HPV Vaccine Completion Research Articles

Effectiveness of Digital Education on Human Papillomavirus Knowledge, Vaccination Intent and Completion Rates in Adolescents and Young Adults: A Meta-Analysis.

To examine the effects of digital educational intervention on HPV knowledge, vaccination intent and completion rates among adolescents and young adults. A systematic review and meta-analysis. The study followed PRISMA guidelines. Studies included randomised controlled trials assessing digital HPV educational interventions on individuals aged 9-26 years. Odds ratios (ORs), confidence intervals (CIs) and standardised mean differences (SMDs) were calculated and analysed with fixed- and random-effects models, depending on the degree of heterogeneity. Seven databases (Medline, PubMed, CINAHL, Cochrane Library, Web of Science, EMBASE and ASC) were searched from inception through April 9, 2024. Twelve studies enrolled 4925 participants were included. Six studies demonstrated that the intervention group significantly had higher HPV knowledge compared to the control group. Five studies reported a significant improvement on vaccination intent and vaccine completion rate. Subgroup analysis of the completion rates indicated that male participants demonstrated significantly greater vaccine competed rates. A tailored educational intervention was likely to effectively enhance HPV vaccine completion rates. Our findings confirmed that digital education was beneficial in enhancing adolescents and young adults' HPV knowledge, vaccination intention and vaccine completion rates. The tailored education might be considered prioritised in the design of interventions, while also considering the impact of gender on digital education. Digital interventions for HPV vaccinations require at least 7 months of follow-up, highlighting the vital role of tailored education for high-risk groups in designing effective interventions. The efficacy of digital interventions for HPV vaccination may differ across genders. There was no direct patient or public contribution, as this is a review of previous research. CRD-42023406919.

Abstract A066: Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019)

Abstract Introduction: The HPV vaccination rates among Asian American adolescents were found to be below optimal levels. Understanding the high-risk demographics and the various factors influencing HPV vaccine acceptance is essential for addressing disparities and enhancing vaccination rates in this population. This study aimed to investigate HPV vaccine uptake in adolescents aged 13 to 17 across six major Asian American ethnic groups using nationally representative data. Methods: The study analyzed data from the National Immunization Survey- Teen (2015-2019), comprising 3,968 Asian American adolescents from Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese backgrounds. Provider and practice characteristics were examined alongside HPV vaccine initiation and completion rates within each subgroup. Results: Findings revealed that while the overall initiation rate among Asian American adolescents was 66.65%, significant variations existed among subgroups, ranging from 57.3% in Asian Indians to 71.22% in Chinese adolescents. Similarly, completion rates ranged from 30.89% in Asian Indians to 48.14% in Chinese adolescents, with an aggregated completion rate of 40.37% for the total Asian American sample. Household survey data generally showed lower initiation and completion rates compared to provider-reported data but still reflected subgroup disparities. Conclusion: Across all ethnic groups, a common barrier to HPV vaccination was the lack of physician recommendation. However, slight variations in this barrier were observed among subgroups. These findings underscore the importance of considering socioeconomic, cultural, and acculturation-related factors in designing effective public health and clinical interventions to promote HPV vaccination among Asian American adolescents. Citation Format: Lin Zhu, Elaine Z. Liu, Philip Siu, Chun Pan, Grace X. Ma. Unmasking differences in adolescent HPV vaccine uptake in six Asian American subgroups: data from the national immunization survey-teen (2015-2019) [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A066.

A multilevel intervention to promote HPV vaccination among young adults in Texas: protocol for a randomized controlled trial

BackgroundHuman papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol.MethodsThe study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18–26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4–6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention.DiscussionRecruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden.Trial RegistrationNCT05057312.

Association of Maternal Cervical Cancer Screening Adherence with Adolescent HPV Vaccination Among Adolescent-Mother Pairs.

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11-17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06-1.13) and completion (APR:1.16, 95%CI:1.08-1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01-1.07) and completion (APR:1.12, 95%CI:1.05-1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.

