesise the pooled prevalence of the HPV vaccine uptake among adolescents, men having sex with men and transgender persons with 95% confidence interval (CI). The random effects meta-analysis was performed in STATA version 13.0 (College Station, TX, USA) to evaluate and summarise the results. The forest plots were made using the midas package in STATA. The heterogeneity between qualified studies was reported using I 2 index. Results Twenty-three articles regarding the HPV vaccination coverage were qualified for the quantitative synthesis including 27,80,307 adolescents, 11,909 men having sex with men and 207 transgender women. The pooled prevalence of the adolescent HPV vaccine uptake among adolescent girls was 67.75% (95% CI: 62.81%,72.69%) and adolescent boys was 58.32% (95% CI 48.88%, 67.76%). The pooled prevalence among men having sex with men (MSM) was 27.94% (95% CI 14.35, 41.53) and the pooled prevalence in transgender women was 32.59% (95% CI 8.35%. 56.83%) Conclusion Significant gender inequities exist in the HPV vaccination coverage and less number of gender minorities were vaccinated against HPV in high income countries. The major challenges were low awareness, lack of recommendations from clinicians, and public mistrust towards all vaccines. PROSPERO registration number CRD42025641689 What is already known on this topic ➢ HPV vaccination programmes extending to adolescent boys and catch-up vaccination of men up to 26 years is more cost-effective than vaccinating only adolescent girls and women. ➢ The gender neutral HPV vaccination approach ensures gender equity as gender diverse populations such as TGW and MSM are at higher risk of persistent HPV infections. ➢ The HPV vaccination coverage is suboptimal among adolescents and young adults in high income countries, despite the well proven vaccine efficacy. WHAT THIS STUDY ADDS ➢ The rural health care providers were less likely to recommend adolescent HPV vaccination for cancer prevention. ➢ The HPV vaccine coverage of transgender women and men having sex with men (MSM) is minimal, despite being at higher risk of HPV infection. ➢ In contrast to TGW, men having sex with men in the USA showed better awareness of sexually transmitted diseases and were not hesitant to consult healthcare professionals if needed. ➢ The reduced HPV vaccine uptake among sexual minorities was mainly attributed to the low awareness among healthcare professionals, lack of recommendations by clinicians, and public mistrust of healthcare systems. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ➢ This systematic review presents the pooled prevalence of gender neutral HPV vaccination uptake that may assist policy makers, and stakeholders in making shared decisions. ➢ The barriers to HPV vaccination uptake should be managed by targeted public health and clinical practice interventions. ➢ Further research among gender minorities should be planned to analyse their perceptions and to bridge the knowledge gaps.