Human Papillomavirus Vaccine Series Research Articles

Accountable care organizations and HPV vaccine uptake: a multilevel analysis.

To examine associations between accountable care organization (ACO) membership and human papillomavirus (HPV) vaccination and to evaluate variation in HPV vaccination across ACO providers. Retrospective cohort study. We analyzed the records of commercially insured children and adolescents aged 11 to 14 years using Connecticut's All-Payer Claims Database from January 2012 to December 2017. A total of 23,911 adolescents receiving care from 933 ACO-attributable providers and 923 non-ACO-attributable providers were included. The mean rate of HPV vaccine initiation was 53% overall (51% among boys, 55% among girls). Among those who initiated the vaccine, the mean rate of HPV vaccine completion was 69% (67% among boys, 70% among girls). Adolescents receiving care at ACOs vs non-ACOs were significantly more likely to receive initial HPV vaccination (OR, 1.80; 95% CI, 1.69-1.91) and to complete the HPV vaccine series (OR, 1.12; 95% CI, 1.01-1.23). Among adolescents receiving care in ACOs, providers were responsible for 14% of variability in HPV vaccine initiation and 10% of variability in HPV vaccine completion and ACOs were responsible for less than 1% of variability in HPV vaccine initiation and completion. Adolescents receiving care from ACOs were significantly more likely to initiate and complete HPV vaccination than were adolescents receiving care in non-ACO settings. Variation in HPV vaccine uptake attributable to providers within ACOs dwarfed variation attributable to ACOs, indicating that vaccine uptake was more dependent on the provider irrespective of the ACO with which they were affiliated. Efforts to improve HPV vaccination rates may require provider-focused interventions regardless of the overall performance of their health care system orproviderorganization.

Abstract A146: Racial/ethnic differences in the relationship between human papillomavirus vaccination status and up-to-date Papanicolaou tests

Abstract Background: Human papillomavirus (HPV) vaccination and routine Papanicolaou (Pap) testing can prevent morbidity and mortality associated with cervical cancer (CC). Research suggests women who have initiated and completed the HPV vaccine are more likely to have an up-to-date Pap test than women who are unvaccinated against HPV. Limited research has focused on whether the association between HPV vaccination and Pap testing varies based on the number of HPV vaccine doses received across racial/ethnic groups. Methods: We conducted a cross-sectional analysis of 2018 – 2022 Behavioral Risk Factor Surveillance System data to investigate the relationship between HPV vaccination status and having an up-to-date Pap test by race/ethnicity. Based on the Advisory Committee on Immunization Practices’ (ACIP) guidelines, women who received 0 doses of the HPV vaccine were unvaccinated, women who received 1 or 2 doses initiated the vaccine series, and women who received 3 doses completed the HPV vaccine series. Based on the United States Preventive Services Task Force guidelines, women were considered to have an up-to-date Pap test if they reported having one within the past 3 years. We used weighted multivariable logistic regression models to examine the association. Results: Most women (n = 14,615) were unvaccinated (82.9%) and had an up-to- date Pap test (75.5%). Non-Hispanic White (NHW) women had the highest rate of HPV vaccine series completion (11.8%), followed by non-Hispanic Other (NHO) women (11.2%), non- Hispanic Black (NHB) women (8.6%), and Hispanic women (8.3%). NHW women also had the highest rate of up-to-date Pap test (78.8%). NHB women had the second highest rate (77.6%), followed by Hispanic women (67.8%), and NHO women (66.4%). In adjusted analyses, NHO women were 34% less likely to have an up-to-date Pap test than NHW women (OR, 0.66; 95% CI: 0.51-0.86). Compared to unvaccinated women, those who completed and initiated the HPV vaccine series were more likely to have an up-to-date Pap test (initiated: OR: 1.40, 95% CI: 1.04-1.87; completed: OR:1.77, 95% CI: 1.35-2.34). NHB and NHO women who initiated the HPV vaccine series were more likely to have an up-to-date Pap test (NHB: OR: 3.37, 95% CI: 1.65-6.85; NHO: OR: 3.21, 95% CI: 1.73-5.95). NHW women who completed the HPV vaccine series were more likely to have an up-to-date Pap test (OR: 2.19, 95% CI: 1.55-3.08). Conclusion: NHB and NHO women who initiated the HPV vaccine series were three times as likely to have an up-to-date Pap test; NHW women who have completed the HPV vaccine series were twice as likely to receive an up-to-date Pap test. Women who do not receive Pap tests or the HPV vaccine miss important CC prevention opportunities. Thus, relevant stakeholders should aim to improve HPV vaccination rates; doing so could potentially enhance Pap test adherence simultaneously. This may be especially important for NHB and NHO women as they have lower rates of Pap test adherence and HPV vaccine series completion. Citation Format: Elinita Pollard, Meng-Han Tsai, Minjee Lee, Alice W. Lee, Mary A. Gerend. Racial/ethnic differences in the relationship between human papillomavirus vaccination status and up-to-date Papanicolaou tests [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 A146.