Multicomponent Strategy Improves Human Papillomavirus Vaccination Rates Among Adolescents with Sickle Cell Disease

ObjectiveTo evaluate the effectiveness of a vaccine strategy bundle to increase HPV vaccine initiation and completion in a specialty clinic setting. Study DesignOur Hematology clinic utilized an implementation framework from October 1, 2018, to December 31, 2019, involving nurses, nursing coordinators, and clinicians in administering the HPV vaccination series to our adolescent sickle cell sample of nearly 500 patients. The bundle included education for staff on the need for HPV vaccine administration, provider incentives, vaccines offered to patients in SCD clinics, and verification of patients' charts of vaccine completion. ResultsFollowing the implementation of the bundle, the cumulative incidence of HPV vaccination initiation and completion improved from 28% to 46% and 7% to 49%, respectively. Both rates remained higher post-implementation as well. HPV vaccination series completion was associated with a decreased distance to the healthcare facility, lower state deprivation rank, and increased hospitalizations. ConclusionOur clinic's implementation strategy successfully improved vaccine completion rates among adolescents with SCD while continuing to educate staff, patients, and families on the importance of cancer prevention among people living with SCD.

HPV Vaccination among College Students in the South: The Role of HPV Knowledge on Vaccine Initiation and Completion.

The purpose of this study was to examine factors related to HPV vaccination initiation and completion, especially the role of health knowledge, among college students in a southern state. College students ages 17-45 (n=1,708) were analyzed in this study. Primary outcomes were HPV vaccine series initiation and completion; binary logistic regressions were performed to identify associated factors. Among total participants, students who were aware that HPV could be transmitted even without symptoms were less likely to initiate HPV vaccination. However, among students who have initiated the vaccine series, those who were aware that HPV could be transmitted without symptoms and that men should receive the HPV vaccine were more likely to complete the vaccine series. Other significant variables included age, gender, race, and international student status. Future studies are needed to investigate students' concerns regarding initiating HPV vaccination and how to effectively motivate students to initiate and complete the HPV vaccine series.

Abstract 753: HPV vaccine uptake in survivors of childhood and adolescent and young adult (AYA) cancer

Abstract Introduction: There will be an estimated 110,000 children and adolescents’ cancer survivors in the United States (US) in 2022. Previous studies have argued for the establishment of a specialized adolescent and young adult (AYA) oncology service to better serve their needs. Studies have demonstrated that survivors of childhood and AYA cancers remain at higher risk of developing second primary cancers over their lifetime. AYA cancer survivors are a growing part of the population and will benefit from HPV vaccination. Documenting HPV vaccine uptake among cancer survivors will facilitate interventions to improve vaccination rates in this population. Despite evidence supporting the efficacy of HPV vaccination, AYA vaccination rates are low. Furthermore, studies assessing HPV vaccination coverage in survivors of AYA cancer are lacking. Therefore, we assessed HPV vaccine initiation and completion between survivors of AYA cancer and respondents without a cancer diagnosis among 18-35-year-old in the US. Methods: We analyzed data from the 2017-2018 National Health Interview Survey, an annual cross-sectional national survey that provides information on the health of the noninstitutionalized US population. The outcome variables were HPV vaccine initiation (receipt of ≥1 dose) and completion (receipt of ≥3 doses). Exposure was cancer survivorship (AYA cancer survivors [respondents who were diagnosed with cancer as a child, adolescent, or young adult] vs. respondents without a cancer diagnosis). Weighted multivariable logistic regression models were used to examine the association between cancer survivorship and HPV vaccine initiation and completion, controlling for socioeconomic and healthcare access related factors. Results: A total of 2,942 respondents were included in the study, of which 242 (7.1%) were AYA cancer survivors. HPV vaccine initiation (22.5%) and completion (16.3%) among AYA cancer survivors were comparable to respondents without cancer diagnosis (initiation: 25.5%, completion: 15.3%). In the adjusted analyses, there were no significant differences in HPV vaccine initiation (P=0.6770) or completion (P=0.2001) between AYA cancer survivors and respondents without cancer diagnosis. Conclusions: HPV vaccine series initiation and completion were comparably low among AYA cancer survivors and respondents without a cancer diagnosis in our study. Low uptake of HPV vaccine among AYA cancer survivors is a more notable public health concern given their heightened immunocompromised status and elevated risk for second primary cancers. There is a need for primary care and oncology providers to encourage HPV vaccination and raise awareness of its crucial role among families of AYA cancer survivors. Citation Format: Mrudula Nair, Chaitali S. Dagli, Betelihem B. Tobo, Samantha H. Tam, Nada Al-Antary, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. HPV vaccine uptake in survivors of childhood and adolescent and young adult (AYA) cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 753.

