Introduction In 2014, HPV vaccination program was launched to fifth grade female students in Phra Nakhon Si Ayutthaya province in Thailand. The overall HPV vaccination coverage was 91%, but sub-provincial HPV vaccination coverage varied due to multiple factors. This study aimed to explore factors associated with HPV vaccination coverage at school level during the introduction of HPV vaccine to the national immunisation program.

Methods A retrospective cohort study was conducted in Phra Nakhon Si Ayutthaya province, 613 fifth grade female students from 47 schools were surveyed to determine HPV vaccination coverage at school level. Teachers, healthcare workers (HCWs) and students were interviewed using standardised questionnaire to assess their knowledge and attitude about cervical cancer, HPV vaccine and HPV vaccination program. Furthermore, we explored programmatic activities that might affect HPV vaccination performance then conducted the multiple linear regression analysis to determine their relationship to HPV vaccination coverage at school level.

Results HPV vaccination coverage at schools range from 61.5 to 100 percent. Multiple linear regression analysis revealed that “HCWs knowledge that HPV vaccine safety and efficacy was carefully reviewed prior to registration” (B = 42.2, p-value < 0.01) and “HCWs supported HPV vaccine introduction in the national immunisation program” (B = 8.9, p-value = 0.01) related to increasing HPV vaccination coverage, while “providing vaccine information statement (VIS) to parent” shown a negative relationship (B = -7.6, p-value = 0.04). However, there was no evidence that teacher or student knowledge and attitude were related to HPV vaccination coverage at school level.

Conclusion HCWs’ confidence in HPV vaccine efficacy and safety and their support to HPV vaccine as a part of national immunisation program related to better HPV vaccine coverage, however, providing VIS to parents prior to HPV vaccination shown negative impact on HPV vaccination coverage at school level during HPV vaccine introduction.

Disclosure of interest statement This study was supported by the Department of Disease Control, Ministry of Public Health of Thailand. No pharmaceutical grant was received in the development of this study.