HPV vaccine awareness and uptake among women attending cervical screening in health-resource-limited areas of China: A multicenter cross-sectional study

Evidence shows HPV vaccination reduces infection, precancer and cervical cancer, yet coverage in health-resource-limited of China remains uncertain. We assessed awareness, uptake and correlates among women attending cervical screening, and examined associations with screening outcomes. We conducted a cross-sectional study in eight county sites in 2023-2024 among women aged 35-64 y. A standardized questionnaire captured sociodemographic factors, awareness and vaccination. Cervical samples were tested for hrHPV. Outcomes were awareness, vaccination, hrHPV, HPV16/18 and CIN2+. Associations were estimated using modified Poisson models with site fixed effects and HC3 robust errors. Adjusted prevalence ratios (aPRs) and covariate-standardized marginal estimates were reported. We included 93,027 unique participants. Awareness was 45.15% and vaccination 6.73%. hrHPV prevalence was 11.38% and CIN2+ detection was 0.70%. In 2024 versus 2023, awareness was lower (40.66% vs 51.34%) while vaccination was higher (7.61% vs 5.53%; aPR 1.25, 95% CI 1.18-1.32). Awareness and uptake declined with age; coverage was 23.23% at ages 35-39 and 0.29% at ages 60-64. Urban residence and higher education were associated with uptake (urban aPR 1.19, 95% CI 1.11-1.27; bachelor's or higher aPR 1.73, 95% CI 1.58-1.90). The age-by-year interaction was significant, with standardized gains concentrated at ages 35-49. Vaccination was associated with lower HPV16/18 infection (aPR 0.66, 95% CI 0.52-0.85) but not with overall hrHPV or CIN2+. HPV vaccine awareness and uptake were low among women aged 35-64 y in health-resource-limited areas, with strong age, educational and urban-rural gradients and marked site heterogeneity. Uptake increased in 2024, mainly at ages 35-49, and vaccination was associated with a lower prevalence of HPV16/18 infection.