Vaccine Schedule Disparities Exist for Pediatric Patients with Sickle Cell Disease

Background: Sickle cell centers and pediatricians often work together to ensure appropriate vaccination of patients with sickle cell disease (SCD). Patients with SCD are at high risk for serious infections with encapsulated bacteria, such as Neisseria menigitidis and Streptococcus pneumoniae; thus, vaccine recommendations for pediatric patients with SCD differ from those for the general population. The University of Alabama at Birmingham Lifespan Comprehensive Sickle Cell Center (UAB) encompasses four care locations: the academic center in Birmingham and three satellite clinics (Montgomery, Opelika, Tuscaloosa). Unlike the academic center where providers are reliant on pediatricians to ensure adherence to recommended vaccines (with the exception of PPSV23), patients seen in the satellite clinics are provided with a prescription for PPSV23 and instructed to obtain it through their pediatrician. Data from prior studies suggest that pediatric patients with SCD may have lower vaccination rates than the general population. Thus, the purpose of this study was to determine adherence to recommended SCD-specific vaccination schedules among pediatric patients cared for at UAB , by: 1) determining the mean age at initiation of the HPV, MenACWY, Men B, and PPSV23 vaccines among UAB pediatric patients, compared with SCD-specific recommendations for initiation of each of these vaccines; and 2) comparing vaccination rates for HPV, MenACWY, and Men B among UAB pediatric patients age 13-17 years vs. general population peers. Methods: We performed a retrospective chart review of clinic notes and the Alabama state vaccine registry (Immunization Patient Registry with Integrated Technology [ImmPRINT]) for records of UAB patients, to determine the age at vaccine initiation and number of doses received for HPV, MenACWY, Men B, and PPSV23 vaccines for all 870 UAB patients aged 3-22 years. We calculated the mean age at which the UAB patients initiated each vaccine, the proportion of patients completing each vaccine series, and (for PPSV23) whether patients were vaccinated at UAB or at another location. We used CDC published vaccination rates for HPV, MenACWY, and MenB from 13-17-year-olds in the general population (Pingali et al., MMWR Morb Wkly Rep 2021) to compare with rates from UAB patient peers. Results: The 870 UAB patients were an average age of 12.1 ± 5.4 years; 51.5% were male and 33.9% received most of their care at satellite clinics. HPV vaccination: Mean ±SD age at HPV vaccine initiation was 11.3±1.2 years (recommended age at first dose=11 years, there are no SCD-specific guidelines for HPV vaccination); coverage for HPV vaccine series initiation and completion among 13-17-year-old UAB patients vs. general population peers was 77.8% vs. 75.1% and 58.2% vs. 58.6%, respectively (Table). Meningococcal [MenACWY] vaccination: Mean±SD age at MenACWY initiation was 11.2±1.8 years (recommended age for patients with SCD is 2 months (MenACWY Menveo) or 24 months (MenACWY Menactra); recommended age for general population is 11 years). We found that patients with SCD were 32 (95% confidence interval [CI]: 22-47) times more likely to receive MenACWY after age 11 years. Meningococcal B [MenB] vaccination: Mean age at MenB initiation was 13.5±2.3 years (recommended age for SCD patients is 10 years; vaccine is optional for general population); coverage for ≥1 MenB dose among 13-17-year-old UAB patients vs. general population peers was 17.5% vs. 28.4%, respectively. PPSV23 vaccination: Overall PPSV23 coverage for UAB patients was 70.6%; patients seen at the academic medical center were 1.5 (95%CI, 1.1-2.0) times more likely to receive PPSV23 than patients seen at a satellite clinic (75.2% vs. 59.6%, respectively). Conclusion: Adherence to SCD-specific vaccination age recommendations is poor. We found that patients with SCD were more likely to receive vaccines according to the general population vaccine schedule rather than the SCD-specific vaccine schedule. In addition, reliance on pediatricians to provide PPSV23 for satellite clinic patients resulted in lower PPSV23 vaccination rates among these patients. These data suggest a disparity in adherence to SCD-specific vaccination schedules and suggest the need to develop and test a healthcare provider-focused intervention aimed at improving adherence to the SCD-specific vaccination schedule for children with SCD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

