Improve HPV Vaccination Research Articles

Pay-it-forward strategy reduced HPV vaccine delay and increased uptake among catch-up age girls: A randomized clinical trial.

Catch-up HPV vaccination is challenging in many low and middle-income countries (LMICs). Pay-it-forward offers an individual a subsidized vaccine, then an opportunity to donate to help others access vaccinations. Our randomized control trial assessed the effectiveness of pay-it-forward in improving HPV vaccination among girls aged 15-18 years in China. Eligible participants were randomly assigned to either the pay-it-forward arm or standard-of-care arm (self-paid vaccination). The primary outcome was the first-dose HPV vaccination rate, verified against clinical records. Among 321 participants enrolled, most caregivers were female (80.1%). In the pay-it-forward arm, 55 of 161 (34.2%) girls received the HPV vaccine, compared with 28 of 160 (17.5%) girls in the standard-of-care arm (adjusted proportion difference = 17.9%, 95% CI: 8.7, 27.0, P<0.001). Among 55 girls in the pay-it-forward arm who received the vaccination, 37 (67.3%) wrote a postcard message, and 39 (70.9%) of their caregivers donated to support future girls. The financial cost per person vaccinated was $294 in the standard-of-care arm and $230 in the pay-it-forward arm. The pro-social pay-it-forward strategy was effective to increase catch-up HPV vaccination among teenage girls with comparable costs. ChiCTR2200055542.

HPV and Genital Warts: Mapping Awareness Through Google Trends in the United States Trends

Background: Human Papillomavirus is a sexually transmitted infection in the United States with an estimated 40% prevalence. Methods: This study assessed Google Trends data for genital warts related search terms from 2004 to 2023. The latest Centers for Disease Control-reported National Immunization Survey for 2022 were compared to Google Trends data for patterns or correlations. Results: Average annual searches for genital warts decreased by 73.7% from 2004 to 2023 with the largest reduction (-23.14%) occurring between 2019 and 2020. West Virginia had the highest twenty-year average searches for genital warts related search terms (94), while Utah was found to have the lowest. Minnesota, Massachusetts and Washington were reported on top ten states with the highest HPV vaccination coverage ( ≥ 1 dose) also were found on top ten states with the lowest twenty-year average Google Trend search inquiries for genital warts. Conversely, West Virginia, South Carolina, Oklahoma, Kentucky and Mississippi were found to be on the top ten states with the lowest reported ≥ 1 HPV dose vaccination coverage and among top ten states with highest genital wart searches. Conclusion: Google Trends data can help identify at-risk regions and guide efforts to improve HPV vaccination rates in the United States.

Pediatric providers’ views on participating in an HPV Vaccine Quality Improvement Intervention: a qualitative analysis

BackgroundHuman papillomavirus (HPV), a common sexually transmitted infection in the US, contributes to oropharyngeal and urogenital cancers. To improve HPV vaccine uptake, quality improvement (QI) interventions that address barriers to vaccination in primary care may help. This study aims to understand pediatric primary care providers’ (PCP) perspectives on participating in an HPV QI intervention that utilized practice facilitation to improve HPV vaccine uptake in pediatric primary care clinics.MethodsParticipants were pediatric PCPs whose clinics completed a QI intervention that utilized practice facilitation led by an outside facilitator. One PCP from each practice completed a 15-min semi-structured exit interview. The interview guide contained questions about PCPs’ experiences during the intervention, skills learned, and thoughts on the use of practice facilitation. Transcribed interviews were analyzed with consensual inductive and deductive techniques.ResultsTen participants completed the interview. PCPs had a median experience of 13 years (range: 0–20) in practice, most were female (8/10), white (8/10), and non-Hispanic (9/10). PCPs reported positive experiences and the intervention encouraged them to investigate their current and target vaccination rates more thoroughly. Frequently mentioned practice-wide changes included consistent messaging among all PCPs and staff in a clinic which also extended to other aspects of their care. PCPs liked facilitation and thought that it motivated change. Although they appreciated the flexibility of virtual facilitation meetings with the practice facilitator, they recommended less frequent sessions, focusing some meetings on HPV misinformation, and more support during the intervention (e.g., analyzing data in the context of the practice’s outcomes, communication between participating practices).ConclusionPCPs viewed the facilitation HPV intervention positively. Areas that would improve the intervention include addressing the timing and duration of facilitation sessions, communication strategies, and logistical support (e.g., evidence-based resources for patient education, technological support for data analysis).

