Randomized Controlled Trial of Impact of Mobile Health Technologies on Human Papillomavirus Vaccination Uptake in Mothers of Vaccine-Eligible Girls in Lagos, Nigeria (mHealth-HPVac)

Abstract

Purpose: Expanding high-risk human papillomavirus (HPV) vaccine coverage in resource-constrained settings is critical to bridging the cervical cancer gap and achieving the global action plan for elimination. Mobile health (mHealth) technology via short message services (SMS) has the potential to improve HPV vaccination uptake. The mHealth-HPVac study evaluated the effectiveness of mHealth interventions in increasing HPV vaccine uptake among mothers of unvaccinated girls aged 9-14 years in Lagos, Nigeria.

Methods: A randomized controlled trial was conducted at the Lagos University Teaching Hospital between June 2024 and March 2025. We randomly assigned n = 180 eligible mothers to either a text message (intervention) or a usual care (control) arm. The primary analysis was conducted using the intention-to-treat principle. Bivariable and multivariable logistic regression models were performed to compare HPV vaccination uptake between the two arms, adjusting for potential confounders using odds ratios (ORs) and 95% CIs.

Results: mHealth intervention significantly increased HPV vaccination uptake among mothers of vaccine-eligible girls (adjusted odds ratio [adj OR], 3.05 [95% CI, 1.61 to 5.77]; P = .001). Higher education level was also significantly associated with increased vaccine uptake (adj OR, 3.35 [95% CI, 1.77 to 6.33]; P < .001). There were no significant interaction effects by baseline characteristics on the association between mHealth intervention and HPV vaccine uptake.

Conclusion: The study showed that mHealth interventions significantly improve HPV vaccine uptake. Integrating mHealth strategies into routine immunization programs could be a scalable and cost-effective approach to increasing HPV vaccination coverage. However, future multicenter studies should consider using cluster randomization at the facility level to better optimize mobile interventions for diverse populations, identify the key drivers of successful SMS-based mHealth interventions, and gain deeper insights into the complex barriers to HPV vaccination uptake.

Trial registration: ClinicalTrials.gov PACTR202406727470443.