An overview of implementing an evidence based program to increase HPV vaccination in HIV community clinics

BackgroundHPV-related anal cancer occurs in excess rates among people living with HIV (PLWH) and has been increasing in incidence. The HPV vaccine is an effective and safe approach to prevent and reduce the risk of HPV-related disease. Yet, HPV vaccine programs tailored and implemented in the HIV population are lagging for this high-risk group.MethodsA pre-post intervention study design will be used to tailor, refine, and implement the 4 Pillars™ Practice Transformation Program to increase HPV vaccination among PLWH. Guided by the RE-AIM framework, the CHAMPS study will provide training and motivation to HIV providers and clinic staff to recommend and administer the HPV vaccination within three HIV clinics in Georgia. We plan to enroll 365 HIV participants to receive HPV education, resources, and reminders for HPV vaccination. Sociodemographic, HPV knowledge, and vaccine hesitancy will be assessed as mediators and moderators for HPV vaccination. The primary outcome will be measured as an increase in uptake rate in initiation of the HPV vaccine and vaccine completion (secondary outcome) compared to historical baseline vaccination rate (control).DiscussionThe proposed study is a novel approach to address a serious and preventable public health problem by using an efficacious, evidence-based intervention on a new target population. The findings are anticipated to have a significant impact in the field of improving cancer outcomes in a high-risk and aging HIV population.Trial registrationNCT05065840; October 4, 2021.

Contributors to cervical cancer disparities in American Indian/ Alaska Native women: Is sufficient research being performed in this population? (572)

<b>Objectives:</b> American Indian/Alaska Native (AIAN) women have 1.5 times the incidence and twice the mortality rate of cervical cancer compared to Non-Hispanic White (NHW) women. This disparity is not limited to cervical cancer but is seen in pap smear screening and HPV vaccination uptake. There appear to be few studies in the literature specific to AI/AN women and the prevention and treatment of cervical cancer. We performed a systematic scoping review to evaluate what is known and what gaps in the literature exist related to cervical cancer and its prevention specific to AI/AN women. <b>Methods:</b> We conducted a systematic scoping review of the literature published between 1990 and 2020 regarding <i>1)</i> cervical cancer epidemiology (incidence, prevalence, and mortality); <i>2)</i> cervical cancer screening and prevention (HPV status, HPV vaccine initiation and completion, cervical cancer screening); and <i>3)</i> cervical cancer diagnoses (presence of cervical dysplasia, and cervical cancer stage) among AI/ANs. Medical Subject Headings (MeSH) terms and key search terms were developed to search PubMed and Scopus databases. Abstracts were separately reviewed and compared; disagreements were discussed, and a consensus was achieved. Data were abstracted for included articles. <b>Results:</b> Our search yielded 515 citations; 146 articles met inclusion criteria and were included in our review. The median impact factor for published articles was 2.14 (0-292). Descriptive studies represented 58.9% of all published articles, followed by observational (23.2%) and interventional studies (11.6%). Cervical cancer screen- ing/dysplasia was the most commonly published topic (50.6%), followed by epidemiologic studies (23.9%), HPV (22.6%), and invasive cancer (2.7%). The Indian Health Service (IHS) regions most heavily represented were the Alaska Area and Great Plains Area (Figure 1). Of the 110 articles in which the funding source was documented, 83.6% were federally funded, 11.8% were funded by a non-profit agency, and the remaining 4.6% were funded by a combination of federal, nonprofit, and/or private industry. <b>Conclusions:</b> AI/AN women continue to experience persistent health disparities related to severe dysplasia and cervical cancer. Our review demonstrates that AI/AN women remain understudied in the literature, with a scant 146 articles published over a 20-year period. We conclude that more resources are needed to be invested in the future to eliminate this preventable cancer in AI/AN women.