Feasibility of interventions to increase HPV vaccination acceptability and coverage in school-based programs: Findings from a pilot study in Quebec, Canada

IntroductionHuman papillomavirus (HPV) vaccines have been offered in Quebec schools to 4th-grade (9–10 years old) girls since 2008 and boys since 2016. HPV vaccine coverage does not reach the 90 % target in many regions. This project evaluated the feasibility and the acceptability of interventions to improve HPV vaccine acceptability and coverage in school-based programs. MethodsThe evaluation was conducted in 32 Quebec schools in 2019–2020. We tested a strategy of three interventions implemented in sequence (face-to-face information session, email reminder with an online decision support tool, and telephone reminder using motivational interviewing (MI) techniques). Parents and school staff completed online surveys. School nurses participated in individual interviews. Key stakeholders participated in a workshop to identify enabling conditions and barriers to implementing interventions across Quebec. ResultsThe strategy was generally well-received by school staff, nurses, and parents. Many parents found the 3 interventions helpful to support their vaccination decision. Most parents (92 %) suggested that the face-to-face information session and the decision support tool (82 %) be offered to all parents. Nevertheless, delivering classroom presentations was perceived by nurses as logistically challenging. Parents were generally satisfied with the telephone reminder, but only a limited number of nurses applied motivational interviewing techniques, as half (51 %) of unreturned consent forms were due to forgetfulness. ConclusionOur strategy was accepted and deemed feasible by a majority of parents, school staff, and nurses. Collaboration between health authorities and schools is essential for implementing interventions to enhance vaccine acceptance in school-based programs.

Quality Initiative to Increase Early Initiation and Series Completion of HPV Vaccine and its Impact on Health Disparities

ObjectiveHPV infection is associated with a large burden of disease prevalence, morbidity, and known disparities. HPV vaccination rates remain lower than other childhood immunizations, despite vaccine safety and effectiveness. The objective of this QI intervention was to improve HPV vaccination rate by 15% over 3-years through early initiation and analyze trends across health disparities. MethodsQI study in ages 9 to 13 at Nemours Primary Care from 2019 to 2022, which includes rural and urban regions and diverse populations. Interventions included updating EHR to begin at age 9, practice-level feedback, and updated education. Primary outcome measure was the HEDIS rate for HPV vaccination (proportion completed by age 13). Process measure was early HPV vaccine initiation rate (proportion aged 9-10 with at least one dose). Year-end early HPV vaccine initiation rates were analyzed to assess trends by race and ethnicity, geography, insurance, and Child Opportunity Index (COI). ResultsThe number of eligible 9 and 10 year olds ranged from 16,466 to 17,925 annually. HEDIS rates improved over three years from 49.2% to 59.5% (p < 0.0001). Early initiation increased from 13.2% in 2019 to 42.2% in 2022 (p < 0.0001) and improved significantly across demographic variables (p < 0.0001). Groups with the lowest baseline early vaccination rates increased significantly. ConclusionHPV vaccine completion by 13 increased significantly with QI supporting early initiation. Demographic analyses showed the highest degree of improvement in populations with the lowest baseline rates. This supports altering CDC recommendation for HPV vaccination initiation at ages 9-12.

Implementation evaluation of a school-based intervention on HPV vaccination (the PrevHPV study)

Abstract Background HPV vaccine coverage (VC) remains lower than expected in many countries, particularly France. We developed and evaluated the PrevHPV multicomponent intervention to improve HPV VC among French adolescents. We evaluated the implementation of the school-based components of the intervention. Methods We carried out a mixed-method study embedded in a cluster randomized controlled trial (July 2021-April 2022; 14/25 French school districts). The cluster was the municipality (n = 91). The school-based components of the intervention were ‘education and motivation’ and ‘at-school vaccination’. Quantitative data were collected through standardized activity reports and self-administered questionnaires; the implementation outcomes were fidelity, dose, reach, acceptability and sustainability. Qualitative data were collected through semistructured group interviews with school staff and analyzed using the Consolidated Framework for Implementation Research. Results We found high rates for: fidelity (e.g., 69% of the targeted classes had two educational sessions and 89% of schools invited all pupils for at-school vaccination, as planned); acceptability (e.g., pupils’ participation satisfying in 90% of the sessions, 96% of vaccinated pupils and 78% of school staff satisfied with at-school vaccination); and sustainability (e.g., respectively 91% and 76% of schools considered conducting sessions and vaccination days during the following year). However, the withdrawal of 1/3 of schools before the trial started and difficulties in mobilizing parents negatively impacted dose and reach. Several facilitators and barriers influenced the implementation of the components; they were related to the components’ design, the characteristics of both the external and internal environment of the school, the numerous stakeholders and individuals involved, and the implementation strategies used. Conclusions These results can guide policy making on school-based HPV vaccine promotion in France and Europe. Key messages • The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • These findings have practical implications for implementing effective and acceptable school-based interventions in real life to improve HPV vaccine uptake and reduce HPV-associated burdens.

