Human Papillomavirus Vaccination Intervention Research Articles

Effectiveness of a School- and Primary Care–Based HPV Vaccination Intervention

The human papillomavirus (HPV) vaccine is safe and effective, yet vaccination coverage remains below public health objectives in many countries. To examine the effectiveness of a 3-component intervention on HPV vaccination coverage among adolescents aged 11 to 14 years 2 months after the intervention ended, each component being applied alone or in combination. A cluster randomized trial with incomplete factorial design (PrevHPV) was conducted between July 1, 2021, and April 30, 2022, in French municipalities receiving 0, 1, 2, or 3 components of the intervention. Randomization was stratified by school district and municipalities' socioeconomic level. Analyses were carried out on 11- to 14-year-old adolescents living in all participating municipalities, regardless of what had been implemented. The PrevHPV intervention had 3 components: (1) educating and motivating 11- to 14-year-old adolescents in middle schools, along with their parents; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school. The primary outcome was HPV vaccination coverage (≥1 dose) 2 months after the intervention ended among 11- to 14-year-old adolescents living in participating municipalities, based on the French national reimbursement database and data collected during the trial in groups randomized to implement at-school vaccination. A total of 91 municipalities comprising 30 739 adolescents aged 11 to 14 years (15 876 boys and 14 863 girls) were included and analyzed. Half the municipalities were in the 2 lowest socioeconomic quintiles and access to GPs was poor in more than two-thirds of the municipalities. Thirty-eight of 61 schools (62.3%) implemented actions and 26 of 45 municipalities (57.8%) had at least 1 trained GP. The median vaccination coverage increased by 4.0 percentage points (IQR, 2.0-7.3 percentage points) to 14.2 percentage points (IQR, 9.1-17.3 percentage points) at 2 months. At-school vaccination significantly increased vaccination coverage (5.50 percentage points [95% CI, 3.13-7.88 percentage points]) while no effect was observed for adolescents' education and motivation (-0.08 percentage points [95% CI, -2.54 to 2.39 percentage points]) and GPs' training (-1.46 percentage points [95% CI, -3.44 to 0.53 percentage points]). Subgroup analyses found a significant interaction between at-school vaccination and access to GPs, with a higher effect when access was poor (8.62 percentage points [95% CI, 5.37-11.86 percentage points] vs 2.13 percentage points [95% CI, -1.25 to 5.50 percentage points]; P = .007 for interaction). In this cluster randomized trial, within the context of the late COVID-19 pandemic period and limited school and GP participation, at-school HPV vaccination significantly increased vaccination coverage. The trial did not show a significant effect for training GPs and education and motivation, although it may be observed after more time has elapsed after the intervention. ClinicalTrials.gov Identifier: NCT04945655.

Selected Articles from This Issue

Highlights| June 01 2023 Selected Articles from This Issue Author & Article Information Online ISSN: 1538-7755 Print ISSN: 1055-9965 ©2023 American Association for Cancer Research2023American Association for Cancer Research Cancer Epidemiol Biomarkers Prev (2023) 32 (6): 739. https://doi.org/10.1158/1055-9965.EPI-32-6-HI Related Content A commentary has been published: Trend in Cervical Cancer Incidence and Mortality Rates in China, 2006–2030: A Bayesian Age-Period-Cohort Modeling Study A commentary has been published: Efficacy of the Outsmart HPV Intervention: A Randomized Controlled Trial to Increase HPV Vaccination among Young Gay, Bisexual, and Other Men Who Have Sex with Men A commentary has been published: Survival of Middle Eastern and North African Individuals Diagnosed with Colorectal Cancer: A Population-Based Study in California View more A commentary has been published: Somatic Mosaic Chromosomal Alterations and Death of Cardiovascular Disease Causes among Cancer Survivors View less Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Article Versions Icon Versions Version of Record June 1 2023 Citation Selected Articles from This Issue. Cancer Epidemiol Biomarkers Prev 1 June 2023; 32 (6): 739. https://doi.org/10.1158/1055-9965.EPI-32-6-HI Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest Search Advanced Search Routine human papillomavirus (HPV) vaccination is recommended for young adults, yet many young gay, bisexual, and other men who have sex with men (YGBMSM) remain unvaccinated. Reiter and colleagues report the efficacy of Outsmart HPV, a web-based HPV vaccination intervention for YGBMSM. Results showed that Outsmart HPV increased HPV vaccination among participants and that participants reported higher levels of satisfaction with the intervention. These data suggest that Outsmart HPV is an efficacious intervention and a promising tool for increasing HPV vaccination among YGBMSM. Cardiovascular disease is a major cause of illness and death in cancer patients. Sun and colleagues analyzed data from the UK Biobank to investigate the link between mosaic chromosomal alterations (mCAs), a type of clonal hematopoiesis, and cardiovascular outcomes in cancer patients. The authors found that patients with mCAs had a significantly higher risk of death from coronary artery disease compared to those without mCAs. These findings... You do not currently have access to this content.

