People were eager to learn about the HPV vaccine. Religious leaders reported that this was the first time that staff from a health programme had come to discuss a health intervention with them, and that they would discuss cervical cancer and HPV vaccination with their congregations. Limitations of the qualitative sub-study included the fairly small purposive samples and the fact that, in schools, a teacher selected the parent, student and teacher participants for GDs who might have been the most accepting of new health interventions.

However, the interviewer then selected IDI see more participants from the groups. These included several teachers who opposed vaccination, parents who asked critical questions, and female students who stated they would defy parental wishes in terms of accepting vaccine. In USA, beliefs about the safety of vaccines, likelihood

of HPV infection, as well as doctor’s recommendations, have been associated with increased HPV vaccine acceptability [39], [40] and [41]. In Mwanza, anti-fertility rumours, experience of previous school-based health interventions for girls, and lack of knowledge about cervical cancer in targeted communities, including amongst health workers, buy Talazoparib could be a potential challenge to vaccine uptake. It will therefore be essential that correct information about HPV vaccination is provided to parents, pupils, community members and key personnel (teachers, health workers) to help prevent the emergence and/or spread of rumours before and during HPV vaccination programmes. In light of the recent price reduction of the Gardasil® vaccine for low-income countries [42], many African governments may now consider

adding the HPV vaccine to their national programs. Our research identified key issues related to vaccine acceptability and allowed adaptation of communication materials for the subsequent HPV vaccination Thymidine kinase demonstration project in Mwanza. Our findings also informed health worker training on issues related to obtaining parental agreement to vaccinate daughters, and rumour management. For a successful national programme on cervical cancer prevention, health workers should acquire additional training on the disease and prevention strategies. Adequate sensitisation, through school and/or community meetings and mass media, of all relevant populations, including parents, students, teachers, community and religious leaders will be essential for the success of a national HPV vaccination campaign in Tanzania.