Abstract
ObjectivesTo test the effectiveness of a comprehensive team-based intervention to improve human papillomavirus (HPV) vaccination completion rates and reduce missed opportunities to vaccinate in rural Oregon.DesignStepped-wedge cluster randomized trial.ParticipantsForty family physicians and pediatricians who are members of the Oregon Rural Practice-based Research Network.InterventionTailored to individual practice needs, components will include (1) practice facilitation with clinicians, nurses, front office staff, and others who have patient contact to redesign patient care and communication strategies to optimize HPV vaccine series completion; (2) workflow mapping adapted to practice context to support HPV vaccine delivery; (3) a practice improvement model designed to firmly establish reminder and recall systems and then standing orders; (4) education for patients and parents that underscores HPV vaccination is safe, effective, and an important approach for reducing cancer risk; and (5) partnering with community organizations to plan and implement a social marketing campaign on HPV vaccination.Main outcome measuresInitiation and completion of the HPV vaccine series as well as reduction in rates of missed opportunities to vaccinate derived from Oregon Immunization Program data.Trial registrationClinicalTrials.govPRS, NCT03604393: .Trial was registered on July 11, 2018. The first participant was enrolled on September 11, 2018.
Highlights
The human papillomavirus (HPV) types in the current 9 valent vaccine account for about 73% to 88% of cancers of the cervix, vagina, and anus and for approximately 55– 65% of cancers of the vulva, penis, and oropharynx [1, 2]
Though several versions of HPV vaccines have been available in the past, only Gardasil-9, which protects against strains of HPV most closely associated with cancers of the cervix, penis, vulva, anus, and oropharynx, is currently available in the USA
We found that 47% of adolescents at the 53 primary care practices in rural Oregon that we included in this analysis have initiated the vaccine and 24% of patients have completed the series
Summary
The human papillomavirus (HPV) types in the current 9 valent vaccine account for about 73% to 88% of cancers of the cervix, vagina, and anus and for approximately 55– 65% of cancers of the vulva, penis, and oropharynx [1, 2]. About $8 billion is spent annually to manage the sequelae of HPV infections, primarily to manage abnormal cervical cytology and cervical neoplasia [3]. This exceeds the economic burden of any other sexually transmitted infection except for the human immunodeficiency virus [3]. Though several versions of HPV vaccines have been available in the past, only Gardasil-9, which protects against strains of HPV most closely associated with cancers of the cervix, penis, vulva, anus, and oropharynx, is currently available in the USA. The FDA recently expanded licensure of Gardasil-9 (October 5th, 2018) to include adults up to age 45, though most professional bodies have not yet evaluated this option [9]
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