Are Interventions Efficacious at Increasing Human Papillomavirus Vaccinations Among Adults? A Meta-Analysis.

A variety of intervention strategies to improve Human Papillomavirus (HPV) vaccination rates in adults exist; however, they have shown varying efficacy and inconsistent outcomes. This meta-analysis tested the efficacy of HPV vaccination interventions for adults in increasing vaccine intentions, rates of initiation of the vaccine series, and completion rates. The study also tested potential moderators (intervention strategy, theory-based versus nontheory-based interventions, race/ethnicity, gender, study quality) of relationships between intervention receipt and vaccine intentions. Electronic databases (PsychINFO, Web of Science, Scopus, EBSCO, JSTOR, PubMed) were searched for English-language articles published up to September 2021. Eligible studies included outcomes of vaccine intentions, receipt of the first dose, or vaccine series completion and included intervention and comparison conditions. The search yielded 38 eligible studies reporting 78 effect sizes. Random effects, multilevel, meta-analytic models revealed a significant, small effect of interventions on vaccine intentions (OR = 0.36, 95% CI [0.07, 0.65]); a nonsignificant effect on vaccine initiation rates (OR = 1.29; 95% CI [0.87, 1.91]); and significant effects on vaccine completion rates (OR = 1.58, 95% CI [1.18, 2.11]). Race/ethnicity, gender, intervention strategy, theory-based interventions, and study quality did not moderate the intervention effects on vaccine intentions. Evidence supports the efficacy of interventions to increase intentions to receive the HPV vaccine and completion of the HPV vaccine series in adults. However, evidence did not support the efficacy of interventions to increase HPV vaccine initiation. Findings highlight directions for developing more efficacious HPV vaccine interventions for adults.

Perceived Barriers and Use of Evidence-Based Practices for Adolescent HPV Vaccination among East Texas Providers.

Adolescents living in rural areas are less likely to be up to date on the human papillomavirus (HPV) vaccine, which can prevent cervical cancer. We administered a telephone survey to 27 clinics in rural East Texas to assess perceived barriers to HPV vaccination and current use of evidence-based interventions to promote HPV vaccination. Perceived barriers were assessed using a 5-point Likert scale and clinical implementation of evidence-based practices was determined. Findings are reported using descriptive statistics. The most commonly reported barriers were missed vaccination opportunities due to the pandemic (66.7%), followed by vaccine hesitancy due to the pandemic (44.4%) and due to the HPV vaccine specifically (33.3%). Fewer than a third of clinics reported using the evidence-based strategies of use of a "refusal to vaccinate" form (29.6%), having an identified HPV vaccine champion (29.6%), and recommending the HPV vaccine at age 9 (22.2%). While many clinics surveyed currently implement evidence-based practices to promote HPV vaccination, there is a need and desire for additional HPV vaccination interventions in East Texas clinics.

119 Recruiting rural clinics to participate in an HPV vaccination intervention: protocol for a feasibility study and subsequent effectiveness trial