Educational and communication strategies to promote HPV vaccination: A Systematic Review

Abstract Background Despite the evidence supporting the value of vaccination, Cervical Cancer (CC) and HPV-related diseases still represents a public health challenge, requiring international efforts to address all barriers that can reduce vaccine acceptance and equitable uptake. In this context, implementing interventions aimed at enhancing knowledge levels within target populations emerges as a crucial approach to improve vaccination coverage. Thus, this study conducted within the PERCH project (PartnERship to Contrast HPV), aimed to explore all educational interventions/communication strategies adopted at the international level to improve HPV vaccine uptake. Methods A systematic literature review was conducted by querying three databases from July 1, 2006 (the time of the first HPV vaccine licensure) to January 30, 2024. It included studies focused on educational interventions/communication strategies adopted by healthcare providers (HCPs) targeting the World Health Organization (WHO)-recommended population for HPV vaccination, as well as parents, caregivers, teachers, and other influential individuals involved in vaccination decision-making. Results Overall, 16 studies were considered, with 68.7% (11/16) focusing on educational initiatives and 50% (8/16) on communication strategies. Regarding the target population, 19% (3/16) involved parents/caregivers, 25% (4/16) included both parents and adolescents, and the remaining 56% (9/16) targeted adolescents/young adults. Videos were the most commonly used channel for both types of interventions (54%), followed by informative materials (31%), person-to-person solicitation (17%), social media (15%) and slide presentations (23%). Conclusions Understanding the strengths and weaknesses in HPV knowledge and communication is crucial for developing effective, tailored strategies to disseminate reliable information and promote evidence-based knowledge, thereby implementing high-value healthcare. Key messages • Effective communication of vaccination’s value to stakeholders is essential for informing health policies, guiding best practices, and countering misinformation. • Further research is needed to develop interventions that effectively increase HPV vaccine acceptance, aligning with the WHO’s goals to eliminate CC and HPV-related diseases.

Attitudes, healthcare interactions, and communication preferences for HPV vaccines among hesitant Hispanic/Latinx parents: how does this compare with influenza and COVID-19 vaccines?

ABSTRACT Objective We explored HPV vaccine concerns and healthcare provider communication among Hispanic/Latinx hesitant parents during the COVID-19 pandemic, and how those concerns and provider communications compared for influenza and COVID-19 vaccines. As a secondary aim, we explored communication needs and strategies for these recommended vaccines. Design We applied a concurrent, multi-method study design (survey and interview) with 23 Hispanic/Latinx American parents of adolescents aged 11–18 years. An inductive deductive thematic approach was used to interpret interview data. Descriptives were used to analyze survey data. Results Overall, most parents (77%) perceived that their child was receiving too many vaccines. Regarding hesitancy for the HPV vaccine, major parental concerns related to vaccine effectiveness (83%), vaccine necessity (83%), and vaccine safety (80%). For the COVID vaccine, major concerns were the newness of vaccine (83%), vaccine safety (77%), low perceived effectiveness (77%), and low perceived need (77%). For influenza vaccines, major parental concerns were vaccine safety (73%), low perceived need (73%), and preference for natural over vaccine-induced immunity (73%). Parents had overall positive views towards vaccination. Some parents prioritized school-required vaccines, and others ranked the recommended vaccines- HPV, COVID-19, and influenza vaccines- for their children. They saw the benefits of recommended vaccines; however, there were concerns. The majority received a provider’s recommendation for HPV vaccination for their child, while over half had not received a recommendation for COVID-19 and influenza vaccines. Recommended communication strategies were diverse with parents highlighting the need for providers to capitalize on waiting and clinic rooms to provide education. Conclusion Healthcare providers should take advantage of missed opportunities, improve healthcare interactions with a strong recommendation and persistent communication, and offer diverse communication strategies and messaging for vaccines. Future work should further explore multi-vaccine concerns and how addressing these concerns through healthcare-provider communication could improve HPV vaccination along with COVID-19 and influenza vaccination.

