To assess determinants of human papillomavirus (HPV) vaccine non-uptake among adolescent girls in Ethiopia.

Community-based cross-sectional study.

Ethiopia.

A weighted sample of 5341 adolescent girls.

A secondary analysis was conducted using the 2024 Ethiopian National Immunization Evaluation Survey dataset. A two-stage stratified sampling technique was used to select 467 enumeration areas (EAs). Within each EA, 30 households with adolescent girls aged 15–18 were systematically selected. Data were collected using a semi-structured questionnaire. Mixed-effects logistic regression was used to identify individual-level and/or household-level, and community-level determinants. Associations were presented using adjusted ORs with 95% CIs and statistical significance was set at p

Individual and household-level determinants of HPV vaccine non-uptake include age 17–18 years (adjusted OR (AOR)=1.41; 95% CI 1.16 to 1.72), illiteracy (AOR=3.03; 95% CI 2.14 to 4.28), not currently attending school (AOR=2.84; 95% CI 2.24 to 3.60), poor knowledge (AOR=8.91; 95% CI 6.63 to 11.99), unfavourable attitude (AOR=4.24; 95% CI 3.34 to 5.37) and living in the poorest households (AOR=1.48; 95% CI 1.04 to 2.10). Community-level determinants were urban residence (AOR=1.40; 95% CI 1.01 to 1.95); and living in Addis Ababa (AOR=2.73; 95% CI 1.29 to 5.74), Afar (AOR=4.73; 95% CI 2.08 to 10.77), Dire Dawa (AOR=2.69; 95% CI 1.21 to 5.98), Harari (AOR=2.09; 95% CI 1.05 to 4.14) and Somali (AOR=3.68; 95% CI 1.61 to 8.38).

The determinants of HPV vaccine non-uptake were older age (17–18), illiteracy, school non-attendance, poor knowledge, unfavourable attitude, living in the poorest households, urban residence and living in Addis Ababa, Afar, Dire Dawa, Harari and Somali. The findings call for improved health literacy, knowledge and attitude through health extension programmes and targeted outreach in underserved urban and pastoralist settings.