Background: Cervical cancer is the third most common malignancy among Colombian women (1). The Expanded Program on Immunization (EPI) includes the quadrivalent HPV vaccine for children 9–17 years of age, regardless of gender; however, coverage in 2024 remained close to 30% (2). A key factor contributing to this low uptake has been the discontinuation of school?based vaccination strategies (3). To address this gap, the National Cancer Institute, in alliance with the Ministry of Science, Technology and Innovation and regional stakeholders, developed the study “Effectiveness of two educational interventions aimed at increasing HPV vaccination coverage in four regions of Colombia” (ClinicalTrials.gov ID NCT07113236). This work aligns with the WHO cervical cancer elimination initiative and seeks scalable solutions for low? and middle?income countries.

Objective:

To evaluate the effectiveness of two school?based educational interventions to increase HPV vaccine coverage in four regions of Colombia.

Methods: A pragmatic cluster?randomized controlled trial was conducted in educational institutions located in municipalities with reported HPV vaccination coverage below 25%. Context?specific educational materials were developed for each region, and structured training on HPV?associated cancer prevention was delivered to health and education personnel. Parents or guardians and children belonging to the EPI target cohort were invited to participate. All study arms received a community?based psychoeducational intervention; additionally, clusters were randomized to: Group 1, a face?to?face session delivered by a health professional; Group 2, a face?to?face session delivered by a teacher with support from a health professional; or Control, community intervention only. Immediately after each session, school?based vaccination sessions were implemented and extended up to 30 days in municipal health facilities. Outcomes included: receipt of at least one HPV vaccine dose within 30 days, acceptability of HPV vaccination, and perceived effectiveness of the strategies. Quantitative analyses followed the intention?to?treat principle, and a complementary qualitative analysis explored contextual barriers and facilitators. Data were analysed using R version 4.4.1.

Results: A total of 1,200 parents and children were invited (n=400 per arm), with a participation rate of 59.8% (n=718). Despite regional heterogeneity, recurrent barriers to vaccination were identified: misinformation and myths (infertility, early sexual activity, confusion between HPV and HIV), institutional mistrust, sociocultural stigma around cancer and sexuality, and logistical barriers such as limited geographic access and restricted vaccination sessions. After the interventions, vaccine acceptability among participating children reached 49.4% in the teacher?led group with health?professional support, 40.7% in the health?professional?led group, and 8.5% in the control group (p<0.001), indicating that teacher?led strategies more than quintupled acceptability compared with usual practice.

Conclusion: Teacher?led, school?based educational interventions substantially increased HPV vaccine coverage compared with standard community approaches. Integrating HPV and cancer prevention content into school curricula and empowering trusted educators, while maintaining close collaboration with health professionals and ensuring immediate on?site vaccination, provides a feasible and scalable model. These findings offer an implementation?ready strategy to recover and expand HPV vaccination coverage in resource?limited settings, with direct implications for accelerating progress toward global cervical cancer elimination targets.