Vaccine Uptake Research Articles

Quantifying and Adjusting for Confounding From Health-Seeking Behavior and Health Care Access in Observational Research.

Health-seeking behavior and health care access (HSB/HCA) are recognized confounders in many observational studies but are not directly measurable in electronic health records. We used proxy markers of HSB/HCA to quantify and adjust for confounding in observational studies of influenza and COVID-19 vaccine effectiveness (VE). This cohort study used primary care data prelinked to secondary care and death data in England. We included individuals aged ≥66 years on 1 September 2019 and assessed influenza VE in the 2019-2020 season and early COVID-19 VE (December 2020-March 2021). VE was estimated with sequential adjustment for demographics, comorbidities, and 14 markers of HSB/HCA. Influenza vaccination in the 2019-2020 season was also considered a negative control exposure against COVID-19 before COVID-19 vaccine rollout. We included 1 991 284, 1 796 667, and 1 946 943 individuals in the influenza, COVID-19, and negative control exposure populations, respectively. Markers of HSB/HCA were positively correlated with influenza and COVID-19 vaccine uptake. For influenza, adjusting for HSB/HCA markers in addition to demographics and comorbidities increased VE against influenza-like illness from -1.5% (95% CI, -3.2% to .1%) to 7.1% (95% CI, 5.4%-8.7%) with a less apparent trend for more severe outcomes. For COVID-19, adjusting for HSB/HCA markers did not change VE estimates against infection or severe disease (eg, 2 doses of BNT162b2 against infection: 82.8% [95% CI, 78.4%-86.3%] to 83.1% [95% CI, 78.7%-86.5%]). Adjusting for HSB/HCA markers removed bias in the negative control exposure analysis (-7.5% [95% CI, -10.6% to -4.5%] vs -2.1% [95% CI, -6.0% to 1.7%] before vs after adjusting for HSB/HCA markers). Markers of HSB/HCA can be used to quantify and account for confounding in observational vaccine studies.

COVID-19 vaccine uptake among nursing officers: a cross-sectional study in a tertiary care hospital in Sri Lanka 

COVID-19 vaccine uptake among nursing officers: a cross-sectional study in a tertiary care hospital in Sri Lanka 

Mental illness and COVID-19 vaccination: a multinational investigation of observational & register-based data

Individuals with mental illness are at higher risk of severe COVID-19 outcomes. However, previous studies on the uptake of COVID-19 vaccination in this population have reported conflicting results. Using data from seven cohort studies (N = 325,298) included in the multinational COVIDMENT consortium, and the Swedish registers (N = 8,080,234), this study investigates the association between mental illness (defined using self-report measures, clinical diagnosis and prescription data) and COVID-19 vaccination uptake. Results from the COVIDMENT cohort studies were pooled using meta-analyses, the majority of which showed no significant association between mental illness and vaccination uptake. In the Swedish register study population, we observed a very small reduction in the uptake of both the first and second dose of a COVID-19 vaccine among individuals with vs. without mental illness; the reduction was however greater among those not using psychiatric medication. Here we show that uptake of the COVID-19 vaccine is generally high among individuals both with and without mental illness, however the lower levels of vaccination uptake observed among subgroups of individuals with unmedicated mental illness warrants further attention.

A systematic review of student vaccine attitudes and vaccine policy on college and university campuses, 2000–2022

Objective: To summarize the literature 1) evaluating college student knowledge and attitudes toward vaccines and 2) examining associations between vaccine uptake and school-dependent variables. Methods: We reviewed all U.S.-based English-language primary literature published between January 1, 2000 and September 20, 2022 available online in PubMed/MEDLINE and SCOPUS databases. The initial search included studies mentioning college/university, vaccine/immunization, and one of the following terms: prevention, delivery, acceptance, uptake, or policy. Study screening, quality assessment, and data extraction were performed by author pairs using Covidence, a web-based screening and data extraction tool for conducting systematic reviews. Results: Out of 58 studies, 37 (64%) used survey methodology and 5 (9%) were randomized controlled trials. Forty studies focused on HPV vaccines. Easy access to vaccines, perceived vulnerability to disease, self-efficacy, and social norms influenced vaccine decision-making. Conclusion: While studies assessing student awareness, social norms, and message framing for vaccine uptake on campuses exist, mostly for the HPV vaccine, few have evaluated college vaccine policy.

