HPV Vaccine Coverage in Adolescents and Its Relationship With Primary Health Care in Belém-Pa in the Years 2021 to 2023

Human papillomavirus (HPV) infection is a serious public health problem and one of the main etiological agents of cervical cancer and other anogenital and oropharyngeal neoplasms. The HPV vaccine, provided free of charge by the Sistema Único de Saúde (SUS), is an effective preventive strategy. However, coverage remains uneven between sexes and across territories. To analyze HPV vaccination coverage in adolescents aged 9 to 14 years in the municipality of Belém, Pará, from 2021 to 2023, comparing it with Primary Health Care (PHC) coverage in the same period. Descriptive study with a quantitative approach, based on secondary data from the e-Gestor AB and Programa Nacional de Imunizações information systems of the Departamento de Informática do Sistema Único de Saúde (SI-PNI/Datasus). Information on PHC coverage in the municipality and percentages of quadrivalent HPV vaccination for boys and girls from 2021 to 2023 were collected. PHC coverage in Belém was 26.45% in 2021, 38.12% in 2022 and 31.70% in 2023, remaining below the minimum target of 70%. Vaccination coverage in girls was considerably higher than in boys in all years, reaching 71.20% (2021), 66.98% (2022) and 68.50% (2023). For boys, rates were significantly lower: 32.19% (2021), 32.28% (2022) and 42.14% (2023). It was also observed that changes in PHC coverage did not directly mirror variations in vaccination: despite PHC expansion in 2022, coverage remained stable for boys and slightly decreased for girls. In 2023, PHC coverage declined, but there was a significant increase in vaccination among boys, suggesting that immunization may be influenced by specific actions disconnected from primary care. This disconnection points to weaknesses in the articulation between PHC and vaccination strategies, particularly regarding active case-finding and outreach actions. Weak PHC in Belém hinders effective implementation of public policies that promote comprehensive and equitable immunization. The results reinforce the need for intersectoral actions, with stronger links between health and education, and specific campaigns targeting the vaccine-eligible population to expand equitable access to immunization and reduce existing vulnerabilities.