Improving Access to HPV Vaccination for Inpatient Postpartum Women at Naval Medical Center San Diego [19M

Abstract

INTRODUCTION: Human Papillomavirus (HPV) is the most common sexually transmitted infection in the US and is thought to be the etiologic agent in 99.7% of cervical cancers 1, 2. Despite this, in 2016, only 51.4% of adolescents ages 13-17 have completed the full HPV vaccination series. Vaccination rates at Naval Medical Center San Diego mirror national trends. In our postpartum care, ensuring inpatient vaccination of for diseases (i.e. MMR, Tdap, VZV) is well established, however HPV vaccination was not available on the ward. We sought to develop and evaluate a process improvement program aimed at improving HPV vaccination rates by incorporating screening and administration into an established inpatient postpartum vaccination program. METHODS: Women ages 9 to 45 were evaluated for eligibility and offered the nine valent HPV vaccine as inpatients on the postpartum ward. An IRB exempt retrospective chart review pre- and post- intervention was conducted to determine vaccination status and rates of vaccination. The results were stratification based on active duty status and age. RESULTS: For all patients prior to intervention, the vaccination rate was 6.4% in the postpartum period when the vaccine was only available in the outpatient clinic. After implementation, the overall vaccination rate rose to 33.3% for postpartum patients (RR 5.2, CI 2.54-10.75, P<.0001). Women 26 years of age or younger were 11.2 times more likely to receive vaccination post-intervention (RR 11.2, CI 2.64-47.29, p=0.001). CONCLUSION: An inpatient postpartum HPV vaccination program is associated with increased rates of vaccination.