A Scoping Review of Factors Affecting COVID-19 Vaccination Uptake and Deployment in Global Healthcare Systems.

Introduction: COVID-19 vaccines were rapidly developed and deployed on a large scale during a global crisis. A range of deployment strategies were used globally to maximize vaccine uptake. In this scoping review, we identify and analyze the main healthcare system and policy factors that guided and influenced COVID-19 vaccination deployment and uptake globally. Materials and Methods: JBI guidelines, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), and the population, concept, and context (PCC) framework were applied. Studies on individual COVID-19 vaccination factors, such as vaccine hesitancy, were excluded. The search was last conducted in May 2024 yielding 26,686 articles from PubMed, Embase, CINAHL, Scopus, and COVID-19 websites. A total of 47 articles and 3 guidance documents were included. The results of the thematic analysis were mapped to the Consolidated Framework for Implementation Research (CFIR). Results: The results found the following healthcare system and policy factors as integral to COVID-19 vaccination: types of vaccine products, healthcare workforce capacity, procurement strategies, distribution and cold-chain capacity, partnership, coordination, and leadership, information, communication, and registration strategies, delivery models, organizations, the existing health systems and policies on prioritization of at-risk groups and deployment plans. Discussion: Globally, COVID-19 vaccination programs responded to the pandemic by leveraging and reforming the existing healthcare systems, relying on strong leadership and global cooperation (such as the COVID-19 Vaccines Global Access Initiative). Deployment was enabled by effective communication and adoption of innovative technologies using data-driven policies to create high vaccine demand while overcoming limited vaccine supply and rapidly adapting to uncertainties.

Routine vaccine uptake in school-aged autistic and non-autistic youth: A linked database study.

This study was conducted to determine whether school-aged autistic youth received routine vaccines at a lower rate than their non-autistic peers. In Nova Scotia (NS), Canada, vaccines routinely delivered in early adolescence are administered to Grade 7 students through a school-based Public Health vaccination program. NS youth eligible to receive Grade 7 vaccinations between 2011 and 2017 were included in this study. Autism spectrum disorder (ASD) diagnoses were determined from administrative health data. Rates of receipt of any Grade 7 vaccine and of individual vaccines were compared between autistic and non-autistic youth. Subgroup analyses included comparing Grade 7 vaccine receipt between autistic youth and their non-autistic siblings and early childhood vaccine receipt between autistic and non-autistic cohorts. The rates of receipt of any vaccine were 73% among 916 autistic youth and 82% among 49,599 non-autistic youth (adjusted relative risk = 0.91; 95% confidence interval = 0.87-0.95). Similar results were found for individual vaccines. Subgroup analyses revealed lower rates of Grade 7 vaccine receipt among autistic youth compared to among their non-autistic siblings. Rates of early childhood vaccine receipt did not differ between autistic and non-autistic cohorts. Autistic youth were under-vaccinated compared to their non-autistic peers for Grade 7 vaccinations. Lower vaccination rates in autistic youth than in their non-autistic siblings suggest that setting-related factors may contribute more to the under-vaccination of autistic youth than parental vaccine hesitancy. Barriers to vaccine uptake for school-aged autistic youth, including those unique to school-based vaccination programs, must be explored and addressed.

Demographic and pathogen characteristics of incident bacterial meningitis in infants in South Africa: A cohort study.

