Availability of Human Papillomavirus Vaccine at Medical Practices in an Area with Elevated Rates of Cervical Cancer

Abstract

To assess availability of human papillomavirus (HPV) vaccine at medical practices in an area with elevated cervical cancer rates. During July-November 2007, we conducted a telephone survey of staff at medical practices providing outpatient care to 9- to 26-year-old females in four North Carolina counties with elevated cervical cancer rates. We assessed availability of HPV vaccine and concerns about its provision. Staff from 71 of 96 eligible practices completed a full interview. Overall, 62% of these practices had HPV vaccine available to patients (family practice, 74%; pediatrics, 75%; obstetrics-gynecology, 64%; internal medicine, 15%). In multivariate analysis, practice characteristics that independently predicted a lower likelihood of carrying HPV vaccine were having at least 50% African-American patient population (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.06-0.63) and providing only privately purchased (and no state-supplied) vaccines (OR 0.19, 95% CI 0.06-0.63). HPV vaccine nonproviders were significantly more likely than HPV vaccine providers to report "large" concerns about the up-front costs of purchasing HPV vaccine (52% vs. 27%, p < .05) and late reimbursement (33% vs. 14%, p < .05). Approximately 1 year after its introduction, HPV vaccine was available at three-quarters of family practice and pediatrics practices, two-thirds of obstetrics-gynecology practices, and few internal medicine practices in an area with elevated cervical cancer rates. Practices' concerns about cost and reimbursement have implications for accessibility of HPV vaccine to those who need it most.