Human Papillomavirus Vaccinations During the COVID-19 Pandemic in Middle Schools in the Rio Grande Valley of Texas.

This quasi-experimental study (a community-based, physician-led human papillomavirus [HPV] education campaign and school-based vaccination program) followed 6481 students at eight Pharr-San Juan-Alamo Independent School District (Rio Grande Valley, Texas) middle schools between August 2016 and March 2021. We describe the successes and challenges experienced during the COVID-19 pandemic. HPV vaccine initiation and completion rates increased 1.29-fold and 1.47-fold, respectively, between June 2019 and March 2021. Between March 2020 and March 2021, 268 HPV vaccine doses were provided through 24 school-based interventions. Our program continued successes seen in increasing HPV vaccination rates and reducing possible HPV-associated cancers. (Am J Public Health. 2022;112(9):1269-1272. https://doi.org/10.2105/AJPH.2022.306970).

Assessing Attitudes and Beliefs Toward HPV Vaccination among Ghanaian Parents with Unvaccinated Adolescents: Application of Multi-Theory Model of Behavior Change.

Objective:The purpose of the study was to assess the attitudes and beliefs towards HPV vaccination among Ghanaian parents with unvaccinated adolescents using the Multi-Theory Model (MTM) of behavior change. Additionally, we used MTM constructs to predict the likelihood of parents allowing their adolescents to initiate and complete the recommended HPV vaccine series. Methods:A 44-item validated survey was administered among parents with unvaccinated adolescents living in the Ashanti Region of Ghana. HPV vaccine initiation predictors were perceived beliefs and MTM constructs: participatory dialogue, behavioral confidence, and change in the physical environment. HPV vaccine completion predictors were emotional transformation, social environment, and practice for change. Results: Multiple linear regression analyses showed that perceived beliefs (95% CI: 0.03 – 0.14), change in the physical environment (95% CI: 0.06 – 0.15), and behavioral confidence (95% CI: 0.00 – 0.07), were strongly associated with parents’ likelihood of allowing their adolescents to initiate the HPV vaccine series (p<0.001). Together, perceived beliefs, behavioral confidence, and change in the physical environment accounted for 13.6% of the variance (R2 = 0.136). The emotional transformation (95% CI: 0.04 – 0.10), and social environment (95% CI: 0.25 – 0.35), predictors were both strongly associated with parents’ likelihood of allowing their adolescent to complete the vaccine series (p<0.001). Together, emotional transformation and social environment accounted for 45.8% of the variance (R2 = .458). A sample of 380 parents with unvaccinated adolescents, between the ages of 35 – 60 years, participated in this study. Many of the participants were unaware of HPV (98.7%) and its related vaccinations (96.8%). Conclusion: Our findings underscore the need for comprehensive multi-level interventions to create HPV vaccination awareness among Ghanaian parents with unvaccinated adolescents.

Increasing Knowledge of Human Papillomavirus Among Young Adults

HPV is the most common sexually transmitted infection, affecting more than 43 million Americans. HPV is a public health concern because it is the leading cause of cervical, oropharyngeal, vulvar, vaginal, and anal cancer. Despite a highly effective vaccine, the rate of HPV vaccine completion among young adults falls below the Healthy People goal. In efforts to combat this public health concern, an educational brochure was distributed as a quality improvement project in an urban primary care office. After this educational intervention was implemented, there was a significant increase in young adults who received the HPV vaccine from their primary care provider.

Successful HPV Vaccination in Adolescents with Sickle Cell Disease Following a Quality Improvement Bundle Intervention

