Abstract
BackgroundHPV4 is approved as a series of three timed doses expected to result in efficacy against specific HPV infections. Completion rates in the US are quite low at the same time the structure of health care delivery is changing. The aim of this study was to determine how the patient-, clinic- and systems-level characteristics facilitate or hinder the timely completion of three HPV4 doses in both adolescent and adult female populations in a high-risk safety net population.MethodsThis is a retrospective study in which patient-, clinic- and systems-level data are abstracted from the electronic medical record (EMR) for all females 10–26 years of age receiving at least one dose of HPV4 between July 1, 2006 and October 1, 2009.ResultsAdults were more likely to complete the three dose series if they had at least one health care visit in addition to their HPV4 visit, (aOR = 1.54 (95% CI:1.10, 2.15). Adults were less likely to complete the three dose series if they received their second HPV4 dose at an acute health care, preventive care or postpartum visits compared to an HPV4-only visit (aOR = 0.31 (95% CI: 0.13, 0.72), 0.12 (0.04, 0.35), 0.30 (0.14, 0.62), respectively). Hispanic adults were less likely than whites to complete the series (aOR = 0.24 (95% CI:0.10, 0.59). 39% of adolescents who completed two doses completed the series.ConclusionsHPV4 is more likely to be effectively administered to adults in a safety net population if multiple health care needs can be met within the health care system.
Highlights
Cervical cancer has continued to decline in the US to 8.0/ 100,000 because of Pap screening programs that depend on colposcopy and excisional treatments [1]
The two prophylactic human papillomavirus (HPV) vaccines, approved to prevent HPV 16 and 18, prevent, to various degrees and for uncertain durations, two (HPV4) and seven (HPV2) oncogenic HPV types associated with cervical cancer [2,3,4]
Three quarters of all females had at least one pregnancy prior to HPV4 vaccination, including 6% of the 10–13 year olds; and 30% of those screened had past abnormal cytology
Summary
Cervical cancer has continued to decline in the US to 8.0/ 100,000 because of Pap screening programs that depend on colposcopy and excisional treatments [1]. The two prophylactic human papillomavirus (HPV) vaccines, approved to prevent HPV 16 and 18, prevent, to various degrees and for uncertain durations, two (HPV4) and seven (HPV2) oncogenic HPV types associated with cervical cancer [2,3,4]. Both vaccines are efficacious in a three dose regimen for reducing the incidence of cervical intraepithelial neoplasia grade 3 (CIN 3), and the need for colposcopies and excisional procedures [5]. The aim of this study was to determine how the patient-, clinic- and systems-level characteristics facilitate or hinder the timely completion of three HPV4 doses in both adolescent and adult female populations in a high-risk safety net population
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