Bacterial meningitis is a major cause of death, with an approximate case fatality rate of 37% across all age groups in South Africa. This study aimed to describe the demographic and pathogen characteristics of incident meningitis in children aged <1 year in South Africa from 2014 through 2018, during a period when Haemophilus influenzae type b vaccine and pneumococcal conjugate vaccines (PCV) were both included in the expanded program on immunization (EPI). We conducted a cohort study of routine laboratory data in the National Health Laboratory Service Corporate Data Warehouse, which covers approximately 80% of the South African population. We defined a case of laboratory-confirmed bacterial meningitis as any person aged <1 year with meningitis diagnosed by culture and identification of a pathogen documented as being a common cause of meningitis in CSF. The cause-specific incidence risks were calculated by dividing the number of positive specimens in each age group and year by the corresponding mid-year population for children under 1 year old and those in the post-neonatal period (≥ 28 days to 365 days old). For children under 28 days old, the annual numbers of registered livebirths were used. We used Poisson regression to compare the incidence of meningitis by year. We identified 3575 (1.5%) cases of culture-confirmed bacterial meningitis from the 232,016 cerebrospinal fluid (CSF) specimens tested from 2014-2018. The highest number of cases were recorded in children aged <28 days (1873, 52.4%), male children (1800, 50.4%) as well as in the Gauteng Province (2014, 56.3%). Acinetobacter baumannii (14.9%), followed by Klebsiella pneumoniae (13.5%), and group B streptococcus (GBS) (10.7%), were the most common pathogens detected. Overall, A. baumannii had the highest incidence risk, occurring at 9.8 per 100,000 persons in children aged <1 year in 2018. Among neonates, A. baumannii peaked at 14.9 per 100,000 livebirths in 2018, while Streptococcus pneumoniae was most common in the post-neonatal period (≥ 28 days to 365 days old), peaking at 9.8 per 100,000 persons in 2014. There was an increase in the annual incidence of most pathogens over the study period. There was an increasing trend in the annual incidence of bacterial meningitis in infants caused by most pathogens, particularly A. baumannii, K. pneumoniae and GBS. In addition to increased uptake of vaccination, prevention measures to reduce nosocomial and mother-to-child transmission of bacteria could include antenatal screening for GBS in pregnant women, rigorous hygiene in the hospital environment as well as rational antibiotic use.

Key stakeholder perspectives on delivery of vaccination services in Quebec community pharmacies.

Undervaccination is a public health issue that disproportionately affects underserved populations. Pharmacists are accessible health care professionals who have the potential to better reach communities. The aim of this study is to understand how organizational obstacles influence the pharmacist's ability to meet underserved clients' vaccination needs in community pharmacy. We conducted semi-structured interviews with key stakeholders in Quebec. Results were codified according to domains of the Consolidated Framework for Implementation Research. Fourteen interviews were carried out with representatives from pharmacy associations, pharmacy chains and banners, integrated health and social service centres, and local Quebec Public Health departments. Barriers to promoting vaccination were identified in four areas: 1) vaccine service logistics, 2) the pharmacy setting, 3) external influences and 4) pharmacist's knowledge and beliefs. Technological tools accessible to pharmacists are sufficient but not user-friendly due to the lack of integration between the pharmacy software, the vaccine registry and the provincial appointment system. Technology limits access to vaccination for certain underserved populations. Moreover, the incentives linked to vaccination do not favour the vaccination of difficult-to-reach clients and they limit pharmacists' ability to be proactive with vaccine recommendations. Pharmacists are more inclined to participate in mass vaccination campaigns, and delegating vaccine administration to nurses and technicians allows pharmacies to financially break even. Certain services such as travel health vaccination require an extended set of knowledge, which creates resistance for some pharmacists to integrate the role. Pharmacists are well-placed to improve vaccination uptake, but several technological and organizational barriers limit their ability to provide vaccination services and reach underserved communities. A better alignment between incentives and proactive promotion should be put forward to encourage pharmacists to actively identify and reach underserved populations.

Does donor country impact the efficacy of health aid?: Evidence from the COVID‐19 pandemic

AbstractDuring the coronavirus disease 2019 (COVID‐19) pandemic, many nations relied on unprecedented amounts of health‐sector aid to efficiently vaccinate their populations. These vaccines and supporting materials came from a variety of traditional and nontraditional donors, with the majority donor differing by recipient country. Previous research has examined the political benefits to donor states of providing health aid before and during the COVID‐19 pandemic. Less is known, however, about how recipients view health aid based on the donor and whether this impacts health aid resource use. This research aims to investigate whether recipient preferences over the source of health assistance affects the efficacy of aid, while using a novel vax‐score method to account for existing trends and predictors of vaccine uptake. Using COVID‐19 vaccine donation and uptake statistics collected by the Duke Global Health Innovation Center, the IMF, and the World Health Organization, we compare vaccine uptake across many vaccine recipient countries to investigate the impact of vaccine origin (Chinese vs. non‐Chinese source). We find that while increased donated vaccines per capita significantly raises the proportion of the population vaccinated at 12 months, the source of the donated vaccines has no impact. Previously reported recipient‐side concerns over vaccine origin have no impact on population‐level uptake at 12 months. Additionally, we observe that a vax‐score metric derived from vaccine uptake of a suite of childhood vaccines predicts COVID‐19 vaccine uptake beyond differences in GDP and GDP per capita. These results have implications for health aid policy and future research into foreign aid efficacy.