OBJECTIVES/GOALS: Rural teens have lower human papillomavirus (HPV) vaccination rates than urban teens, promoting geographical cervical cancer disparities. Giving HPV vaccination earlier than the recommended 11-12 years might increase vaccination rates. We describe a feasibility study for recruiting rural clinics to participate in early HPV vaccination studies. METHODS/STUDY POPULATION: Leveraging professional contacts, we identified two clinics in North Carolina that serve predominantly rural populations. To assess the feasibility of adapting clinic monitoring systems to promote early vaccination, we requested to review electronic medical records (EMR) to identify the size of the vaccine-eligible patient population, HPV vaccination coverage, and the accuracy of EMR queries to monitor HPV vaccination status. Next, we completed in-depth interviews with clinic staff to collect insights on perceived advantages and disadvantages of promoting early HPV vaccination at 9-10 years, and potential facilitators and barriers to doing so. RESULTS/ANTICIPATED RESULTS: We expect that existing clinic systems will easily accommodate early recommendation and administration of HPV vaccine by expanding EMR queries and vaccination status indicators to include 9- and 10-year-olds. Clinics that are interested in promoting early HPV vaccination can use these adapted tools to monitor vaccine coverage over time. From in-depth interviews we expect to encounter a mix of support and hesitation to promote early HPV vaccination, based on personal beliefs on safety and effectiveness of HPV vaccination, perceptions of adolescent HPV risk, perceptions of parental acceptability of HPV vaccination, and perceived burden of changing current clinic protocols. DISCUSSION/SIGNIFICANCE: This feasibility study’s findings will help determine clinic readiness to recommend early HPV vaccination, and intervention components that maximize staff acceptability of early HPV vaccination. A subsequent randomized effectiveness study will evaluate early HPV vaccination as a method to increase rural adolescent vaccination coverage.

A cluster randomized controlled trial for a multi-level, clinic-based smoking cessation program with women in Appalachian communities: study protocol for the \u201cBreak Free\u201d program

BackgroundThe cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program.MethodsThe broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3) provider implementation of AAR to identify and treat women who want to quit smoking within the next 6 months, (4) facilitated access to cessation phone counseling plus pharmacotherapy, and (5) the bundling of Break Free tobacco cessation with HPV vaccination and cervical cancer screening interventions in an integrated approach to cervical cancer prevention. The study spans 35 Appalachian health clinics across 10 healthcare systems. We aim to enroll 51 adult female smokers per health system (total N = 510). Baseline and follow-up data will be obtained from participant (provider and patient) surveys. The primary outcome is self-reported 12-month point prevalence abstinence among enrolled patients. All randomized patients are asked to complete follow-up surveys, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Secondary outcomes will assess program implementation and cost effectiveness.DiscussionAddressing high tobacco use rates is critical for reducing cervical cancer morbidity and mortality among women living in Appalachia. This study evaluates the implementation and effectiveness of a smoking cessation program in increasing smoking cessation among female smokers. If results demonstrate effectiveness and sustainability, implementation of this program into other health care clinics could reduce both rates of smoking and cervical cancer.Trial registration NCT04340531 (April 9, 2020)

Cost-effectiveness of human papillomavirus vaccine in China: a systematic review of modelling studies

ObjectivesChina suffers from high burdens of human papillomavirus (HPV) and cervical cancer, whereas the uptake of HPV vaccine remains low. The first Chinese domestic HPV vaccine was released in 2019....

Application of theoretical frameworks on human papillomavirus vaccine interventions in the United States: systematic review and meta-analysis.

Theoretical frameworks are useful tools to explain the dynamics of behavioral change, develop, and implement intervention studies. The purpose of this systematic review and meta-analysis is to evaluate the application of theoretical frameworks and models to HPV vaccination intervention studies in the United States (US) from January 2006 to December 2019. A comprehensive search across databases, including PubMed, EMBASE, ERIC, CINAHL, Academic Search Complete, Scopus, Web of Science, and PsycINFO, was conducted. Articles were included in the systematic analysis if at least one theory was used to develop the intervention phase. All intervention studies targeting populations in the US without restrictions of age, income, sex, and ethnicity were included. Articles were included in the meta-analysis if vaccine uptake and/or vaccine completion was addressed. The Health Belief Model, Motivational Interviewing, Theory of Planned Behavior, and Information-Motivation-Behavioral Skills were the most used theories. Based on theory integrity, theory rationale, and theory operationalization, most of the studies (60%) were rated high for the application of the theoretical frameworks. Our results suggest a preference for theoretical frameworks targeting individual change rather than community change and the existence of gender disparities in the application of theoretical frameworks. The association between theory and increase of likelihood in vaccine uptake and completion was not supported. This review spotlights common issues in the application of theoretical frameworks in HPV vaccine interventions in the US. Our results suggest we are still in a developmental phase on several aspects of theory application to HPV vaccination.

Successful Multi-Level HPV Vaccination Intervention at a Rural Healthcare Center in the Era of COVID-19.