Message framing's limited efficacy in counteracting parental hesitancy towards human papillomavirus vaccination for female adolescents: Insights from a randomized trial.

Parental acceptance of HPV vaccination remains low. This study investigates the influence of different message framing on Chinese parental intentions to vaccinate their daughters against HPV. A 2 (appeal framing: gain vs. loss) × 2 (cultural value: individualism vs. collectivism) × 2 (evidence type: narrative vs. non-narrative) factorial design was used in an online experiment. Parents of unvaccinated junior high school girls were recruited and included in the experiment. The primary outcome assessed was the reduction in HPV vaccine hesitancy (VH). The analysis of variance tests (ANOVAs) and hierarchical regression analyses were conducted to test the hypotheses. Of 4012 participants, the majority were women with low VH. Only loss-framing exerted a direct effect on advocacy (p = .036). Initial VH negatively moderated this effect (p = .027). Except for narrative evidence (p = .068), message framings showed significant small effects in low-hesitant participants (p = .032). An incentive policy negatively moderated the initial VH's effect on advocacy (p = .042). Persuasion was evident only among low-hesitant participants not receiving incentives (p = .002). In contrast, for highly hesitant individuals without incentive policies, loss-framing (p = .024) and collectivism perspective (p = .033) produced counterintuitive effects. Message framing is effective among low-hesitant parents of female adolescents in improving HPV vaccination decisions without economic incentives. Non-narrative evidence and loss-framing messages should be prioritized over narrative evidence and gain-framing messages. Nonetheless, caution is warranted when engaging with highly hesitant parents.

The Effectiveness of Interventions Targeting Adolescents in HPV Vaccination-A Scoping Review.

Adolescents are the target group for HPV vaccination. Studies that examine factors influencing acceptability among adolescents and interventions aimed at improving knowledge, attitudes, perceptions, intentions, and, most importantly, vaccination rates are less common than those addressing parents or healthcare professionals. The specialized literature was searched for studies evaluating the impact of various interventions on adolescents. In the final analysis, 41 studies were included (35 original studies and 6 reviews). Educational interventions increased adolescents' knowledge scores in the selected studies. Peer education proved highly effective in rapidly and significantly improving knowledge about HPV. Additionally, multicomponent interventions generated awareness and knowledge that persisted for months after the interventions. HPV vaccine uptake increased following educational interventions in 11 out of the 14 studies that evaluated this outcome; studies presenting multicomponent interventions also proved effective in improving vaccination rates. Higher HPV vaccine series completion was reported following a reminder system strategy. Interventions directed at adolescents, combined with strategies involving parents and healthcare professionals, can play an important role in improving HPV vaccination rates. Educated adolescents must be involved in decisions about their own health and can be a valuable source of information for their peers and parents.

Abstract B027: Adapting communication resources for clinic staff in a multisite FQHC to improve HPV vaccination encounters with Spanish-speaking parents of adolescents

