In the repeat surveys, we aimed at recruiting ≈1,000 female students 18–20 years of age in each country from the same high schools included in the baseline survey. In Rwanda, we included secondary schools in the Nyarugenge District of Kigali. Of the 22 schools (8 public and 14 private), all but 1 overlapped with the 21 schools included in the baseline survey. In Bhutan, we included high schools in the capital of the country, Thimphu (n = 7), and in the nearby town of Paro (n = 3). Of these 10 schools (3 public and 7 private), 6 overlapped with the 6 schools included in the baseline survey. School authorities gave full support to the conduct of the study, and no school refused participation. The repeat surveys were performed during March–November 2017 (Rwanda) and September–November 2017 (Bhutan). Students in the targeted age groups were invited by school staff to attend study information and recruitment meetings. The large majority of students present at information and recruitment meetings signed the informed consent form, but exact denominators of students by age in each school were not available. In Rwanda, 50 students 17 years of age and 24 students 21 years of age also attended recruitment meetings and were allowed to join the study. Similarly, in Bhutan, 10 students 17 years of age, 68 students 21 years of age, and 30 students 22 years of age also joined the study.

All students who signed an informed consent form received a device for self-collection of urine. Participants were asked to collect first-void urine from the first urination of the day and to return the urine sample on the same morning as collection. Urine samples were recovered at school entry the day after recruitment, and on this day, a short online questionnaire was filled in by a study interviewer (Rwanda) or directly by the student (Bhutan). The questionnaire included information on places of birth and living, history of sexual intercourse, and recalled HPV vaccination status. Urine samples and questionnaires could only be matched through an anonymized identification number.

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