Objectives: To develop and test a human papillomavirus (HPV) vaccination intervention that includes healthcare team training activities and patient reminders to reduce missed opportunities and improves the rate of appointment scheduling for HPV vaccination in a rural medical clinic in the United States.Methods: The multi-level and multi-component intervention included healthcare team training activities and the distribution of patient education materials along with technology-based patient HPV vaccination reminders for parents/caregivers and young adult patients. Missed vaccination opportunities were assessed pre- and post-intervention (n = 402 and n = 99, respectively) by retrospective chart review and compared using Pearson χ2. The patient parent/caregiver and young adult patient population (n = 80) was surveyed following the reminder messages and penalized logistic regression quantified unadjusted odds of scheduling a visit.Results: Missed opportunities for HPV vaccination declined significantly from the pre-intervention to the post-intervention period (21.6 vs. 8.1%, respectively, p = 0.002). Participants who recalled receipt of a vaccination reminder had 7.0 (95% CI 2.4–22.8) times higher unadjusted odds of scheduling a visit compared with those who did not recall receiving a reminder. The unadjusted odds of confirming that they had scheduled or were intending to schedule a follow-up appointment to receive the HPV vaccine was 4.9 (95% CI 1.51–20.59) times greater among those who had not received the vaccine for themselves or for their child.Conclusions: Results from this intervention are promising and suggest that vaccination interventions consisting of provider and support staff education and parent/caregiver and patient education materials, and reminders can reduce missed opportunities for vaccinations in rural settings.

Effects of a randomized controlled trial of a brief, student-nurse led, parent-based sexual health intervention on parental protective factors and HPV vaccination uptake

BackgroundParents play a pivotal role in adolescent sexual health and Human Papillomavirus (HPV) vaccination. Nurses are on the frontlines of healthcare and play a critical role in promoting HPV vaccination and parent-child sexual health communication. We enhanced the Families Talking Together (FTT) parent-based sexual health curriculum to include adolescent vaccinations herein, FTT + HPV, and trained student nurses to provide a strong HPV vaccination and parent-child sexual health communication endorsement.MethodsUsing a randomized attention-controlled trial design, we examined the efficacy of FTT + HPV among 519 parents and their 11–14 year old youth recruited from medically underserved communities between 2015 and 2018. Participants were recruited from 22 after-school programs (e.g., Boys and Girls Clubs) and 19 charter schools. For parents, we examined protective factors including parent-child sexual health communication and parental involvement. For youth, we examined sexual health knowledge, parent-child sexual health communication, and parent-child connectedness. To assess HPV vaccination initiation and completion, we searched IMMTRAC immunization registry records for 85% of youth and used parental report for youth without registry records. Group differences were calculated using the estimated mean difference at one- and six months post-intervention with significance set at the p < 0.05 level.ResultsBaseline rates of HPV vaccination were low at 55.7%. No significant difference between the groups was seen in vaccination initiation or completion rates by one-month post-intervention. However, by six-months post intervention, there was a significant difference between the groups with 70.3% of the intervention group initiating the HPV vaccination series vs. 60.6% for the control group (p = 0.02). No difference between the groups was found for HPV series completion at six-months. There were significant differences in condom knowledge (p = 0.04), parent-child connectedness (p = 0.04), and communication frequency (p = 0.001) with greater improvement in the intervention vs. the control group. Rates of sexual activity remained low in both groups throughout the six-month follow-up period.ConclusionA brief parent-based adolescent sexual health and HPV vaccination intervention delivered by student nurses can improve sexual health outcomes including protective parental factors, adolescent sexual health knowledge, and HPV vaccination initiation rates.Trial registrationClinicalTrials.gov Identifier: NCT02600884. Prospectively registered September 1, 2015.

Internal and External Validity of Social Media and Mobile Technology-Driven HPV Vaccination Interventions: Systematic Review Using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework.

Social media human papillomavirus (HPV) vaccination interventions show promise for increasing HPV vaccination rates. An important consideration for the implementation of effective interventions into real-world practice is the translation potential, or external validity, of the intervention. To this end, we conducted a systematic literature review to describe the current body of evidence regarding the external validity of social media HPV vaccination-related interventions. Constructs related to external validity were based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. Seventeen articles published between 2006 and 2020 met the inclusion criteria. Three researchers independently coded each article using a validated RE-AIM framework. Discrepant codes were discussed with a fourth reviewer to gain consensus. Of these 17 studies, 3 were pilot efficacy studies, 10 were randomized controlled trials (RCTs) to evaluate effectiveness, 1 was a population-based study, and 3 did not explicitly state which type of study was conducted. Reflecting this distribution of study types, across all studies the mean level of reporting RE-AIM dimensions varied with reach recording 90.8%, effectiveness (72.1%), adoption (40.3%), implementation (45.6%), and maintenance (26.5%). This review suggests that while the current HPV vaccination social media-driven interventions provide sufficient information on internal validity (reach and effectiveness), few have aimed to gather data on external validity needed to translate the interventions into real world implementation. Our data suggest that implementation research is needed to move HPV vaccination-related interventions into practice. Included in this review are recommendations for enhancing the design and reporting of these HPV vaccination social media-related interventions.

