BACKGROUND: Cervical cancer is the leading cause of cancer-related mortality among women in sub-Saharan Africa (SSA), but almost entirely preventable through prophylactic human papillomavirus (HPV) vaccination. The introduction of HPV vaccines has been challenging in low and middle income countries (LMIC), with a major barrier being the costs and logistical challenges of delivering the vaccine as a multi-dose schedule. In addition, data on HPV epidemiology in SSA needed to inform HPV vaccination strategies have historically been limited. METHODS: This analytic commentary aims to synthesise and critically appraise the published results of two studies on HPV epidemiology and two studies on HPV vaccine in Tanzania. These studies included one of the first prospective studies of HPV epidemiology in East Africa, a cross-sectional study in adolescent girls around the time of sexual debut, the first trial of HPV vaccine in SSA (HPV-021), and the first randomised trial of single-dose HPV vaccination in girls in the target age range for vaccination (9-14 years), the DoRIS trial. The main overarching objectives of these studies were to assess: the prevalence and incidence of HPV infection among adolescent girls and young women in Tanzania; the effect of malaria and helminth infections on HPV vaccine immune responses; and whether a single dose of HPV vaccine given to the target age for routine vaccination produces immune responses that are likely to be effective in preventing cervical cancer in SSA. RESULTS: Our cohort study found one of the highest HPV prevalences (55%) and incidence rates (51/100 person-years for high-risk (HR) HPV) described globally for young females in the general population. HPV prevalence among adolescent girls around the time of sexual debut was also very high (32%). However, in this age group, prevalence of most vaccine genotypes was low. In the HPV-021 trial, there was no evidence that malaria or helminth infections decreased vaccine antibody responses following 3 doses of HPV vaccine. In the DoRIS trial, 99% of girls in the 1-dose arms were HPV16 antibody seropositive at month (M)24, and seropositivity was non-inferior to that in the 2 and 3 dose arms. Although the prespecified non-inferiority criteria were not met for HPV18, ≥98% girls in the 1-dose arms were HPV18 seropositive, and HPV 16/18 antibody avidity was non-inferior to that generated by 2 and 3 doses. HPV16/18 antibody geometric mean concentrations (GMCs) in the 1 dose arms were non-inferior to those in observational cohorts of women who received a single dose of HPV vaccine and in whom vaccine efficacy had been shown. CONCLUSIONS: Data from our HPV epidemiology studies in Tanzania showed that, without HPV vaccination or screening programmes in place, it is likely that cervical cancer would continue to contribute significantly to morbidity and mortality among women in the region. The results from the DoRIS trial showed that one dose of HPV vaccine induces immune responses in young girls that are comparable with those seen in young women in whom efficacy has been shown, and are sustained for up to two years after vaccination. In 2022, the World Health Organization (WHO) endorsed a 1-dose regimen for individuals aged 9-20 years, based in part on evidence from the DoRIS trial.