IntroductionHuman papilloma virus (HPV) infection can cause cervical, anal, penile, vaginal, and oropharyngeal cancer. The CDC recommends HPV vaccination as a 2 or 3-dose series at <15 or ≥15 years, respectively. Completion of the vaccine series decreases rates of cervical cancer in young women by 29%(Guo, F. et al. American Journal of Preventive Medicine 2018). For this reason, focus is currently on vaccinating younger patients to optimize benefit. Historically, adolescents have had low rates of completion of the HPV vaccine series. African Americans, in particular, have significantly lower rates than whites in receiving the full series (De, P. and H. Budhwani. Public Health 2017). Vaccine hesitancy in sickle cell disease (SCD) patients exists and is exemplified by a lower uptake in teenagers with SCD compared to non-SCD counterparts (Beverung, L. et al. American Journal of Hematology 2018). However, completion of 23-pneumococcal vaccine polyvalent (PPSV-23), which is routinely administered as a series during well-child visits, has notably been high. SCD programs serve as medical homes where primary care may also be provided. With this in mind, we introduced a quality improvement (QI) intervention to improve the uptake of HPV vaccination in the adolescent SCD clinic. A bundle intervention was developed including 1) provider education about HPV vaccination importance, 2) nurse review of each adolescent's vaccine records prior to clinic visit, 3) provider notification by the nurse regarding the need for HPV during the visit, 4) discussion of the vaccine benefits with the family, 5) provision of the vaccine in the SCD clinic after parent consent, and 6) offering of MOC points as incentive to providers for project participation. We sought to evaluate the impact of the QI bundle on completion of the HPV vaccine series. We hypothesized that implementation of the QI bundle would increase the rate of completion of the HPV vaccine series among adolescents with SCD. Secondary objectives included association between completion of the HPV vaccine series and frequency of outpatient visits to the SCD clinic, quality of life (QoL), SCD-specific knowledge, completion of the PPSV-23 series, and markers of socio-economic status (SES).MethodsRetrospective data was collected using the Sickle Cell Clinical Research and Intervention Program (SCCRIP) study database (Hankins JS, et al. Pediatr Blood Cancer 2018). Patients aged 12-18 years between October 1, 2018 and December 31, 2019 with any SCD genotype and who were enrolled on the SCCRIP study were included in analysis. The following variables were extracted: age, sex, race, ethnicity, age, economic hardship index (EHI), parental education level, household income, genotype, SCD-specific knowledge, and distance to healthcare facility. The prevalence of completed HPV series, defined as 2 doses ages <15 years and 3 doses ages ≥15 years, in the 12 months prior to implementation of the bundle vaccination program (before October 1, 2018) and after implementation of program (October 2, 2018 to December 31, 2019) was calculated using Fisher's exact. Demographic characteristics and QoL were compared between patients who completed the vaccine series and those who did not.ResultsIn total, 373 patients met inclusion criteria. Their median age was 15.2 (range 12-19), 50% were female, 225 (60.3%) had HbSS/Sβ 0-thalassemia, and 114 (29.7%) had HbC/Sβ +-thalassemia. The mean SES index was 70% (±27%) and the mean QoL score 73 (±14.6). HPV vaccine completion rates increased from 31% to 56.2% after the bundle implementation (Figure 1, p<0.01). Completion of the series was associated with higher SES index, completion of the PPSV-23 series, and higher frequency of outpatient visits. There was no significant association between completion of the vaccine series and QoL, distance from healthcare facility, and disease-specific knowledge (Table 1).DiscussionPrevention of communicable diseases such as HPV is imperative in the general population. However, baseline vaccination rates in adolescents with SCD is low. A QI intervention that includes provider education and incentives, active verification of HPV vaccination status, and promotes coordinated communication between the nurse, providers, and patients effectively increased completion of the HPV vaccine series among adolescents with SCD. Continued strategies are needed to further increase the rates of vaccine completion. [Display omitted] DisclosuresHankins: Vindico Medical Education: Consultancy; Global Blood Therapeutics: Consultancy; UpToDate: Consultancy; Bluebird Bio: Consultancy.

HPV vaccination and factors influencing vaccine uptake among people of Indian ancestry living in the United States.