Covid-19 vaccination status and beliefs of individuals with co-occurring serious mental illness and alcohol use disorder

ObjectiveThe study objective was to determine factors associated with obtaining COVID-19 vaccination in people with co-occurring alcohol use disorder (AUD) and serious mental illness (SMI). MethodsSurvey responses were obtained from 135 adults with SMI seeking community-based AUD treatment about their primary series vaccination status, COVID-19 preventative practices, vaccination motivators, reasons for vaccine hesitancy, and strategies to increase vaccination uptake. Vaccinated and unvaccinated groups were compared. Responses to survey items with nominal or Likert scales were analyzed with chi-square tests of association. Logistic regression was employed to determine predictors of vaccine status. ResultsSeventy-nine percent (n=107) of participants reported they were vaccinated. A higher proportion of vaccinated participants believed COVID-19 was a serious disease. While both groups adopted preventative hygiene practices at similar rates (e.g., washing hands), vaccinated participants engaged in more interpersonal practices directly involving others (e.g., wearing masks and avoiding crowds). The strongest vaccine motivator was protecting personal health, while the primary reason for hesitancy was potential side effects. Most unvaccinated participants endorsed increased safety information availability (61.1 %) and living with a high-risk-for-severe-infection individual (55.6 %) as reasons to overcome hesitancy. ConclusionsVaccination rates, motivators, and hesitancy reasons were similar to the general United States population. Strategies to increase vaccination in this high-risk population should include education on vaccine safety and side effects and the impacts of COVID-19 and other respiratory illnesses on others.

Moving from crisis response to a learning health system: Experiences from an Australian regional primary care network

AbstractIntroductionThe COVID‐19 pandemic challenged primary care to rapidly innovate. In response, the Western Victorian Primary Health Network (WVPHN) developed a COVID‐19 online Community of Practice comprising general practitioners (GPs), practice nurses, pharmacists, aged care and disability workers, health administrators, public health experts, medical specialists, and consumers. This Experience Report describes our progress toward a durable organizational learning health system (LHS) model through the COVID‐19 pandemic crisis and beyond.MethodsIn March 2020, we commenced weekly Community of Practice sessions, adopting the Project ECHO (Extension of Community Health Outcomes) model for a virtual information‐sharing network that aims to bring clinicians together to develop collective knowledge. Our work was underpinned by the LHS framework proposed by Menear et al. and aligned with Kotter's eight‐step change model.ResultsThere were four key phases in the development of our LHS: build a Community of Practice; facilitate iterative change; develop supportive organizational infrastructure; and establish a sustainable, ongoing LHS. In total, the Community of Practice supported 83 unique COVID‐19 ECHO sessions involving 3192 h of clinician participation and over 10 000 h of organizational commitment. Six larger sessions were run between March 2020 and September 2022 with 3192 attendances. New models of care and care pathways were codeveloped in sessions and network leaders contributed to the development of guidelines and policy advice. These innovations enabled WVPHN to lead the Australian state of Victoria on rates of COVID vaccine uptake and GP antiviral prescribing.ConclusionThe COVID‐19 pandemic created a sense of urgency that helped stimulate a regional primary care‐based Community of Practice and LHS. A robust theoretical framework and established change management theory supported the purposeful implementation of our LHS. Reflection on challenges and successes may provide insights to support the implementation of LHS models in other primary care settings.

The more the merrier? Two online experiments on how decoys can increase vaccine uptake.

The more the merrier? Two online experiments on how decoys can increase vaccine uptake.

