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Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries



The World Health Organization revised its human papillomavirus (HPV) vaccination recommendations to include a two (2-) dose schedule for girls aged ≤ 15 years. We investigated acceptability of 2- versus 3-dose schedule among adolescent vaccination providers and mothers of adolescent girls in five countries.


Adolescent vaccination providers (N = 151) and mothers of adolescent girls aged 9–14 years (N = 118) were recruited from Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers’ preference for a 2- versus 3-dose HPV vaccination schedule via quantitative surveys. Mothers’ attitudes towards a 2-dose schedule were assessed through focus group discussions.


Most adolescent providers preferred a 2- over a 3-dose HPV vaccination schedule (overall: 74%), with preference ranging from 45.2% (South Africa) to 90.0% (South Korea). Lower cost, fewer clinic visits, and higher series completion were commonly cited reasons for 2-dose preference among providers and mothers. Safety and efficacy concerns were commonly cited barriers to accepting a 2-dose HPV vaccination schedule among providers and mothers. Mothers generally accepted the reduced schedule, however requested further information from a trusted source.


Adolescent vaccination providers and mothers preferred the 2-dose over 3-dose HPV vaccination schedule. Acceptability of a 2-dose HPV vaccination could be improved with additional information to providers and mothers on HPV vaccination safety and efficacy.

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Human immunodeficiency virus


Human  papillomavirus


Low- and middle-income country


Strategic Advisory Group of Experts


Sexually transmitted infections


World Health Organization


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The authors gratefully acknowledge the participants of this study. The authors thank Suzanne Landi, Shoshana Goldberg, and Sara Smith for their assistance in developing this manuscript. JYI was supported by a NIH NRSA individual predoctoral fellowship (F31-CA210474-01A1). Cervarix is a trademark owned by or licensed to the GSK group of companies.


This study was funded by GlaxoSmithKline Biologicals SA (Study ID: 117339); all data collection, analysis, and interpretation was conducted by study co-authors, and GSK had the opportunity to review this paper. GSK did not have input into the research data collection, analysis, or interpretation of results.

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Correspondence to Jennifer S. Smith.

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Jennifer S. Smith has received research grants, served on paid advisory boards, and/or been a paid speaker for GSK group of companies and Merck & Co., Inc. over the past 5 years. The remaining authors have no conflicts of interest to disclose.


Appendix 1

See Table 5.

Table 5 Site-specific recruitment procedures of providers and adolescent mothers

Appendix 2

See Table 6.

Table 6 Quantitative questions that assessed healthcare provider’s willingness for initiation and for completion of a 2- versus 3-dose HPV vaccination schedule

Appendix 3

See Table 7.

Table 7 Qualitative questions in focus group discussion (FGD) guide surrounding maternal attitudes towards a 2- versus 3-dose vaccination schedule

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Islam, J.Y., Hoyt, A.M., Ramos, S. et al. Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries. Cancer Causes Control 29, 1115–1130 (2018).

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  • Adolescent vaccination
  • Acceptability
  • Human papillomavirus
  • Dose
  • Adolescent
  • Providers
  • Parents
  • Focus groups