126 Background: Despite HPV vaccine availability, approximately one-third of annual global cervical cancer deaths occur in India. This may be related to cultural norms that lead to vaccine hesitancy. We sought to determine whether people of Indian ancestry (POIA) who move to the US continue to have disproportionately lower HPV vaccination rates than the rest of the US population and factors that influence HPV vaccine uptake in this group. Methods: The National Health Interview Survey (NHIS) is the largest source of health information for Americans and is designed to be representative of the entire civilian non-institutionalized US population. We utilized the 2018 NHIS to compare HPV vaccine initiation and completion rates between POIA and the general US population and factors correlating with HPV vaccine uptake in this group. Results: There were 17,004 people, representing 185,065,802 in the population, who were between the ages of 18-64 and who responded to questions regarding racial ancestry and HPV vaccination. Of this cohort, 1.69% identified themselves as being of Indian ancestry. Compared to other racial groups, POIA had a significantly lower rate of HPV vaccination (8.18% vs. 12.16%, 14.70%, 16.07%, and 12.41%, in White, Black, Other Asian, and those of other/mixed ancestry, respectively, p = 0.003). However, of those who received one HPV shot there was no difference in vaccine series completion between racial groups (3.17% vs. 4.27%, 3.51%, 4.31%, and 5.04% for POIA vs. White, Black, Other Asian, and those of other/mixed ancestry, respectively, p = 0.465). Among POIA, younger individuals and those who were single were more likely to obtain HPV vaccination (vaccination rates of 38.12%, 6.45% and 1.79% for ages 18-25, 26-45, and 46-64, respectively, p = 0.018, and 29.53% vs. 3.11% for single vs. married, respectively, p = 0.006). All individuals who were vaccinated had some form of health insurance (p = 0.020). Those born in the US had a higher rate of vaccination than those who were not (p = 0.019); however, duration of residence in the US did not influence vaccination rates among POIA (p = 0.502). While high levels of English proficiency were associated with a higher vaccination rate (p = 0.029), education status was not correlated (p = 0.231). Interestingly, both male and female POIA had equivalent rates of vaccination (3.12% and 2.81%, respectively, p = 0.949). Conclusions: POIA are significantly less likely to receive HPV vaccination than the general US population but are equally likely to complete the vaccine series if initiated. Age, insurance status, being born in the US, English speaking proficiency, and marital status significantly influence HPV vaccine initiation among POIA. These data suggest that public health measures promoting HPV vaccination among POIA immigrants may significantly improve vaccination rates among this population.

HPV vaccination uptake and administration from 2006 to 2016 in a commercially insured population of the United States

BackgroundHuman papillomavirus (HPV) infection can cause various cancers and can be prevented through vaccination. The American Cancer Society (ACS) has set an HPV vaccination completion target in 13-year-old children to 80% by 2026. While HPV vaccine coverage (proportion ever vaccinated) estimates are available, annual uptakes (proportion initiating vaccine in a year) in the United States (U.S.) are not well-known.MethodsWe analyzed MarketScan® claims database to assess HPV vaccination uptakes in the U.S. among the 9- to 26-year-olds in 2006–2016. The annual uptake was the ratio of the number of enrollees who had a first record of an HPV vaccine during the year, and the number of enrollees of similar age and sex that year.ResultsUptake was below 1% among children turning 9 and 10 years old during the year. Since 2009 among female and since 2013 among males, the annual uptake has been the highest in those turning 13 years old (19.7% among females and 17.6% among males in 2016). Catch-up vaccination among older adolescents and young adults increased after Advisory Committee for Immunization Practices (ACIP) recommendations, but eventually slowed down as more younger persons were vaccinated. Most young adolescents were vaccinated by pediatricians, whereas young adult women were predominantly vaccinated by obstetricians/gynecologists and young adult males by family physicians. While only about half of the adolescents had well-check visits, the majority of those who initiated HPV vaccination had one the same year.ConclusionContinued increase in uptake is needed to reach the ACS 2026 goals.

Differences in school factors associated with adolescent HPV vaccination initiation and completion coverage in three Australian states

BackgroundSchools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake. MethodsInitiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015–2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25thpercentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage. ResultsMedian initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates. ConclusionThis study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage.