Human Papillomavirus Vaccination Coverage Among Adolescent Girls Aged 13-17 Years - U.S.-Affiliated Pacific Islands, 2013-2023.

Worldwide, cervical cancer is the fourth most common cancer among women, and the World Health Organization (WHO) Western Pacific Region, where the U.S.-affiliated Pacific Islands (USAPI) are located, accounts for one quarter of all estimated cases. Human papillomavirus (HPV) vaccines are recommended at age 11-12 years to prevent most cervical cancers. HPV vaccines were introduced across USAPI during 2007-2016, predominantly provided through school-located vaccination programs. Retrospective analysis using data from jurisdictional immunization information systems was used to estimate vaccination coverage among adolescent girls as of the last day of each calendar year during 2013-2023. This analysis measured progress toward the WHO 2030 vaccination coverage goal of ≥90% completion of the HPV vaccination series among girls by age 15 years. As of December 2023, initiation of the HPV vaccination series among adolescent girls aged 13-17 years ranged from 58.0% in Palau to 97.2% in the Northern Mariana Islands, and HPV vaccination series completion coverage ranged from 43.4% in Palau to 91.8% in the Northern Mariana Islands. HPV vaccination series completion coverage is >90% in the Northern Mariana Islands and is on track to meet WHO goals by 2030 in American Samoa. Assessment of adolescent vaccination coverage can help immunization programs monitor progress toward regional goals and identify populations and areas with low coverage. Implementing evidence-based strategies to increase vaccine access and coverage would benefit jurisdictions with lagging coverage.

Disparities in HPV Vaccination Among Adolescents by Health Care Facility Type

Approximately 31 000 cases of human papillomavirus (HPV)-associated cancers are diagnosed annually in the US. The HPV vaccine can prevent more than 90% of these cancers, yet national uptake remains lower than the Healthy People 2030 target of 80% completion. To devise targeted interventions to increase the uptake of HPV vaccines, it is crucial to understand the vaccination rates across various health care settings. To examine the association between health care facility type and adolescent HPV vaccine uptake and clinician recommendation for the vaccine in the US. This cross-sectional study uses a complex sampling design of data from the 2020 National Immunization Survey-Teen. The study included adolescents aged 13 to 17 years. The data analysis was completed between March 1 and May 31, 2022. Health care facility type classified as public, hospital-based, private, mixed (more than 1 type), and other facilities (eg, military health care facility; Women, Infants, and Children clinic; school-based health center; pharmacy). Initiation of HPV vaccination was defined as the receipt of at least 1 dose of the HPV vaccine and completion as receipt of at least 2 or 3 doses, depending on age of initiation. Parent or guardian self-reported clinician recommendation was categorized as yes or no. Weighted, multivariable logistic regression models were used to estimate the odds of initiating and completing the HPV vaccine series and receiving clinician recommendation by health care facility type adjusted for adolescent and maternal characteristics. A total of 20 162 adolescents (mean [SD] age, 14.9 [1.4] years; 51.0% male) were included. Clinician recommendation for the HPV vaccine was received by 81.4% of adolescents, and 75.1% initiated and 58.6% completed the HPV vaccine series. In the adjusted analyses, adolescents who received recommended vaccinations at public facilities had lower odds of initiating (adjusted odds ratio [AOR], 0.71; 95% CI, 0.58-0.88) and completing (AOR, 0.62; 95% CI, 0.51-0.76) HPV vaccination compared with those who received recommended vaccinations at private facilities. Similarly, adolescents who received recommended vaccinations at public facilities (AOR, 0.62; 95% CI, 0.51-0.77) had lower odds of receiving a clinician recommendation for the HPV vaccine compared with those who received recommended vaccinations at private facilities. These findings reveal health disparities in HPV vaccination among adolescent populations served by public health care facilities, suggesting that a greater focus is needed on vaccine recommendations and uptake in public facilities.

Occupational Exposure to Aerosolized Human Papillomavirus: Assessing and Addressing Perceptions of and Barriers to Vaccination of at-Risk Health Care Workers.