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 A162: The influence of parental barriers to healthcare on adolescent HPV vaccination uptake and completion among Latinos in Los Angeles

Abstract Objective: This study aims to investigate the association between parental barriers to healthcare access and HPV vaccination uptake among Latino adolescents in Los Angeles. Background: Human papillomavirus (HPV) induced cervical cancer (CC) remains a significant public health concern. Routine HPV vaccination has been recommended in the United States for girls since 2006 and boys since 2011 yet disparities in vaccine initiation and completion persist, particularly among Latino adolescents in Los Angeles. Methods: This cross-sectional study analyzed child data provided by mothers recruited from the Es Tiempo campaign (2016-2018). A total of 353 Latino adolescents aged 9 to 26 years were included in the sample. We used crosstabs to assess vaccine initiation and completion differences by child sex and birth order, while logistic regression models were used to evaluate the association between parental barriers to healthcare, such as lack of health insurance and access to a primary care provider (PCP), and HPV vaccination initiation. Results: Among the sample, 44% initiated the HPV vaccine, and 23% completed the series, with significantly higher rates among girls and firstborn children. Regarding barriers, lack of health insurance was associated with decreased odds of HPV vaccination uptake while access to a PCP showed a slight increase in vaccination uptake odds. Conclusion: HPV vaccination uptake among Latino adolescents in Los Angeles remains suboptimal, with disparities observed by gender and birth order. To improve public health outcomes, targeted interventions are needed to increase HPV vaccination uptake among Latino adolescent boys, and further research is needed to understand vaccine adherence patterns within families and among siblings. Moreover, while parental barriers to healthcare may influence vaccination uptake, future studies should also explore how factors like parental education level and socioeconomic status influence HPV vaccination status in combination with access barriers. Citation Format: Anju F. Kane, Lourdes Baezconde-Garbanati. The influence of parental barriers to healthcare on adolescent HPV vaccination uptake and completion among Latinos in Los Angeles [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 A162.

Abstract A163: Factors associated with human papillomavirus vaccination uptake among a clinic-based sample in Puerto Rico

Abstract BACKGROUND: Human papillomavirus (HPV) vaccine can protect against several cancers such as anal, cervical, vulvar, vagina, penis, and oropharyngeal. HPV vaccination is recommended for individuals, regardless of sex-at-birth, aged 9 through 26 years old. In addition, patient-physician clinical decision-making is recommended for individuals up to the age of 45. HPV vaccination can protect against the most common HPV genotypes that cause cancer and is the only preventive strategy for HPV infection. Therefore, this study aims to assess factors associated with HPV vaccination uptake among patients from the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Cancer Center (ANC-UPRCCC). Methods: Data from baseline visit of individuals aged ≥18 years of age who received services at the ANC- UPRCCC were used for this analysis (N=1,170). During this visit, all patients completed a questionnaire given by the clinic physicians, which collects information on sociodemographic, clinical, and lifestyle characteristics. HPV vaccination uptake was defined as having ≥1doses. Pearson chi-square and generalized regression models were used to evaluate factors associated with HPV vaccination uptake. Results: Most participants were men (66.9%), aged ≥46 years old (50.7%), and people living with human immunodeficiency virus (PLWH) (72.0%). Although HPV vaccine uptake was 15.7%, only 8% of participants reported vaccine completion (3 doses). Higher uptake was seen among younger people, men who have sex with men, people with a history of sexually transmitted infections (STIs), people without HIV, and people with anal pap uptake history (p&amp;lt;0.05). Given that a statistically significant interaction with age was observed, logistic regression models were stratified by age. On multivariable analysis, we observed higher odds of HPV vaccine uptake among persons with a history of STIs aged 27-45 (OR27-45:1.12, 95% CI: 1.01, 1.26) and ≥46 years (OR≥46:1.06, 95% CI: 1.01,1.11) in comparison to those without a history of STIs. Higher HPV vaccine uptake was also observed among people aged ≥46 with anal pap uptake history (OR≥46:1.09, 95% CI:1.01-1.19) in comparison to their counterparts. PLWH had lower odds of HPV vaccine uptake than people without HIV across all age groups (OR18-26:0.73, 95% CI:0.57-0.93; OR27-45:0.77, 95% CI:0.71-0.83; OR≥46:0.93, 95% CI:0.89-0.98). Conclusions: Despite their increased high-risk for HPV-related cancers, our results showed lower HPV vaccination uptake for PLWH across all age groups. This is concerning and highlights the importance of including educational materials about the HPV vaccine during consultation with healthcare providers, especially among individuals at high-risk for HPV-related cancers, such as PLWH. Citation Format: Jeslie M. Ramos-Cartagena, Maribel Tirado, Miriam Matos, Keimari Méndez, José Torres-Russe, Gabriela Pisiellos-Echevarria, Cristina Muñoz, Karen Del Valle, Humberto M. Guiot, Ana Patricia Ortiz. Factors associated with human papillomavirus vaccination uptake among a clinic-based sample in Puerto Rico [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 A163.

