Human Papillomavirus (HPV) is the primary cause of nearly all cervical cancers, as well as the majority of anal, vaginal, vulvar, penal, and oropharyngeal cancers (Saraiya et al., 2015). It is estimated that HPV contributes to 5% of new cancers worldwide (de Martel et al., 2017). Further, the burden of disease is disproportionately experienced by marginalized populations, including those living in poverty, of a minoritized race, ethnicity, gender or sexual identity, and individuals living with HIV (Clifford et al., 2021; Whop et al., 2021; Liu et al., 2016; Benard et al., 2008; Moss et al., 2022). The conditions underlying this higher burden in marginalized populations are multifactorial and vary across groups, settings, and time, but as the differences in disease outcomes for each of these groups can be connected to social and economic barriers to accessing timely, high-quality preventive care (including sexual and reproductive care and cancer screening) (Gleason et al., 2023; Akoto and Allsop, 2023; Mengesha et al., 2023; Suk et al., 2022), these differences are considered health inequities (Braveman, 2022).

HPV vaccination offers an opportunity to greatly reduce the morbidity and mortality of HPV-associated disease, but the short- and long-term impact of vaccination on equity is unclear. Numerous simulation models have been developed, across a variety of countries and settings, to evaluate the impact or cost-effectiveness of HPV vaccination, inform policy, and assess the long-term impact of interventions to improve HPV vaccination (Brisson et al., 2016; Fesenfeld et al., 2013; Suijkerbuijk et al., 2016; Markowitz et al., 2024; Ochalek et al., 2020). The explicit inclusion of systematically marginalized populations in decision models may help demonstrate the impact of vaccination on health inequities as well as guide key policy decisions and implementation of interventions targeting HPV vaccine uptake to maximize effectiveness, efficiency, and equity.

We conducted a systematic review of studies that use HPV vaccination simulation models explicitly incorporating one or more marginalized population (through differentiation of model inputs). We sought to explore which populations were included, what research questions were studied, and what recommendations or conclusions were reached. We also identified areas for future research in the realm of HPV vaccination modeling.