This study aimed to assess current vaccination rates among health care workers at risk for occupational human papillomavirus (HPV) exposure and explore factors that influence decisions about HPV vaccination. Using a mixed-methods design, this study included a questionnaire and qualitative focus groups. The study took place at an academic medical center. Participants were 37 health care professionals in occupations at risk for workplace HPV exposure. The primary qualitative outcome measured was HPV vaccination status. The primary qualitative outcomes assessed were perceptions of occupational HPV exposure risk, protective measures, and HPV vaccination. Most participants were female (86.5%, n = 32) and younger than 35 years (51.4%; n = 19) and therefore would have been eligible to receive the HPV vaccine series as a teenager or young adult. Nearly two-thirds (67.6%; n = 25) of participants had received the HPV vaccine; of those, half were vaccinated as teenagers (52%; n = 13). One-third (n = 4) of those vaccinated as adults reported vaccination due to workplace HPV exposure. Focus groups revealed themes consistent with the Health Belief Model. Most participants recognized their risk of aerosolized HPV exposure in the workplace but felt uneducated about occupational exposure risk and protective measures. Many participants recognized risk of exposure through surgical smoke but perceived that risk was stratified by medical specialty, proximity to surgical field, and personal protective equipment use. Many participants had some level of concern for head and neck lesions with exposure to aerosolized HPV. Most participants recognized the need to protect themselves against workplace HPV exposure. Those who were vaccinated felt that they were better protected against HPV exposure. Almost all participants said that they had not received formal education on workplace HPV exposure risk. Many participants voiced perceived barriers to HPV vaccination. Health care workers encounter the HPV virus in a myriad of fields and procedures. Our mixed-methods study demonstrated that at-risk health care workers feel uninformed about their risk of HPV exposure in the workplace, availability of HPV vaccination, and appropriate protective equipment recommendations.

Pediatric Human Papillomavirus Vaccination Rates Within a Tertiary Military Medical Center.

To determine our center's human papillomavirus (HPV) vaccination rate and identify common negative perceptions surrounding the vaccine to guide more effective HPV vaccine counseling. We reviewed immunization records for patients ages 11 to 26 that receive care at Brooke Army Medical Center. Vaccine uptake rate was determined by dividing the number of patients who had completed the HPV vaccine series by the total target population. From October 2021 to December 2022, a clinic survey was distributed to parents (for patients ages 11-17) or patients themselves (ages 18-26) during otolaryngology visits to poll vaccination status and attitudes toward the vaccine. A total of 3038 patients ages 11 to 26 are enrolled for primary care at Brooke Army Medical Center, but only 962 (32%) are vaccine complete. Thirty-five surveys were collected during the study period. Twenty-two surveys (63%) from patients/parents reported they/their child had received the HPV vaccine. Concerns about vaccine safety, sexual behaviors, lack of immunization requirement for school, and difficulty getting scheduled were the most common reasons patients were unvaccinated. Counseling patients on the HPV vaccine can be difficult given the common misconceptions surrounding vaccination, but understanding these attitudes will allow otolaryngologists to educate patients more effectively. This matters since patients more knowledgeable about HPV are more likely to receive the vaccine. Our clinic has developed new strategies in partnership with primary care departments to facilitate more streamlined vaccination for eligible patients, and moving forward we plan to trend HPV vaccination rates over time to determine our impact on uptake.

Trends in human papilloma virus vaccination uptake by sex and race/ethnicity among US adolescents and young adults, 2011-2020.

10519 Background: High-risk strains of human papillomavirus (HPV) are associated with a variety of oral and anogenital cancers, many of which are preventable through HPV vaccination. In the US, completion of an HPV vaccination series is recommended for all individuals from age 9 through 26; however, national trends in HPV vaccination uptake across sex and racial/ethnic groups over the past decade are not well described. Methods: We analyzed data from the National Health and Nutrition Examination Survey across 4 survey cycles spanning January 2011 to March 2020. We used univariate logistic regression to evaluate temporal trends in HPV vaccination uptake across sex and racial/ethnic strata, with the midpoint of each survey cycle modeled as a continuous independent variable. Vaccination uptake was defined as self/parent-reported receipt of ≥ 1 dose of an HPV vaccine series (estimates for 2 and 3 doses were unreliable due to recall bias and missing data). All estimates incorporated appropriate survey weights to be representative of the US population. Results: We identified 10,927 participants representing 70,066,252 individuals: mean age 17.4 years, 48.8% male, 54.9% White. Between 2011-March 2020, overall HPV vaccination uptake steadily increased from 23.3% to 43.0% ( P trend < 0.001; Table). HPV vaccination rates improved from 37.7% to 49.4% among females ( P trend < 0.001) and from 7.8% to 36.4% among males ( P trend < 0.001). HPV vaccination uptake increased similarly across all racial/ethnic strata by approximately 20%, with White individuals achieving the greatest vaccination uptake (45.5%) by March 2020. Conclusions: Among US adolescents and young adults, HPV vaccination uptake rose by ~20% overall and across all racial/ethnic groups. HPV vaccination uptake accelerated the most among males but still lags behind females, perhaps because routine vaccination wasn’t recommended for males until 2011, 5 years after it had been recommended for females. [Table: see text]

