Inequitable by design: A critical review of national HPV vaccination programmes and their approaches to out-of-school girls

Most national HPV vaccination programmes rely on school-based delivery, which excludes girls who are temporarily or permanently out of school or beyond school age. This critical review of 23 studies on non-school delivery strategies for girls aged 9-19 in low- and middle-income countries finds very little evidence on coverage, outcomes, or effective approaches for reaching out-of-school girls. It identifies multisectoral collaboration, community health workers, and targeted communication as promising strategies, and calls for delivery approaches designed specifically for these girls.