Abstract Introduction: Adopting evidenced-based strategies (EBS) targeting clinic staff in safety-net settings can improve adolescent HPV vaccination rates. Still, adaptations of EBS are needed to reach racial/ethnic minority patients and families effectively. As part of a larger implementation study on HPV vaccination, we examined and addressed adaptation needs for HPV vaccine communication resources to support clinic staff serving Hispanic adolescent FQHC patients. Methods: In October 2022-January 2023, we partnered with a large multi-site FQHC in Los Angeles, CA to deliver two clinic staff trainings designed to i) improve HPV knowledge and communication strategies; and ii) discuss HPV vaccine workflow. Informed by the Practice Change Model, we completed baseline qualitative interviews with clinic team members (providers, clinic staff, and leadership) and provider and clinic staff surveys to inform the development, implementation, and adaptation of clinic staff training on HPV vaccine knowledge and communication strategies. We then conducted site visits and key-informant interviews with clinic staff immediately post-training. Notes from site visits and key-informant interviews were transcribed to identify potential barriers to adoption and opportunities for adaptation. Results: Baseline data indicated 95% of clinic staff identified as Hispanic and 94% reported speaking a language other than English. Notes from site visits and key-informant interviews with clinic staff indicated clinic staff identified the need for Spanish language messaging to communicate HPV and cancer prevention messages to monolingual Spanish families. As a result, we adapted Spanish-language messages from the 2023 Health Resources and Services Administration toolkit and American Cancer Society to develop a handout with scripts that address top concerns about HPV vaccination with monolingual Spanish-speaking parents of adolescents to that were identified from baseline data collection. Bilingual-bicultural staff then validated messages and confirmed cultural relevance. Developed materials were then presented to clinic leadership to review and suggest further refinement before delivering them to clinic staff. Discussion: Key-informant interviews and post-training site visits played an important role in identifying opportunities to adapt EBS designed to improve HPV vaccination among culturally diverse patients. To better serve diverse communities disproportionately impacted by HPV-associated cancers, clinic staff need resources with HPV vaccine communication messages available in languages that reflect the needs of their patient population. Citation Format: Samantha Garcia, Adrienne Martinez-Hollingsworth, Sheila Salinas Navarro, Sharon Hudson, Zehui He, Emily Dang, Lawrence Palinkas, Lourdes Baezconde-Garbanati, Jennifer Tsui. Adapting communication resources for clinic staff in a multisite FQHC to improve HPV vaccination encounters with Spanish-speaking parents of adolescents [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 B027.

Influential factors and willingness to advocate for HPV vaccination among male nursing interns in China

BackgroundHuman papillomavirus (HPV) infection significantly contributes to the global cancer burden. Understanding the factors influencing male clinical interns’ willingness to promote HPV vaccination is crucial for developing effective public health strategies in China.MethodsThis study employed a stratified random sampling method to select 1,980 male clinical interns from five provinces in China between January and March 2024. Data were collected on participants’ demographic characteristics, HPV-related clinical experience, and knowledge. The Theory of Planned Behavior framework, encompassing attitudes, subjective norms, and perceived behavioral control, was used to examine factors influencing the willingness to promote the HPV vaccine. Logistic regression analyses were conducted to identify factors associated with the willingness to promote the HPV vaccine.ResultsAmong the respondents, 72.29% were willing to encourage others to receive the HPV vaccine. Significant factors influencing this willingness included older age (OR = 3.065, P ≤ 0.001), higher monthly household income (OR = 1.449, P = 0.025), participation in the diagnosis and treatment of HPV-related diseases (OR = 3.458, P ≤ 0.001), positive attitude towards the vaccine (OR = 13.503, P = 0.004), and strong perceived behavioral control (OR = 2.364, P = 0.006).ConclusionThis study highlights the critical role of practical experience and targeted education in promoting HPV vaccination among male clinical interns in China. Enhancing the training and education of this group is essential for improving HPV vaccine advocacy and supporting public health efforts to reduce HPV-related diseases.

HPV vaccination intention among guardians of female secondary school students in Chongqing, China

ABSTRACT Background: In China, Chongqing is the first province implement a province-wide HPV vaccination free program for female students. Given the HPV vaccination of adolescents is largely dependent on the intent of their guardians, this study examined the factors associated with the parental intention to vaccinate their daughter against HPV. And we could explore how to change the factors to incentivize more guardians to vaccinate their children. Methods: This study used a cross-sectional survey designed by multi-stage non-randomized sampling. Study participants were guardians of female students of second year of junior high in all districts and counties of Chongqing, who were most knowledgeable about the immunization status of the adolescents. Data was collected by an online survey platform between December, 2022 to March, 2023. Results: We collected 20, 642 valid samples. Among the participating guardians, nearly 40% guardians had never heard of HPV and HPV vaccine. 68.8% guardians considered vaccinating their children against HPV, 12.5% guardians had vaccinated or vaccinating HPV vaccine for their children, and only 16.7% were reluctant to vaccinate for their children right now. Some individual characteristics of guardians (e.g. age, number of the children) were associated with the intention of HPV vaccines. Sufficient knowledge of HPV and HPV vaccine would promote the HPV vaccination, and vaccine hesitancy prevented guardians from vaccinating their children. Conclusions: Majority of guardians held a positive intention to vaccinate their daughter, higher than the foreign uptake. Exploring the methods of social propaganda to promote HPV-related knowledge and reduce the safety concerns of guardians could help improve HPV vaccination intention.