HPV Multilevel Intervention Strategies Targeting Immunization in Community Settings (HPV MISTICS): Study protocol for a hybrid 1 stepped-wedge cluster randomized trial

BackgroundThis protocol paper describes the overall design for HPV MISTICS, a multilevel intervention to increase human papillomavirus (HPV) vaccination initiation and completion rates among adolescents aged 11–17. MethodsWe will conduct a hybrid type 1 implementation-effectiveness trial using a stepped-wedge cluster randomized trial in eight federally qualified health centers (FQHCs) in Florida. Intervention components target three levels: system, providers, and parents. Outcomes will be assessed using quantitative (e.g., vaccination data, survey data) and qualitative methods (e.g., staff and parent interviews). We expect to quantify changes in HPV vaccine series initiation and completion rates for adolescents ages 11–17 in the eight FQHCs. We have hypothesized a 20-percentage point increase in HPV vaccine series initiation and a 10-percentage point increase in series completion. We also anticipate being able to explore factors at the system, provider, and patient levels as potential covariates. Implementation outcomes, barriers, and facilitators identified in the study will help characterize the implementation process and inform potential future intervention scale-up. ResultsThe project is ongoing; effectiveness and implementation outcomes will be determined following project completion. ConclusionsFindings will provide evidence of an equity-informed research design and implementation procedures that could help improve HPV vaccination rates in similar health systems.Clinical trials identifier:NCT05677360 (date registered: 2022-12-22); https://clinicaltrials.gov/study/NCT05677360?lead=Moffitt%20Cancer%20Center%20&aggFilters=status:rec&page=2&rank=17

Effect of age at initiation of the human papillomavirus vaccine on the association between race/ethnicity and completion of the vaccine series

BackgroundUp-to-date (UTD) of the human papillomavirus (HPV) vaccine series has been low despite 2016 recommendations for 2 doses among initiators <15 years of age and 3 doses for 15+ year olds. This study examined how age at initiation affected the association between race/ethnicity and UTD among adolescent HPV vaccine initiators. We also examined how administration of other adolescent vaccines affected UTD. MethodsA secondary analysis of The National Immunization Survey – Teen data between 2016 and 2020 was conducted. Characteristics associated with initiation of the vaccine series was examined and used to evaluate UTD among initiators. All data were weighted. Associations between characteristics and HPV vaccine initiation were examined using Rao Scott chi-square tests and univariable logistic regression. Multivariable binary logistic regression models stratified by race/ethnicity calculated the strength of association between independent variables and odds of initiation and UTD among initiators. ResultsThe final sample size was 99,719 with 67,855 (68.1 %) initiating HPV vaccination. Among HPV vaccine initiators, Hispanic and black adolescents had lower odds of UTD. However, 9–10-year-old initiators had increased odds (aOR: 5.71; 95 %CI: 3.78–8.63) of UTD compared to 12-year-old initiators. Increased odds of UTD among initiators younger than 12 years were found across racial/ethnic groups. Flu vaccination was associated with decreased odds of UTD among white (aOR: 0.76; 95 %CI:0.65–0.88) and black adolescents (aOR: 0.67; 95 %CI: 0.46–0.96). ConclusionStrong recommendations to ensure patients are UTD on the HPV vaccine series are essential to improving UTD among all adolescents and follow-up should occur when administering other vaccines to reduce missed opportunities.

A Cross-Sectional Analysis of 2017-2022 National Immunization Survey: Sociodemographic Disparities Associated With Human Papillomavirus Vaccine Initiation and Completion Series Among US Adolescents.

The introduction of the Human Papillomavirus (HPV) vaccine has led to future decline in prevalence of HPV-causing cancers; however, disparities in early HPV vaccine uptake and coverage may contribute to persistent inequalities in HPV-related cancers in the United States. We assess the current trend of sociodemographic factors significantly associated with the initiation and Up To Date (UTD) HPV vaccine series among adolescents in the U.S. The retrospective National Immunization Survey-Teen data were analyzed for a cohort of adolescents aged 13-17 years who initiated HPV vaccine and completed the series from 2017 to 2022. A multivariable logistic regression estimated the correlation of sociodemographic variables to determine the odds of HPV vaccine initiation and completion as the outcomes. There were 3.2% and 5% surge in HPV vaccine initiation and UTD, respectively, with teens' mean age of 14.98 over the years. The unvaccinated dropped by 5.6%, and those not UTD declined by 4.6% in the HPV vaccine series during this period. The proportion of teens who initiated and completed the vaccine series were mostly older female teens, non-Hispanics, regularly insured with private coverage, raised by educated older mothers, above poverty status, and living in the South. The adjusted multivariable logistic regression shows the odds of initiating and completing increases over the years, and older teens are more likely to initiate the HPV vaccine and complete the vaccine series. However, boys with non-Medicaid coverage/uninsured in the South have lower odds to initiate and complete the vaccine. Improved HPV vaccine uptake and UTD were found in older females, insured with Medicaid, and from highly educated mothers in the Northeast. Findings underscore the importance of effective strategies to address current HPV vaccination disparities among identified teens with lower uptake and UTD that may reduce future burden of HPV-related cancers in the U.S.