Evaluating a Technology-Mediated HPV Vaccination Awareness Intervention: A Controlled, Quasi-Experimental, Mixed Methods Study.

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students. A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes (n = 58) at a public university in the southeastern United States of America. Classes were randomized to receive one of two cancer prevention programs (i.e., HPV vaccination (intervention) or healthy weight (control)). Both programs contained eight technology-mediated sessions, including weekly emails and private Facebook group posts. Participants completed pre-/post-test surveys and submitted weekly qualitative reflections. Data were analyzed using descriptive statistics and thematic review for qualitative data. Knowledge improved among participants in the HPV vaccination intervention relative to those in the control condition. Participants (97%) interacted on Facebook by “liking” a post or comment or posting a comment. Participants demonstrated robust engagement and high treatment satisfaction. Results suggests that social media is an effective platform to reach college students with health promotion interventions and increase HPV vaccination awareness in this important catch-up population.

Abstract PO-273: Human papillomavirus vaccination: California state-level mapping to identify gaps and inform practice and policy

Abstract Background: The human papillomavirus (HPV) virus is a known pathogen and carcinogen causing deadly cancers of the genitalia and head and neck. The HPV vaccine is a safe, effective cancer-preventing vaccine recommended for girls and boys at ages 11-12. Full HPV vaccine coverage is available through health insurance plans and the state of California, yet no data were readily available to describe California state-wide coverage of HPV vaccination. The Data Workgroup of the California HPV Vaccination Roundtable aimed to map State-level HPV vaccine coverage. Methods: Workgroup collected, analyzed, and mapped 2018 HPV vaccination data from the NIS-T survey, quality performance metrics from public and private health plans, and the statewide CAIR. NIS-T provides state-level estimates of routine adolescent vaccines, including HPV. Performance data were obtained from Medi-Cal and commercial health plans, administrative claims, and medical records. CAIR contains individual-level, provider-reported immunizations. HPV vaccination coverage for adolescents were estimated at the state and county level. Maps of county-level HPV vaccination and HPV-related cancer rates were built. Results: Rates of HPV-related cancers ranged from 6-12 per 100,000. Regarding HPV vaccination, there were considerable variation in the metrics and limitations of each data source, therefore estimates are not easily comparable. CAIR estimates of HPV vaccination coverage (28%) are lower than those for Medi-Cal managed care (45%) and commercial HMO members (50%). In 2018, aggregated results showed that overall 50% of 13 year old were vaccinated. We observed in the CAIR data that boys and girls are vaccinated at similar rates. However, significant county/regional HPV vaccination rates exist ranging from 9% (rural, northern) to 55% (urban, western). Northern, rural country have both the lowest HPV vaccination completion rates for 13-year-olds (9%), and the highest HPV-attributable cancer rates in the state (12 cases per 100,000 persons. Race/ethnic variations exist for HPV vaccination and HPV- related cancers–especially cervical cancer. Conclusions: This state-level data report approach may facilitate practice and policy action and help other states in developing their own reports for HPV vaccine improvements. Stakeholders are encouraged to utilize this Report when planning HPV vaccination interventions. We recommend that health systems: 1) assess HPV vaccination rates for 13-year-olds, 2) establish data exchange with CAIR, 3) implement recommended strategies to improve coverage, 4) collaborate with health plans and clinicians and 5) partner with community advocacy groups and clinic/hospital parent/patient advisory groups to improve data accuracy, as well as reduce HPV vaccine hesitance and promote at least 80% HPV vaccination completion by 2026. Citation Format: Jaime Adler, Raquel Arias, Kimlin Tam Ashing, Shauntay Davis-Patterson, Hilary Gillette-Walch, Jeffrey Klausner, Jim Knox, Beverly Mitchell, Autumn Ogden-Smith, Jane Pezua, Rita Singhal, Hoa Su. Human papillomavirus vaccination: California state-level mapping to identify gaps and inform practice and policy [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-273.