Influences of HPV disease perceptions, vaccine accessibility, and information exposure on social media on HPV vaccination uptake among 11,678 mothers with daughters aged 9–17 years in China: a cross-sectional study

BackgroundMothers play a crucial role in influencing their daughters’ HPV vaccination decisions. Addressing barriers to receiving HPV vaccination among mothers of girls may achieve two goals in one strike: increasing vaccination coverage among both mothers and their daughters. This study aims to examine the HPV vaccination uptake and its determinants among mothers of girls in China at both the individual and interpersonal levels.MethodsFrom July to October 2023, a cross-sectional online study was conducted to investigate HPV vaccine refusal for daughters aged 9–17 years among 11,678 mothers in Shenzhen, China. A randomized selection method was employed, targeting 11 primary schools and 13 secondary schools in Shenzhen. The research team invited mothers of girls to participate in an anonymous online survey. Multilevel logistic regression models (level 1: schools; level 2: individual participants) were employed to analyze the data.ResultsAmong 11,678 mothers, 41.1% self-reported receiving at least one dose of HPV vaccination. Through multilevel logistic regression analysis, eight items measuring illness representations of HPV, which refers to how people think about HPV, were associated with higher HPV vaccination uptake (AOR: 1.02–1.14). These items included identity (identifying symptoms of HPV), timeline (whether HPV is acute/chronic), negative consequences, personal and treatment control (whether HPV is under volitional control), concern, negative emotions, and coherence (overall understanding of HPV). In addition, participants refusing HPV vaccines for the index daughters (AOR: 0.82, 95%CI: 0.76, 0.89) had lower vaccine uptake. Perceived more difficulties in accessing the 9-valent vaccines (AOR: 1.06, 95%CI: 1.04, 1.08) and more satisfaction with vaccine-related promotional materials (AOR: 1.50, 95%CI: 1.46, 1.54) at the individual level were associated with higher vaccine uptake. At the interpersonal factors, higher frequency of exposure to testimonials given by others about HPV vaccination on social media (AOR: 1.19, 95%CI: 1.14, 1.25) and thoughtful consideration of the veracity of the information (AOR: 1.11, 95%CI: 1.07, 1.16) were correlated with higher HPV vaccination uptake.ConclusionsThese findings offer essential implications for modifying HPV disease perceptions, addressing difficulties in accessing the 9-valent HPV vaccines, and enhancing health communication needs to improve HPV vaccine uptake among mothers of girls.

Human papillomavirus vaccine delivery practices among pediatricians and pediatric trainees in a tertiary hospital in Singapore

AbstractHuman Papillomavirus (HPV) is the most common sexually transmitted infection and is associated with cervical, anogenital, and oropharyngeal cancers. It is crucial to improve vaccination uptake in both genders as primary prevention for these conditions. Pediatricians play an active role in advocating for HPV vaccination and our study aims to assess the level of knowledge, attitudes, barriers, and practices among pediatric trainees and general pediatricians regarding HPV infection and vaccination. A survey‐questionnaire was administered to our target groups. It comprised 14 questions regarding demographics of the healthcare provider, knowledge of HPV infection and vaccination, practices and barriers of recommending HPV vaccination, and effective strategies for improving HPV vaccine uptake. Among survey respondents, majority did not recommend for HPV vaccination (66.7%) or receive any enquiry about it (80.6%) within the preceding 12 months. The most common perceived barrier was inadequate knowledge, which was consistent with the misconceptions regarding HPV infection and vaccination that were identified in this survey. Strategies which physicians felt would be most effective in increasing vaccine uptake include educating and providing resources for both physicians and caregivers as well as making the vaccine free. Our study revealed a low advocacy rate for HPV vaccination. Physicians need to be equipped with the knowledge, skills, and resources to better counsel caregivers as well as focus our efforts on vaccinating male patients in order to increase vaccine uptake in both genders.

Impact of the COVID-19 pandemic on HPV vaccine uptake in a predominantly Hispanic Border Community: A retrospective cross-sectional analysis of the "Tiempo de Vacunarte Program"

