In Ethiopia, where cervical cancer is the second most common cancer among women, the school-based HPV vaccination strategy structurally excludes out-of-school girls — particularly in pastoralist and hard-to-reach communities. The HPV-VISION project evaluated two community-based integration models across four districts: integration into routine immunisation services (ARM 2) and integration into Adolescent and Youth-Friendly Services (ARM 3), following household mapping of 18,831 girls and training of 322 health workers and 465 community mobilisers. Across both arms, 63% of vaccinated girls were out-of-school, with YFS integration (ARM 3) proving particularly effective at reaching older out-of-school adolescents and exceeding its vaccination target by 108%. The findings demonstrate that integrating HPV vaccination into existing community health platforms is both effective and equity-enhancing, offering a scalable model for low-resource settings with low school enrolment.