Ashenafi Kibret Sendekie ^1* Biruk Beletew Abate ² Betelhem Anteneh Adamu ³ Aschalew Mulatu Tefera ³ Kaleab Temelket Mekonnen ³ Melkam Alemu Ashagrie ³ Yabibal Berie Tadesse ⁴ Abera Dessie Dagnaw ⁴ Mequannent Sharew Melaku ⁵ Gizachew Kassahun Bizuneh ³

• ¹ Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Amhara Region, Ethiopia
• ² Department of Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
• ³ Departement of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Ethiopia, Gondar, Ethiopia
• ⁴ Department of Medicinal Chemistry, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Amhara Region, Ethiopia
• ⁵ Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia

Background: Human papillomavirus (HPV) vaccinations protect against HPV infections. The infection might lead to vaginal cancer, vulvar cancer, genital warts, cervical intraepithelial neoplasia lesions, and cervical cancer. This study assessed hesitancy of HPV vaccination, associated factors, and barriers to vaccination among youth girls in Ethiopia.Methods: An institutional-based cross-sectional study was conducted among female undergraduate students at the University of Gondar, College of Medicine and Health Sciences, between July and August 2022. The data was collected using a self-administered questionnaire.A simple random sampling method was used to recruit participants. The data were entered and analyzed with SPSS version 26. Descriptive statistics were used to describe the participants' demographic characteristics. Logistic regression was performed to identify the significant factors associated with acceptance of the HPV vaccine. A p-value < 0.05 was considered statistically significant.The study included 423 participants with a mean age of 22.5±6.7 years. Only more than one-third (35.2%, 95% CI: 27.2-44.1) received the HPV vaccine. Currently, more than onefourth (27.9%, 95% Cl: 21.4-33.8) of participants are hesitant to receive the HPV vaccine.Higher monthly income (AOR = 1.52, 95% CI: 1.08-6.34), good knowledge of the HPV vaccine (AOR = 2.12, 95% CI: 1.12-4.87), and a positive attitude towards the vaccine (AOR = 3.03, 95% CI: 1.63-9.56) were significantly associated with acceptance of HPV vaccination. Safety concerns (63.1%), misinformation (42.8%), and parental concerns (42.3%) about the HPV vaccine were among the top perceived reported barriers to receiving the HPV vaccine.This result showed that more than a quarter number of youth girls are still hesitant to receive HPV vaccinations. To increase vaccination acceptance, interventions should focus on awareness-raising programs about HPV infection and vaccines and addressing safety and parental concerns.