BackgroundHuman Papillomavirus (HPV) is implicated in the pathogenesis of cancer in the cervix, vagina, throat and anogenital region. Although HPV vaccination rates in the Hispanic community have increased owing to public health efforts, the COVID-19 pandemic has brought unique public health challenges and contributed to health inequity in this population.MethodsTo evaluate the impact of the COVID-19 pandemic on HPV vaccine uptake in a program designed to improve HPV vaccination rate in a predominantly Hispanic community in the border region of Texas (Tiempo de Vacunarte [time to get vaccinated]), we performed a retrospective cross-sectional analysis to evaluate the uptake of the first dose of HPV vaccine series among eligible adolescents and adults before (2016–2019), during (2020–2021), and after the COVID-19 pandemic (2022–2023).ResultsWe observed a decrease in HPV vaccine uptake during the pandemic (69.59% vs. 89.92%) and post-pandemic (76% vs. 89.92%) compared to the pre-pandemic period. After adjusting for confounding factors, the reduction in the odds ratio was more pronounced in the pandemic (OR = 0.091, p < 0.001) and post-pandemic (OR = 0.109, p < 0.001) periods.ConclusionOur findings suggest that the COVID-19 pandemic significantly impacted the uptake of the HPV vaccine in a comprehensive intervention program to increase HPV vaccination in a border community.

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.

Who are vaccine champions and what implementation strategies do they use to improve adolescent HPV vaccination? Findings from a national survey of primary care professionals

BackgroundImplementation science researchers often cite clinical champions as critical to overcoming organizational resistance and other barriers to the implementation of evidence-based health services, yet relatively little is known about who champions are or how they effect change. To inform future efforts to identify and engage champions to support HPV vaccination, we sought to describe the key characteristics and strategies of vaccine champions working in adolescent primary care.MethodsIn 2022, we conducted a national survey with a web-based panel of 2527 primary care professionals (PCPs) with a role in adolescent HPV vaccination (57% response rate). Our sample consisted of pediatricians (26%), family medicine physicians (22%), advanced practice providers (24%), and nursing staff (28%). Our survey assessed PCPs’ experience with vaccine champions, defined as health care professionals “known for helping their colleagues improve vaccination rates.”ResultsOverall, 85% of PCPs reported currently working with one or more vaccine champions. Among these 2144 PCPs, most identified the champion with whom they worked most closely as being a physician (40%) or nurse (40%). Almost all identified champions worked to improve vaccination rates for vaccines in general (45%) or HPV vaccine specifically (49%). PCPs commonly reported that champion implementation strategies included sharing information (79%), encouragement (62%), and vaccination data (59%) with colleagues, but less than half reported that champions led quality improvement projects (39%). Most PCPs perceived their closest champion as being moderately to extremely effective at improving vaccination rates (91%). PCPs who did versus did not work with champions more often recommended HPV vaccination at the earliest opportunity of ages 9–10 rather than later ages (44% vs. 33%, p < 0.001).ConclusionsFindings of our national study suggest that vaccine champions are common in adolescent primary care, but only a minority lead quality improvement projects. Interventionists seeking to identify champions to improve HPV vaccination rates can expect to find them among both physicians and nurses, but should be prepared to offer support to more fully engage them in implementing interventions.

A Randomized Study to Determine the Effect of a Culturally Focused Video Intervention on Improving HPV Vaccine Intentions in a Christian Population in the United States.

Safe and effective vaccines have been developed that protect against high-risk strains of HPV, but uptake is relatively low. We previously identified factors such as sexual attitudes and HPV knowledge that impact the intent of Christian parents to vaccinate their children against HPV. We hypothesized that culturally specific interventions in the form of short videos would be effective at improving HPV vaccine intentions and attitudes. We made three short educational videos, one with a Christian focus, one informational about HPV, and one control. Videos were distributed electronically with accompanying surveys, and responses were measured before and after watching a randomly selected video. The religious-focused and educational interventions significantly (p < 0.0001, p = 0.0015) improved intentions towards HPV vaccination. The religiously-focused video also significantly diminished the belief that the HPV vaccine is unnecessary because of a family's values (p = 0.014). Parents significantly credited both interventions with improving their intent to vaccinate their children against HPV (p < 0.001 for both). These results suggest that culturally focused educational interventions are effective at influencing vaccine intentions and attitudes, even when those are based on religious or cultural feelings. Highly specific interventions are likely to be necessary for optimal improvement in vaccine hesitancy.

Optimizing Cancer Prevention in Adolescents by Improving HPV Vaccine Delivery.

Routine HPV vaccination can prevent six cancers. Best practices for achieving high adolescent HPV vaccination coverage include automatically scheduled appointments, presumptive provider recommendations, standing orders, feedback on vaccination rates, and incentives. Promising practices include starting HPV vaccine recommendations and vaccine registry forecasting at age 9 and school entry requirements.