Knowledge, Attitude, and Practice of HPV vaccination in prevention of Cervical Cancer among Indian females of reproductive age group: A narrative review

Abstract

Cervical cancer remains a major cause of morbidity and mortality among Indian women despite being largely preventable through human papillomavirus (HPV) vaccination and screening. Over the past 15 years, India has seen variable progress in HPV vaccination awareness, attitudes, and uptake. This narrative review synthesizes peer-reviewed studies, systematic reviews, program documents, and Government of India notifications to examine the knowledge, attitudes, and practices (KAP) relating to HPV vaccination in Indian females of reproductive age and to identify barriers and facilitators to effective rollout. We searched major databases and grey literature covering PubMed/PMC, Scopus, DOAJ, Google Scholar and government releases, focusing on KAP studies, implementation pilots, policy milestones, and syntheses. Key findings of our review are evident that knowledge about HPV and its vaccine is heterogeneous as many studies report low-to-moderate awareness, higher among urban, educated and health professional groups and lower among rural and low literacy groups. Attitudes are often receptive when adequate information is provided, but concerns about safety, cost, cultural acceptability and misinformation reduce acceptance. Reported vaccine uptake prior to national rollout was very low (pooled estimates <10% in several systematic reviews), though pilot programmes (e.g., Sikkim) demonstrated high coverage when school-based, state-supported campaigns were used. Major policy milestones occurred in 2022–2023, including national decisions to prioritize HPV vaccination and the availability of an indigenously produced, lower cost vaccine, which create favorable conditions for rapid expansion. We highlight gaps in population level awareness, health worker training, communication strategies, equitable access, and monitoring. Recommendations from our review may include but not limited to school-based delivery, community engagement, provider education, cost-reduction strategies, tracking systems, and research on long-term impact.