Evaluation of a Text Messaging-Based Human Papillomavirus Vaccination Intervention for Young Sexual Minority Men: Results from a Pilot Randomized Controlled Trial.

Men who have sex with men (MSM) are at high risk for human papillomavirus (HPV) infection and HPV-related anal cancer. Although a safe and effective vaccine is available to prevent HPV infection, HPV vaccine uptake among young MSM remains low. This pilot randomized controlled trial tested the acceptability, feasibility, and preliminary efficacy of a text messaging-based HPV vaccination intervention for young sexual minority men. In 2018, unvaccinated sexual minority men aged 18-25 years were recruited from Chicago to participate in a 9 month sexual health program called txt2protect. Participants (N = 150) were randomized to the intervention or control condition. Intervention condition messages focused primarily on HPV vaccination, with only a brief mention of other sexual health practices (e.g., condom use and HIV testing), while control condition messages focused on a variety of sexual health practices with only a brief mention of HPV vaccination. Participants received daily text messages for the first 3 weeks and monthly text messages for the remaining ~8 months of the trial. Participants completed surveys at baseline and 3 week and 9 month follow-ups. Participants reported high satisfaction with the intervention. Although trial retention was high (with over 88% completing the 9 month survey), the study fell short of meeting its recruitment goal. HPV vaccine series initiation was significantly higher among intervention participants (19.4%) compared to control participants (6.6%), odds ratio = 3.43, 95% confidence interval: 1.17, 10.08. Findings suggest that txt2protect is an acceptable and potentially promising intervention for increasing HPV vaccine initiation among young sexual minority men. NCT02994108.

Abstract B048: HPV vaccination in Hmong-American adolescents: A multilevel and assets-based qualitative study

Abstract Background: Rates of human papillomavirus (HPV) vaccine uptake in Hmong-Americans, an Asian American and Pacific Islander (AAPI) minority group, are substantially lower than the majority of Americans. In 2015, a community health center (CHC) in Minnesota found that HPV vaccine rates for Hmong children ages 9-17 were 32% in girls and 20% in boys, much lower than nationally published HPV coverage rates in 2017 (47% and 53%, respectively). This qualitative study identified barriers, facilitators, and decision-making processes about HPV vaccinations among Hmong adolescents and parents. Methods: Hmong adolescents (14-17 years old) and their parents were recruited from a local CHC to participate in focus group sessions. Using a community-based participatory action research approach, bilingual community researchers conducted eight focus groups with adolescents and parents. Prior to focus groups, participants provided demographic information and completed a survey about HPV and HPV vaccination. Focus group transcripts were analyzed using participatory thematic analysis. Themes were codified using a socioecological model (multilevel) framework combined with an assets lens. Results: A total of 12 adolescents and 13 parents participated in the focus groups (N = 25). Both survey and focus group results showed that Hmong adolescents and parents had low levels of awareness regarding HPV or the HPV vaccine. At the individual-level, both adolescents and parents reported concerns about side effects and costs as potential reasons for not getting vaccinated. Whereas, an individual-level facilitator for both adolescents and parents included personal agency (i.e., individual desire to want to learn more about HPV and the HPV vaccine). At the community-level, barriers included community narratives around traumatic experiences with vaccine, and facilitators included strong community connections and communications. At the institutional-level, barriers included lack of a school policy requiring HPV vaccinations and structural constraints in health care settings, while facilitators included ease of obtaining vaccines at school-based clinics and provider authoritative decision making. Finally, there was a range of decision-making processes between parents and adolescents and parents and providers. Conclusion: A culturally-appropriate HPV educational program for Hmong adolescents and parents could address barriers and build on facilitators and assets to promote HPV vaccine uptake. These findings have been used in the development of an eHealth application to increase HPV vaccinations in Hmong adolescents. Future research studies that test the feasibility, acceptability, and efficacy of culturally-tailored, multilevel HPV vaccination interventions may provide evidence about the efficacy of culturally-appropriate education in comprehensive vaccine strategies. Citation Format: Serena Xiong, Maiyia Y Kashouaher, Bai Vue, Kathleen A Culhane-Pera, Shannon L Pergament, Jay Desai, Hee Yun Lee. HPV vaccination in Hmong-American adolescents: A multilevel and assets-based qualitative study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B048.