Abstract C006: Understanding barriers to low HPV vaccination in the LGBTQ+ community in Los Angeles: Collecting neighborhood-level data at pride events

Abstract Background The uptake of the Human Papillomavirus vaccine and anal cancer screening remain low among LGBTQ+ communities, especially in Los Angeles County. The LA metropolitan area has the nation’s second largest LGBTQA+ community, with an estimated 523,000 persons representing intersectional identities including the racial and ethnic diversity within lesbian, gay, bisexual, transgender, non-binary and questioning. Significant barriers to vaccination and screening exist, including inadequate knowledge, reluctance to disclose personal information, fear of a cancer diagnosis, and conflicting messages. Methods Cedars Sinai Cancer Center Community Outreach and Engagement (COE) created the Transgender Research Advisory Committee (T-RAC), a subcommittee of our Community Advisory Board, and facilitated bi-directional engagement with the research team to ensure that voices of the community were included in each phase of designing an intervention to increase HPV vaccination. T-RAC has n=8 members representing LGBTQ+ patients, advocates, and community navigators and their roles include: (1) weigh in on all materials development for community audiences, recruitment and research implementation strategies; (2) review the progress of study; (3) provide guidance on developments in the community; (4) contribute to interpretation of study findings; and (5) participate in dissemination of study findings. Results With T-RAC’s advice, a needs assessment survey was developed, and data was collected at Long Beach Pride on May 2024 with N=205 survey respondents. While 82% have heard about HPV, only 48% were vaccinated with at least one dose and only 12% completed all three doses. Among those who have not completed the HPV vaccine series (n=177), 33% are in interested in getting the vaccine, 55% prefer a mobile health clinic, and 70% would be vaccinated at Pride events. Qualitative responses indicated the following barriers to getting screened: “not ready”, “need more information”, “prefer a health provider”, and “unsure about side effects”. For those interested, a mobile health clinic was available during Pride event and N=16 people were vaccinated. Conclusion More outreach, education and engagement are needed to address barriers and low uptake of the HPV vaccine among LGBTQ+. Further, this initiative has led to the application for Research Program Project Grants (P01) and plans to launch a health education initiative, EndHPV, along with continuing to make mobile health clinics available at Pride events throughout Los Angeles County. The role of T-RAC has been instrumental in catalyzing gender-affirming interventions that directly address the unique needs and challenges faced by the LGBTQ+ community and promote equitable access to services for all. Citation Format: Alex Caro, Victor Cristanto, Richard Zaldivar, Marc Goodman, Reener Balingit, Zul Surani. Understanding barriers to low HPV vaccination in the LGBTQ+ community in Los Angeles: Collecting neighborhood-level data at pride events [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 C006.

Abstract A028: Revisiting cancer care inequities in Sub-Saharan Africa: standpoint and recommendations

Abstract Introduction: Cancer is a major global public health concern that claims around 2000 lives per day in Africa alone. Mortality rates are expected to rise in the absence of appropriate interventions. Equity and prioritizing are the main obstacles to cancer care in Africa, as policymakers and other stakeholders in the healthcare system do not give cancer enough attention. All aspects of the cancer care continuum especially these three main levels of cancer care—prevention, diagnosis, and treatment/management—are negatively impacted by this neglect. Addressing concerns of equity and prioritizing is essential to promoting equality in cancer care, as it guarantees that all individuals have an equal opportunity at cancer prevention, early detection, appropriate therapy, and follow-up treatment. Methods: We present an overview of the current status of cancer care in Africa and offer recommendations to bridge the gap using the material currently accessible from recognized databases. Results: Insufficient funding for cancer research, inadequate screening or diagnostic facilities, a lack of a well-organized and efficient cancer registry system and access to care, a shortage of specialized medical staff, high costs for screening, vaccination, and treatment, a lack of technical capacity, poor vaccination response, and late patient presentation for cancer screening are some of the factors that we highlighted as contributing to the disparity in cancer care in Africa. We also offer suggestions on overcoming some of these barriers to achieving fairness in cancer care. Our recommendations are broken down into capacity-based and national-level initiatives. These include improving healthcare budgeting for personnel, supplies, and facilities; encouraging screening and vaccine uptake; raising awareness of cancer health among medical professionals during every hospital visit, gaining knowledge through specialized training, financing cancer research, offering cancer insurance, and putting mobile health technologies to use for telemedicine diagnosis.Conclusion: A comprehensive approach to addressing issues related to cancer equity would increase the chances of cancer patients surviving longer, reduce risk factors for at-risk groups, and guarantee fair access to cancer care across the continent. This report describes the present barriers to achieving equity in cancer care, identifies the African countries' current positions on the matter, and offers recommendations that could have the greatest impact on achieving equity in cancer care. Citation Format: John Oluwafemi Teibo, Olabode Omotoso, Festus Adebayo Atiba, Tolulope Oladimeji, Tomiwa Kehinde Paimo, Farid S. Ataya, Gaber El-Saber Batiha, Athanasios Alexiou. Revisiting cancer care inequities in Sub-Saharan Africa: standpoint and recommendations [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 A028.