Immunogenicity of 2-Dose HPV Vaccine Series for Postpartum Women

Postpartum human papillomavirus (HPV) vaccination is a promising strategy to increase HPV vaccination uptake in the US, particularly for reaching vaccine-naive women and those who lack health insurance beyond the pregnancy period. However, completion of the 3-dose vaccine regimen is challenging. To evaluate the immunogenicity of a 2-dose postpartum HPV vaccination regimen (0 and 6 months) and assess whether it is noninferior to a 3-dose postpartum HPV vaccination regimen (0, 1-2, and 6 months) administered to historical controls. A noninferiority, open-label, nonrandomized immunogenicity trial was conducted from August 4, 2020, to June 23, 2022, of postpartum patients aged 15 to 45 years who delivered at 2 hospitals in Baltimore, Maryland. Historical controls were adolescents and young women aged 16 to 26 years. Two doses of the nonavalent HPV vaccine administered 6 months apart. The primary outcome was noninferiority (90% CI, lower bound >0.67) of the geometric mean titer (GMT) ratio for HPV-16 among postpartum women compared with historical controls. Secondary outcomes were noninferiority of GMT ratios for the other 8 HPV types and percentage seroconversion for each HPV type. As a noninferiority trial, the primary analysis used the per-protocol analysis. Of 225 enrolled participants, the mean (SD) age at baseline was 29.9 (6.8) years, and 171 (76.0%) were HPV-16 seronegative at baseline. Of these 171 participants, 129 (75.4%) received a second vaccine dose and completed the subsequent 4-week serologic measurements. Relative to historical controls, the HPV-16 GMT ratio was 2.29 (90% CI, 2.03-2.58). At month 7, HPV-16 GMT was higher after the 2-dose regimen (7213.1 mMU/mL [90% CI, 6245.0-8331.4 mMU/mL]) than among historic controls after the 3-dose regimen (3154.0 mMU/mL [90% CI, 2860.2-3478.0 mMU/mL]). Similarly, the lower bound of the 90% CI of the GMT ratio was above 1 for the 8 HPV types 6, 11, 18, 31, 33, 45, 52, and 58. A total of 118 of 134 women (88.1%) seroconverted for HPV-16 after the first dose; 4 weeks after the second dose, the seroconversion rate was 99% or greater for all HPV types. This study suggests that immunogenicity of a 2-dose HPV vaccination regimen given 6 months apart among postpartum women was noninferior to a 3-dose regimen among young historical controls. Most women seroconverted after the first dose of the 2-dose regimen. These results demonstrate that postpartum vaccination using a reduced schedule may be a promising strategy to increase HPV vaccine series completion. ClinicalTrials.gov Identifier: NCT04274153.

The association of caregiver attitudes, information sources, and trust with HPV vaccine initiation among adolescents

ABSTRACT This study described caregiver attitudes and the information sources they access about HPV vaccination for adolescents and determined their influence on human papillomavirus (HPV) vaccination initiation. An online survey was administered to 1,016 adults in July 2021. Participants were eligible if they were the caregiver of a child aged 9–17 residing in Mississippi, Arkansas, Tennessee, Missouri, and select counties in Southern Illinois. Multivariate logistic regression was used to estimate the association of caregiver attitudes and information sources with HPV vaccination. Information from doctors or healthcare providers (87.4%) and internet sources other than social media (31.0%) were the most used sources for HPV vaccine information. The highest proportion of caregivers trusted their doctor or healthcare providers (92.4%) and family or friends (68.5%) as sources of information. The HPV vaccine series was more likely to be initiated in children whose caregivers agreed that the vaccine is beneficial (AOR = 4.39, 95% CI = 2.05, 9.39), but less likely with caregivers who were concerned about side effects (AOR = 0.61, 95% CI = 0.42, 0.88) and who received HPV vaccination information from family or friends (AOR = 0.57, 95% CI = 0.35, 0.93). This study found that caregivers’ attitudes, information sources, and trust in those sources were associated with their adolescent’s HPV vaccination status. These findings highlight the need to address attitudes and information sources and suggest that tailored interventions considering these factors could increase HPV vaccination rates.

