Introduction: Human papillomavirus (HPV) drives a wide spectrum of disease beyond cervical cancer (CC), including anogenital cancers and warts, head and neck cancers (HNCs) and recurrent respiratory papillomatosis (RRP). Globally, HPV-attributable malignancies caused ~1.5?million new cases and 755,000 deaths in 2022, with HPV-positive HNCs especially oropharyngeal cancers among men rising sharply. RRP, though rare (~1–4 per 100,000), imposes high morbidity and costs due to repeated airway surgeries and long-term management.
International analyses estimate direct healthcare costs per RRP patient at USD 75,000 within two years of diagnosis, with national systems spending tens to hundreds of millions annually. Indirect costs from lost productivity and quality-of-life impacts further magnify the burden. While cervical cancer mortality is most visible, the combined morbidity, chronic care needs, and psychosocial impacts of HPV-associated diseases remain underrecognized.  
In Armenia, CC is the leading HPV-related malignancy (~178 new cases, 115 deaths annually). National data also show measurable HNC incidence: laryngeal cancer (~9.3/100,000 males), oral cavity cancer (~2.9/100,000 males), and oropharyngeal cancer (~0.36/100,000 males). HPV-associated HNCs and RRP represent a hidden but clinically significant burden, with repeated interventions and chronic morbidity. Population studies indicate 4.5% of unvaccinated women carry HPV, and 71% of cervical cancers involve HPV-16/18, underscoring vaccine benefits.  
Objective: This study aimed to evaluate health workers’ capacity to deliver HPV-associated disease prevention by examining their knowledge of risk factors, adoption of robust preventive strategies, and use of evidence-based communication practices are elements that directly mirror and influence overall health system performance.
Methods:We triangulated national statistics, epidemiological data with qualitative insights from focus groups and individual interviews involving 35 physicians across ENT, dermatology, gynecology, urology, and primary care. Discussions explored vaccine perceptions, screening practices, training needs, and readiness for policy innovation.
Results: RRP imposes high morbidity due to repeated airway surgeries, while HPV-attributable HNCs are rising. Knowledge gaps were striking: only ~45% of health workers recognized the broad HPV disease spectrum, and only two physicians were aware of HPV-related RRP. Interviews revealed ~1,000 patients with anogenital warts treated annually, yet these cases remain absent from national statistics, reflecting a hidden burden. Fewer than 30% of interviewed physicians were vaccinated, ~50% had ever undergone Pap testing, and only half expressed full confidence in vaccine safety and effectiveness profile. While 60% supported transition to earlier vaccination at age 9 and 72% gender-neutral strategies, most providers emphasized the need for transdisciplinary training spanning epidemiology, immunology, oncology, behavioral sciences, and digital health. Barriers included limited interoperability, though readiness was expressed for advanced diagnostics such as HPV PCR screening and AI-assisted colposcopy.
Conclusions/ Implementations for Practice and Policy: An Integrated Framework of Implementation Science (IS) and Knowledge Management (KM) is essential in Armenia. IS provides structured methodology to embed evidence-based interventions: vaccination, screening, counseling, into routine workflows.  KM complements this by equipping providers with interoperable platforms, updated guidance, and transdisciplinary training, transforming evidence into practice. Together, IS and KM strengthen health system performance, enhance provider confidence, and reduce variability in care.  

HPV Vaccination Coverage in Armenia