Abstract C177: Increasing cervical cancer screening among women living with HIV (WLWH) in Jamaica

Abstract Background: Cervical cancer (CCA) is the third most common cancer and the third leading cause of cancer deaths among women in Jamaica. Although human papilloma virus (HPV), the primary risk factor for CCA, has a prevalence of 54% among sexually active Jamaican women, HPV vaccination uptake is low, and CCA is often diagnosed at advanced stages due to inadequate screening. Women comprise 50% of persons living with HIV in Jamaica and are about six times more likely to develop cervical cancer than women without HIV. However, despite national guidelines requiring annual screenings, a national audit found that fewer than one-third of eligible WLWH underwent a Pap smear in the past year. Objective: We aimed to address gaps in CCA screening among WLWH attending four large HIV treatment sites in Jamaica through programmatic and operational support integrated into HIV care. Method: Working through the UCSF Jamaica Country Programme, funded by PEPFAR, clinical advisors completed site reviews to identify gaps in the CCA screening process. Critical gaps identified at the four sites included insufficient supplies (speculums, slides, cytology brushes, fixative, Pap smear jackets, and bed rolls), limited provider knowledge, delays in sample processing, and the delayed return of results from the national public health lab. From January 2023 to May 2024, our team provided technical assistance and resources for sample collection, private laboratory testing, delivery of samples, and collection and review of results. Results: Cervical cancer modules were integrated into an ongoing clinical management training series that reached 33 clinicians across multiple sessions. With supportive supervision, the sites strengthened patient notification and sample transportation, that facilitated appointment adherence, timely sample delivery, and prompt collection of results. Clinical advisors further supported site teams to identify abnormal results and ensure timely and appropriate follow-up diagnostic tests and treatment referrals. This intervention supported 656 eligible WLWH to complete Pap smears, with 614 timely results returned to the sites by May 2024. Conclusion: Targeted programmatic interventions can increase CCA screening by improving the availability of Pap supplies, clinic workflow, and operational efficiency within HIV care clinics thereby reaching a population at high risk for CCA. Technical and financial support from donors can be expanded to explore clinic-based models for improving and integrating HPV screening and vaccine uptake among vulnerable WLWH. The impact of these interventions can be tested through quality improvement and implementation science frameworks. Citation Format: Sharlene T Beckford Jarrett, Sasha-Kaye Blackwood, Kimlin Tam Ashing, Kamelia Bryan, Tyrone O Ellis, Jeffrey Edwards, Willi McFarland, Nicola Skyers. Increasing cervical cancer screening among women living with HIV (WLWH) in Jamaica [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 C177.

Abstract A123: Awareness of human papillomavirus (HPV) and its vaccine and telehealth: Results from the Health Information National Trends Survey (HINTS) 6, 2022 in the United States