Impact of COVID-19 pandemic and vaccine perceptions on HPV vaccine hesitancy

ObjectiveThis study evaluated the impact of the COVID-19 pandemic and vaccine perceptions on Human Papillomavirus (HPV) vaccine hesitancy. Secondary endpoints included comparing COVID-19 and HPV vaccination trends regarding time, community of residence, and unmet social needs. MethodsThis was a survey-based, cross-sectional study that included 101 participants who were recruited through the Wyandotte County Public Health Department. Participants were eligible for inclusion in this study if they were a parent/guardian of one or more children aged 13 to 17; English- or Spanish-speaking. This study took place in Wyandotte County, Kansas. Descriptive statistics and chi-square analyses were utilized. ResultsThere was no difference in completion of COVID-19 and HPV vaccines (p = 0.0975). Significantly more individuals started and did not finish the HPV vaccine series compared to the COVID-19 vaccine series (p = 0.0004). Most participants indicated their opinion on the HPV vaccine had not changed due to the pandemic (71.3 %). Participants who felt familiar with HPV had higher rates of HPV vaccine completion. While 77 % of participants felt extremely or moderately familiar with HPV, 61.4 % were unaware of its association with oropharyngeal cancer. ConclusionThere was minimal change in parents' perception of the HPV vaccine due to the COVID-19 pandemic despite decreased rates of vaccination during this time. HPV vaccine series completion was significantly lower than COVID-19 vaccine series completion, highlighting a need to improve HPV vaccine completion counseling. Additionally, patient education should address the knowledge gap discovered regarding the link between HPV infection and oropharyngeal cancer.

1172. Compliance with Human Papillomavirus Vaccination At The HIV Outpatient Program in New Orleans, Louisiana

Abstract Background Guidelines recommend the human papillomavirus (HPV) vaccine for all adults through age 26, shared clinical decision-making for those aged 27 through 45 years who are inadequately vaccinated, and for all people with HIV up to age 45 years. The intent of this study is to evaluate HPV vaccination rates at the HIV Outpatient Program (HOP) at University Medical Center in New Orleans. Methods Immunization records from patients aged 18 through 45 years attending a physician visit in the LSU Infectious Diseases fellows’ HIV primary care clinic at HOP in 2022 were reviewed. The purpose of this project was to assess compliance with HPV vaccination recommendations among the infectious diseases fellows. Results Among patients under age 27, 15 of 21 visits (71%) had completed HPV vaccines series. 4 visits (19%) had incomplete status and 2 visits (10%) did not have any HPV vaccines record. Among patients aged 27 through 45 years, 73 of 194 visits (38%) had completed HPV vaccines series. 34 visits (18%) had partial vaccination records and 87 visits (45%) had no records. Conclusion Vaccination compliance among the LSU ID fellows was less than ideal, only 71% of visits for patient aged up to 27 years attending LSU ID fellows’ clinic had completed HPV vaccine series, compared to the Health People 2020 recommendation of 80%. Only 38% of visits for patients aged 27 through 45 years are fully vaccinated with HPV vaccines. Patients in this age group are often labeled “aged out” for HPV vaccines by health maintenance reminders however, due to having HIV, they are still eligible and should be vaccinated. These results led to the institution of quality improvement project to address HPV vaccinations. This intervention will focus on educating all HOP providers about the vaccination recommendations and updating the health maintenance care gaps reminder in the electronic medical record. Disclosures All Authors: No reported disclosures

Exploring Delivery of Adolescent Preventive Health Services During the COVID-19 Pandemic: Perceptions and Experiences Shared by Healthcare Professionals