Abstract C132: A multilevel approach to accelerating the human papillomavirus (HPV) vaccine at a rural clinic for Native and non-Native youth

Abstract Accelerating the uptake of Human Papillomavirus (HPV) vaccinations is a priority for cancer prevention and an issue for mitigating cancer health disparities particularly among rural youth, both Native American and non-Native. The rate of HPV vaccinations for rural and Native adolescents is markedly lower than urban adolescents. Based on a Memorandum of Collaboration between the UC Davis Comprehensive Cancer Center and Northern Valley Indian Health (NVIH), a tribal health organization serving rural youth; funding from the National Cancer Institute; and the principles of community-based participatory research, we developed a multi-level approach to accelerate the HPV vaccination rates at the NVIH rural clinic in Willows, CA. Ultimately, the goal is to raise the HPV vaccination rates among patients ages 11-17 from the current 27% at this clinic to the Healthy People 2020 goal of 80%. Our presentation documents a year’s relationship-building that includes the intentional input and promising data from multiple levels for launching an accelerated HPV vaccination program, exemplifying the collaboration between NVIH and a NCI Comprehensive Cancer Center. Starting with community outreach and engagement, our multiple levels included provider and staff trainings; and parent workshops. We began by surveying 12 community members on their HPV vaccination knowledge, attitudes, and behaviors and learned that they had low knowledge of the HPV vaccine and stressed the importance of educating both the community as well as parents. We followed with training of 26 clinic providers and 44 staff (participants were from all four of NVIH’s medical clinics). Pre-tests were administered prior to the training and post-tests administered four months later. The training content had 3 objectives: (1) explaining the importance of HPV vaccinations and the rationale for vaccinating at ages 11-12; (2) providing an effective recommendation by clinicians; and (3) providing support to families to decide in favor of HPV vaccination. While there was attrition from pre to post tests, we achieved significant quantitative realignment of the rank order of HPV vaccination (from 3rd to most important) over other vaccinations and increased confidence in their ability to make a strong HPV vaccination recommendation (14% and 6% respectively). Interviews from parents provided insights on their perspectives of HPV vaccination that should be incorporated. Our next steps will be to apply these findings into a multi-pronged HPV vaccination intervention program for rural Native and non-Native adolescents. Citation Format: Julie HT Dang, Duke LeTran, Alexandra Gori, Arzoo Mojadedi, Teresa Martens, Sharon McClure, Inder Wadhwa, Chester Austin, Moon S Chen, Jr. A multilevel approach to accelerating the human papillomavirus (HPV) vaccine at a rural clinic for Native and non-Native youth [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C132.

Factors Influencing the Cost-Effectiveness Outcomes of HPV Vaccination and Screening Interventions in Low-to-Middle-Income Countries (LMICs): A Systematic Review.

Cervical cancer ranks fourth amongst the commonest malignancies worldwide and the second most prevalent cancer afflicting women in low-to-middle income countries (LMICs), hence, of great public health importance. LMICs are the most affected regions as evidenced by their high prevalence of the disease. Mortality associated with cervical neoplasms is preventable through the implementation of recommended preventive approaches. This review aimed to appraise evidence on the cost effectiveness of cervical cancer prevention interventions in LMICs involving cervical screening and human papilloma virus (HPV) vaccination programmes. A search of CINAHL, MEDLINE, PubMed, and Web of Science was elicited and studies published between 1st January 2008 and 31st December 2018 were retrieved. Two authors independently undertook the screening, review, selection of studies, and data extraction with disagreements being resolved through discussion and consensus. Twelve studies were selected. The cost-effectiveness outcomes of HPV vaccination and screening interventions are dependent on age, screening method used, intervention coverage, and the number of doses or visits required for vaccination and screening, respectively. A combination of visual inspection with acetic acid (VIA) screening and HPV vaccination appears to be the most cost-effective approach in reducing the lifetime risk for HPV-linked cervical neoplasms. Similarly, vaccination as a stand-alone intervention is potentially cost effective provided the coverage is maintained between 70 and 100%. HPV vaccination and screening interventions may be cost effective in LMICs and potentially reduce the lifetime risk, economic burden, and associated mortality. However, it is important to consider the factors that influence the cost effectiveness of cervical cancer prevention interventions for better outcomes to be realised.

A Web-Based Human Papillomavirus Vaccination Intervention for Young Gay, Bisexual, and Other Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial.

