Abstract
BACKGROUND: Persistent infection with high-risk human papillomavirus (HPV) types is a well-established risk factor for various malignancies, and timely vaccination of university students is a cost-effective strategy to reduce infection rates and the burden of HPV-associated consequences. Although many studies have examined HPV knowledge, vaccine acceptance, and uptake in university students, findings remain heterogeneous, and comprehensive quantitative synthesis is limited. This systematic review and meta-analysis aims to assess global estimates of university students' knowledge of HPV and its vaccine, willingness to receive the vaccine, and actual vaccination behaviors. METHODS: The study was reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 Checklist. A systematic search was conducted in PubMed, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure and Wan Fang Database for studies published from January 2006 through August 2024. Studies with quality assessment scores > 5 and published in Chinese or English were included for data extraction. Pooled prevalence estimates and 95% confidence intervals (CI) were calculated using the Freeman-Tukey double arcsine transformation. The heterogeneity statistic I-squared and corresponding p value were also reported. RESULTS: A total of 56 studies covering 184,351 university students from four continents (Asia, Africa, Europe and North America) were included. Among students, 68.3% (95% CI 56.4%-79.0%) and 53.5% (95% CI 53.0%-54.1%) were aware of HPV and HPV vaccine, respectively, with significant gaps in knowledge about HPV symptoms, cervical cancer screening methods, and optimal vaccination timing. Pooled HPV vaccination willingness was 52.9% (95% CI 44.2%-61.6%), with higher willingness observed among females and medical students. Only 10.4% (95% CI 6.1%-15.8%) had received at least 1 dose of vaccination and 12.4% (95% CI 3.0%-26.9%) had completed the full three-dose schedule. Vaccination coverage among females was 8.6% (95% CI 3.7%-15.1%), and among medical students, 7.7% (95% CI 1.3%-18.4%). CONCLUSIONS: This meta-analysis found that university students exhibit limited awareness of HPV and its vaccine, with about half willing to be vaccinated. Actual vaccination rates remain low and vary widely by gender, major, time of year, and geographic regions. These findings highlight the need for targeted intervention strategies, such as precision education and cross-sector collaboration, to effectively increase HPV vaccination coverage in this population.