Abstract Background While unmitigated vaccine hesitancy was already growing before the emergence of COVID-19, the global pandemic has introduced additional challenges to the immunization sector. Despite the benefits, routine preventive care was forestalled by challenges related to pandemic lockdowns/quarantine, parental reluctance to seek preventative services, poor access to healthcare, loss of income and/or health insurance, and the inability of children under 12 to be immunized against the coronavirus. Considering the potential impacts caused by the pandemic’s disruption of adolescent preventative care services, we explored the experiences of adolescent healthcare providers in Tennessee and Georgia in providing care throughout the COVID-19 pandemic. Methods A series of in-depth qualitative interviews were conducted between December 2020 and May 2021 via the video conferencing platform, Zoom, among a diverse group of adolescent healthcare providers (n=16) representing 5 healthcare practices located within the southeastern states of Georgia and Tennessee. Audio recordings were transcribed verbatim and analyzed using a rapid qualitative analysis framework, guided by the grounded theory and inductive approach. Results Preventive adolescent services were adversely impacted by the COVID-19 pandemic at all participating practices. Participants highlighted an initial decrease in patients due to the pandemic, despite the implementation of protective measures such as an increase in sanitation measures, hand washing, separation of sick and wellness visits, mask mandates, and telehealth/video conferencing opportunities. While practices continued to distribute educational materials, many removed material from their waiting rooms due to sanitary concerns related to COVID-19. Participants reported that patient-provider communications; effective use of presumptive languaging; periodic reminders/recall messages; provider’s personal recommendation on vaccine safety/efficacy; early initiation of human papillomavirus (HPV) vaccination series at 9 years; community partnerships with health navigators/vaccine champions/vaccine advocates; use of standardized forms/prewritten scripts/standard operating protocols for patient-provider interactions; and vaccine promotion through social media, brochures/posters/pamphlets, as well as outreach to schools and churches, served as facilitators to adolescent HPV vaccine uptake. Conclusions By exploring the perceptions and experiences of adolescent healthcare providers, our research identified key factors influencing adolescent vaccination uptake and its relatedness to the COVID-19 pandemic. We argue our findings support and encourage the development of personalized patient-provider communications, trusting relationships, effective use of presumptive languaging, and counteraction of misinformation as solutions to suboptimal preventative services and vaccination coverage rates. Implementation of these comprehensive strategies could not only ameliorate routine adolescent vaccination uptake but could also aid in the expansion of COVID-19 vaccine acceptance on a sizable scale.

Human Papillomavirus Vaccine Completion by 13: A Quality Improvement Initiative in a Large Primary Care Network

ObjectiveFewer than 40% of U.S. children complete the human papillomavirus (HPV) vaccine series before their 13th birthday. In our large pediatric primary care network, HPV vaccine completion rate by age 13 was 30%. We hypothesized that a phased quality improvement (QI) initiative would increase rates of HPV vaccine completion by age 13 across our network. MethodsThis QI initiative was conducted in a network of 30 practices located across two states, in urban and suburban settings, consisting of teaching and non-teaching clinics, and ranging in size from three to 50 providers per office. We used a phased approach incorporating multicomponent network-wide and iterative practice-specific interventions. Key interventions included: updating clinical decision support to default order HPV vaccine due at preventive visits starting at age nine instead of 11, data audit and feedback to providers and practices, encouraging use of a strong provider recommendation, and standing orders. ResultsFrom April 2019 to October 2022, HPV vaccine completion by age 13 across our network increased from 30% to 55% and met criteria for special cause variation on statistical process control charts. A gap in median HPV vaccine completion by age 13 between patients with public insurance and patients with private or commercial insurance decreased from 9% to 1%. ConclusionA QI initiative was associated with a sustained increase in HPV vaccine series completion by age 13 and reduced variation in care across a large network of 30 primary care practices.

The roles of Human Papillomavirus (HPV) test awareness and knowledge in HPV vaccination initiation and completion among college students in the Deep South of the United States: applying the Andersen’s Behavioral Model

ABSTRACT Human papillomavirus (HPV) has the highest prevalence of all sexually transmitted infections in the United States (U.S.). Despite the effectiveness in preventing HPV-related cancers, HPV vaccination rates were still low among young adults. Thus, this study aimed to (1) investigate HPV vaccination initiation and completion rates among college students, (2) examine relevant factors associated with HPV vaccine initiation and completion. A convenient sample of 327 college students was recruited from universities in the Deep South of the U.S. via online surveys. Logistic regressions were conducted to examine factors associated with HPV vaccination initiation and completion. About 54% of participants in the current study initiated HPV vaccination, and most of the participants who initiated the vaccination completed the series (52%). Participants who were female (odds ratio [OR] = 3.01, confidence interval [CI] = 1.38 to 6.58; OR = 2.28, CI = 1.07 to 4.85), aware of the HPV tests (OR = 16.53, CI = 5.60 to 48.83; OR = 7.36, CI = 2.99 to 18.13), and aware that ‘men should have HPV vaccination’ (OR = 2.33, CI = 1.07 to 5.09; OR = 3.27, CI = 1.50 to 7.12) were more likely to initiate the HPV vaccination and complete the vaccine series. The finding that only half of the students initiated and completed the HPV vaccine series indicates that further studies and intervention strategies are needed. Particular attention should be focused on college student populations who are male and with little HPV health knowledge.

Vaccination Coverage Among Adolescents Aged 13-17 Years - National Immunization Survey-Teen, United States, 2022.