BackgroundGay, bisexual, and other men who have sex with men experience several disparities related to human papillomavirus (HPV) infection, including high incidence rates of anal cancer. Although the HPV vaccine is currently recommended for young adults, HPV vaccine coverage is modest among young gay, bisexual, and other men who have sex with men (YGBMSM).ObjectiveWe describe the design and methods for a randomized controlled trial (RCT) to rigorously evaluate Outsmart HPV, a population-targeted, individually tailored, Web-based HPV vaccination intervention for YGBMSM. The RCT is designed to determine the efficacy of the intervention, the mechanism by which the intervention has an effect (ie, mediation), and whether efficacy varies by participant characteristics (ie, moderation).MethodsOutsmart HPV was previously developed and pilot-tested. This study is a 3-arm prospective RCT that will enroll a projected 1995 YGBMSM who are aged 18 to 25 years, live in the United States, and have not received any doses of the HPV vaccine. Participants will be recruited by means of paid advertisements on social media sites and randomized to receive (1) standard information on the Web about HPV vaccine (control group), (2) Outsmart HPV content on the Web with monthly unidirectional vaccination reminders sent via text messages, or (3) Outsmart HPV content on the Web with monthly interactive vaccination reminders sent via text messages. Participants will complete Web-based surveys at 4 time points during the study: baseline, immediately after engaging with Web-based content, 3 months after randomization, and 9 months after randomization. Primary outcomes will include both HPV vaccine initiation (ie, receipt of 1 or more doses of the HPV vaccine) and completion (receipt of all 3 doses recommended for this age range). We will examine constructs from the intervention’s theoretical framework as potential mediators and demographic and health-related characteristics as potential moderators of intervention effects.ResultsThe institutional review board at The Ohio State University has approved the study. Materials have been developed and finalized for all study groups. Recruitment for the RCT began in fall 2019.ConclusionsIf shown to be efficacious, Outsmart HPV has the potential to fill an important gap by promoting HPV vaccination among a population at increased risk of HPV infection and HPV-related disease.Trial RegistrationClinicalTrials.gov NCT04032106; http://clinicaltrials.gov/show/NCT04032106International Registered Report Identifier (IRRID)PRR1-10.2196/16294

The potential population-based impact of an HPV vaccination intervention in Colorado.

BackgroundHuman papillomavirus (HPV) infection is the most common cause of cervical cancer and can be prevented with vaccination, but HPV vaccination rates remain low. An intervention to improve health care provider communication about vaccination has been shown to increase HPV vaccination rates in an initial trial in Colorado, where about 160 cases of cervical cancer are diagnosed each year.MethodsCensus data were combined with Colorado cancer and immunization registry data to identify clinics in locations that would most benefit from implementation of this intervention to improve HPV vaccination rates. ArcGIS Pro was used to map cervical cancer incidence, immunization rates, population data, and location of clinics participating in practice‐based research networks (PBRNs). Results from the provider communication intervention trial and published estimates of the number needed to vaccinate to prevent a case of cervical cancer were used to predict the number of cervical cancer cases prevented based on increased vaccination due to the intervention.ResultsNinety‐eight Colorado PBRN clinics were analyzed. For the 10 clinics with the highest predicted number of cervical cancer cases prevented, 5218 additional patients would be vaccinated and 43 cervical cancer cases prevented with implementation of the intervention. If implemented in all 98 clinics, the intervention would lead to 20 490 additional patients vaccinated (range 7‐658/clinic) and 171 cases of cervical cancer prevented (range 0.05‐5.48/clinic).ConclusionsGeographic data from cancer and immunization registries can inform the dissemination of evidence‐based practices like the provider communication intervention for HPV vaccination to maximize impact on public health.

An intervention for increasing HPV vaccination on a university campus

PurposeTo evaluate the effects of a human papillomavirus (HPV) vaccination intervention implemented on a large university campus in the United States. MethodsThe intervention consisted of student-directed campaign materials promoting HPV vaccination (e.g., posters, yard signs, social media posts) and provider recommendation for HPV vaccine to students attending university health services (UHS) from January through March of 2019. ResultsWe observed a 75% increase in HPV vaccine doses administered at UHS in the spring semester of 2019 vs. 2018. In both semesters a higher percentage of doses was given to females than males. Further, the increase from 2018 to 2019 was larger for females than males. Age at vaccine receipt did not differ by year. ConclusionsPartnering with college and university health centers to implement HPV vaccine interventions could be a promising strategy for increasing HPV vaccination coverage among young adult college students across the country.