Enrolling a rural community pharmacy as a Vaccines for Children provider to increase HPV vaccination: a feasibility study

BackgroundHuman papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. with over 80 million infected individuals. High-risk strains are associated with 6 different cancers. Although infection is preventable, U.S. vaccination rates remain suboptimal and there are noted disparities between urban and rural communities due to economic barriers, lack of access, and low awareness and education.MethodsThe current pilot study sought to overcome these barriers through an interprofessional collaborative enrolling a community pharmacy in a rural, medically underserved Alabama county as a Vaccines for Children (VFC) provider to provide free vaccines to eligible adolescents. Program evaluation was conducted to determine the intervention’s feasibility. Potential efficacy was assessed by analyzing county-level HPV vaccination uptake and completion rates using state immunization registry data.ResultsOver the 8-month study, 166 total vaccines were administered to 89 adolescents ages 10–18, including 55 doses of HPV vaccine, 53 doses of Tdap vaccine, 45 doses of meningococcal vaccine, and 13 doses of influenza vaccine. Among these adolescents, mean age was 12.6 years old, and 64 (71.9%) were VFC patients. The pharmacy recorded an increase in total vaccine administration of 158.8%, an increase in prescription revenue of 34.8%, and an increase in total revenue by 24.4% during the course of the study, compared to the previous year.ConclusionsFindings from the current work demonstrate the potential of this strategy and can serve as a blueprint for statewide and national dissemination and implementation to ultimately increase access to vaccination services, increase vaccination rates, and reduce urban-rural vaccine disparities.

Provider communication and HPV vaccine uptake: A meta-analysis and systematic review

Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6–13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p < 0.002). Recommendations were equally effective for males and females, for different patient ages, and over time. Provider recommendation was also associated with higher HPV vaccine series completion and follow-through. Provider discussion was similarly associated with higher HPV vaccine initiation (OR = 12.4, 95% CI: 6.3–24.3). In summary, provider communication was robustly associated with HPV vaccination initiation, completion, and follow-through. These findings suggest that US public health efforts to increase HPV vaccine coverage should continue to emphasize provider communication.

88. Parent and Provider Views of Using Pharmacies for HPV Vaccination in Adolescents

<h3>Background</h3> West Virginia (WV) has high rates of HPV-related cancers and lagging rates of HPV vaccination. Recent legislation in WV allows pharmacists to administer the HPV vaccine to adolescents if prescribed by a provider. The purpose of this study was to assess parent and provider views about using pharmacies to provide the HPV vaccine to adolescents. <h3>Methods</h3> Pediatric, Family Practice and OBGYN physicians within a single institution that serves rural counties were surveyed regarding HPV vaccination practice, and awareness of using pharmacies for provision. Teaching sessions with providers then reviewed the legislation and the logistics of prescribing the vaccine through a pharmacy. Six months later the same departments were surveyed regarding HPV vaccination practice, pharmacy provision, and perspectives about this pharmacy service. Parents of adolescents age 11-18 were also surveyed. Adolescent vaccination status, gender, and WV county of residence were collected, along with Likert scale questions about usefulness of pharmacy access for vaccination. Provider responses were compared before and after the teaching intervention after six months. Parental responses were compared by adolescent gender and rural/urban county designation. Proportions were compared using Chi square statistics. Institutional review board approval was obtained. <h3>Results</h3> Seventy one physicians completed the initial survey, and 45 completed the six month assessment. Only 22.5% were aware of the pharmacy legislation initially, and 64.4% were aware at six months (p= <.001). Most providers felt that pharmacy access would be beneficial for rural patients initially and at 6 months (69% vs 78%, p=0.31). Providers also felt they would be "Likely" or "Very Likely" to prescribe the vaccine to adolescents through a pharmacy, and this did not change significantly at 6 months (71.8% vs 73.3%, p=0.86). However, at 6 months only 2 providers (both OBGYN) actually reported prescribing the vaccine this way. 121 parents completed the survey, which represented 196 adolescents age 11-18. HPV vaccine completion was not affected by rural/urban county designation, but overall males were less likely to have completed the vaccine (Figure 1). Rural parents lived closer to pharmacies than their primary care providers (Figure 2), but only 16 (13.2%) parents were aware of pharmacy access for the HPV vaccine. Of parents whose adolescents had started or completed the vaccine series, 78.1% felt pharmacy access would have been "Very beneficial", and this did not vary by rural/urban designation. <h3>Conclusions</h3> Pharmacy provision of HPV vaccination is under- utilized. Both parents and physicians had favorable views on using pharmacies for adolescent HPV vaccination series completion.