INTRODUCTION:
Coverage of human papillomavirus (HPV) vaccination among girls and pneumococcal conjugate vaccine (PCV) among adults remains below global targets across sub-Saharan Africa, including Kenya. Pharmacy-based immunization (PBI) approaches may help address gaps in immunization coverage. This study aims to describe pathways to vaccination and existing barriers to access and uptake among clients eligible for HPV and PCV in urban settings in Kenya, Ethiopia, and Nigeria. We also explored stakeholders’ perspectives on the PBI models.

METHODS:
The study draws on formative data from qualitative interviews with 70 target end-users/caregivers in Kenya and 10-15 key informant interviews with immunization stakeholders. We also conducted 100 IDIs end-users/caregivers in Nigeria and Ethiopia, and KIIs with 23 stakeholders. Data was analyzed using thematic content analysis and journey mapping techniques.

RESULTS:
Preliminary data found that while caregivers overall had positive perceptions about immunizations; lack of information, myths/misinformation, and doubts about safety/efficacy contributed to hesitancy. Pharmacies were seen as being widely available, convenient, and providing quality medications. Few respondents had concerns about costs, government backing, “illegal services”and immunization knowledge/skills among pharmacy providers. Most key informants from Nigeria had positive perceptions about the PBI model citing potential advantages including improved accessibility and uptake of vaccines, promoting public-private partnership, and reduced cost to consumers. Informants from Ethiopia felt that the success of the PBI model would depend on good training, cold chain equipment, waste management, and government support.

CONCLUSIONS:
Preliminary findings suggest that PBI may address some access and uptake barriers to HPV and PCV vaccination, especially in combination with effective social and behavior change messaging. Insights will inform the design of the PBI model in Africa.