Background
In Tanzania, since the introduction of the 2 dose HPV vaccine in 2018 for nationwide vaccination among girls aged 9 – 14 years, the uptake of the second dose was low. Since the national roll-out of the HPV vaccination program, several studies have shown a mismatch between the level of acceptance and levels of vaccine uptake, especially the second dose. In 2024, the country adopted the one dose vaccine schedule as currently recommended by the WHO providing the quadrivalent vaccine. The national wide campaign in 2024 that targeted five million eligible girls over a week and was reported to be successful achieving a 97% reach. Even with the recorded success, inter and intra-school variation of the vaccine uptake has been noted and variation across different regions and communities. Previous studies suggested cultural, religious and organizational barriers affecting the uptake of the vaccine. There is paucity of data highlighting the barriers through the lived experiences of unvaccinated eligible girls and their caretakers in Tanzania.  

Objective
To explore the barriers of HPV vaccination among adolescent girls and their caretakers in Dar es Salaam, Tanzania.

Methods
An exploratory qualitative study design will be used to conduct Focus Group Discussions (FGDs) with adolescent girls and In-Depth Interviews (IDIs) with their caretakers in two municipalities (Ilala and Ubungo) of the Dar es Salaam region. Purposive sampling was conducted to include public and private schools from both districts with a high and low uptake of the vaccine. The socio-ecological model was used to create a semi-structured interview tool that was used to explore individual, family, environmental and institutional related factors. Content analysis was done using a deductive approach with aid of NVIVO software.

Results
4 FGD’s were conducted among unvaccinated eligible girls in both the high and low performing schools in vaccine uptake each FGD with an average of 12 girls lasting an average of 1 hour. 27 IDI’s were held with teachers, matrons, counsellors and parents of the recruited girls each lasting an average of 45 minutes. 5 themes emerged from the interviews including inadequate vaccine campaigns showing gaps in knowledge on benefits and adverse effects. Poor involvement of stakeholders mostly parents whose consent was needed for vaccination. Inadequate vaccine access and availability especially in private and faith-based schools where no vaccination activities were held and few doses in public schools.  Influence against vaccination from peers, community and family and faults in information sharing whereby participants reported misinformation and gaps in details surrounding the vaccination activities.  

Conclusion
Barriers to vaccine uptake are multi-factorial cutting across the individual, interpersonal, environmental and organizational levels. The national HPV vaccination program should endeavor to hold vaccine campaigns better adapted to reach the adolescent girls and their surrounding community while emphasizing adequate involvement of parents. Further effort should be directed towards continuity of the vaccination campaigns and exercise ensuring adequate reach and access to all eligible girls.