Three vaccines are routinely recommended for adolescents to prevent pertussis, meningococcal disease, and cancers caused by human papillomavirus (HPV). CDC analyzed data from the 2022 National Immunization Survey-Teen for 16,043 adolescents aged 13-17 years to assess vaccination coverage. Birth cohort analyses were conducted to assess trends in vaccination coverage by age 13 years (i.e., before the 13th birthday) and by age 14 years (i.e., before the 14th birthday) among adolescents who were due for routine vaccination before and during the COVID-19 pandemic. Cross-sectional analysis was used to assess coverage estimates among adolescents aged 13-17 years. In 2022, vaccination coverage by age 14 years among adolescents born in 2008 continued to lag that of earlier birth cohorts and varied by sociodemographic factors and access to health care compared with coverage among earlier birth cohorts. Vaccination coverage by age 13 years among adolescents born in 2009 was similar to coverage estimates obtained before the COVID-19 pandemic. Among all adolescents aged 13-17 years, 2022 vaccination coverage levels did not differ from 2021 levels; however, initiation of the HPV vaccination series decreased among those who were insured by Medicaid. Coverage with ≥1 dose of tetanus, diphtheria, and acellular pertussis vaccine and ≥1 dose meningococcal conjugate vaccine was high and stable (around 90%). Providers should review adolescent vaccination records, especially among those born in 2008 and those in populations eligible for the Vaccines for Children program, to ensure adolescents are up to date with all recommended vaccines.

Communication Interactions, Needs, and Preferences During Clinical Encounters of African American Parent-Child Dyads.

Human papillomavirus (HPV) vaccination rates remain suboptimal among African American adolescents. Although provider recommendations during clinical encounters are believed to be highly effective in increasing uptake and series completion, little has been reported about parent-child perspectives on the counseling received during these encounters. Among African American parent-child dyads, we sought to explore and compare interactions, needs, and preferences during clinical encounters by child's HPV vaccination status. We applied a qualitative, phenomenological study design to conduct semi-structured interviews with African American parent-child dyads representing children who were unvaccinated (n = 10), had initiated but not completed (n = 11), or had completed the HPV vaccine series (n = 9). Using iterative, inductive-deductive thematic analysis, five themes were generated: (1) parents' attitudes varied about the HPV vaccine but were mostly positive for vaccines in general; (2) patient-parent-provider clinical encounters from the parent perspective; (3) patient-parent-provider clinical encounters from the child perspective; (4) methods of distribution of supplemental HPV information; and (5) communication desired on HPV vaccination by parents and children. Parents stating they received a provider's recommendation increased by vaccination status (unvaccinated: 6 out of 10; initiated: 7 out of 11; completed: 9 out of 9). Most parents and children were not satisfied with provider communication on the HPV vaccine and used supplemental materials to inform decision-making. Ongoing communication on the HPV vaccine was requested even post-vaccination of the child. During clinical encounters, children and parental messaging needs are similar yet dissimilar. We offer communication strategies and messaging that can be used for African American parent-child dyads by child HPV vaccination status during a clinical encounter.

Racial, Ethnic, and Gender Differences in the Timing of Initiating the HPV Vaccine in the UnitedStates: the Case of Southeast Asian Americans.

Despite the availability of the human papillomavirus (HPV) vaccine, non-Latinx (NL) Southeast Asian Americans have the highest incidence of HPV-associated cervical cancer in the US. Little is known about NL-Southeast Asian Americans' HPV vaccination coverage due to being categorized under the "Asian American" monolith. Therefore, this study uses restricted data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) to disaggregate NL-Southeast Asian Americans and compare this population's age-specific probabilities of initiating HPV vaccinations to two Asian American subgroups (NL-East Asian and NL-South Asian Americans) and NL-White, NL-Black, and Latinx Americans. Multinomial logistic regression models examine the differences in the timing of initiating the HPV vaccine series, late (ages 13-26) or never, relative to on-time vaccination (by age 12). NL-Southeast Asian Americans are significantly more likely to never vaccinate and to vaccinate late than NL-White, NL-Black, and Latinx Americans, relative to on-time vaccination. NL-Southeast Asian American boys/men are significantly more likely to never initiate the HPV vaccine than Latinx boys/men, relative to on-time vaccination. NL-Southeast Asian American girls/women are significantly more likely to never vaccinate and vaccinate late than NL-White, NL-Black, and Latinx girls/women, relative to on-time vaccination. There are significant gender differences in uptake among all racial and ethnic groups, except among NL-Southeast and NL-East Asian Americans. Disaggregated data on NL-Southeast Asian Americans helps scholars and public health officials uncover health disparities and improve health interventions. Targeted HPV vaccine promotion and services for this population are needed to mitigate current and future health disparities and promote health equity.