Abstract Background: Human Papillomavirus (HPV) vaccination is essential to prevent occurrences of a variety of HPV associated cancers. The awareness of HPV and its vaccine could be associated with the use of telehealth. The aims of this study were to examine the association between awareness of HPV and HPV vaccine with receiving telehealth for health care within the past year. Methods: Data from the Health Information National Trends Survey (HINTS) 6 (N=5,887) were utilized. Dependent variable was awareness of HPV and HPV vaccine. The independent variable was those who received care from a doctor or health professional using telehealth. Weighted multivariable logistic regression was performed to determine association of awareness of HPV and its vaccine with receiving healthcare using telehealth while adjusting for age, gender, race, education, and census region. Results: The study sample consisted of 68.28% awareness of HPV and 63.47% awareness of HPV vaccine. After controlling for covariates, we found those who were aware of HPV and HPV vaccine have received telehealth care (aOR=1.40, 95%CI:1.11-1.78; aOR= 1.40, 95%CI:1.09 -1.80), respectively. In the adjusted model, the awareness of HPV for being female (aOR=2, 95%CI:1.60-2.48) and college graduates (aOR=3.80, 95%CI: 2.59-6.56). In the adjusted model, the awareness of HPV vaccine for being female (aOR= 2.68, 95%CI:2.13-3.36) and college graduates (aOR=4.68,95%CI:2.77-7.91). HPV and HPV vaccine awareness, Non Hispanic Whites had significantly higher adjusted odds compared to other race/ethnicity groups. Conclusion: Hence public health programs could be directed to promote use of telehealth to increase awareness of HPV causing cancers, reduce stigma associated with vaccination, boost healthcare recommendation and uptake of HPV vaccination considering socio demographic factors. Citation Format: Manali Desai, Iman Igab, Ogochukwu Ezeigwe, Devesh Malgave. Awareness of human papillomavirus (HPV) and its vaccine and telehealth: Results from the Health Information National Trends Survey (HINTS) 6, 2022 in the United States [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 A123.

Abstract C176: Implementing HPV vaccination services in people living with HIV in Trinidad and Tobago: COVID-19 vaccination may have boosted HPV vaccination

Abstract Background: Globally, Caribbean countries are among the most heavily burdened by both HIV and cervical cancer (CCA). People living with HIV (PLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. There is a pressing need for clinic-based CCA prevention in PLWH. Objective: A preliminary quality improvement evaluation of the vaccination program targeting PLWH in Trinidad and Tobago from October 2018 to May 2024. Methodology: The electronic health information system from a large clinic was used to abstract HPV vaccination data. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: A total of 5,615 PLWH were eligible to participate in the HPV Vaccination clinic from October 2018 to May 2024. The average age was 39.6 (age range: 18- 51); 51.4% were women and 48.6% were men. Most (81.7%) PLWH reported their sexual orientation was heterosexual. Among our participants, 62.4% were Afro-Caribbean, 18.6% were Mixed, and 7.4% were East Indian/Indian. The majority of PLWH completed at least secondary education (69.8%). Half were single (50.5%), and 42.1% were employed/self-employed. Among these HPV vaccine-eligible persons, 1,157 patients (20.6%) received HPV vaccines. For those who had received vaccines, 254 patients (22.0%) were vaccinated with at least 1dose of the HPV vaccine, 301 (26.0%) were vaccinated up to dose 2 HPV vaccine, and 602 (52.0%) were vaccinated up to dose 3 HPV vaccine. Importantly, of those who received the HPV vaccine, the rate of uptake varied for each year. The uptake of HPV vaccine from January to May 2024 was 10.5% and in 2023 it was 18.5%. The highest uptake was in 2021 which was 22.4% followed by that in 2022 which was 20.3%. Between 2018 and 2020, the uptakes were 13.7% for 2020, 12.1% for 2019, and 5.3% for 2018. Discussion: Overall, the HPV vaccination rate for PLWH was relatively low; only 1 in 5 was vaccinated. Still, we saw an interesting trend with the highest vaccination uptake during the peak years of COVID-19 vaccinations. Hence, our data suggest that the COVID-19 vaccination program may have boosted HPV vaccination. Given our lessons learned, our goal is to seek funding for an implementation and dissemination science approach for adopting, implementing, and sustaining clinic-based HPV-related cancer prevention by bundling services such as Pap-Testing, PSA testing and/or co-vaccination (e.g., flu, shingles) to improve reach and uptake towards reducing cancer-related morbidity and mortality among PLWH. Citation Format: Tessa Galindo, Jonathan Edwards, Gaole Song, Sharon Soyer, Selena Todd, Gregory Boyce, Kimlin Ashing, Jeffrey Edwards. Implementing HPV vaccination services in people living with HIV in Trinidad and Tobago: COVID-19 vaccination may have boosted HPV vaccination [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 C176.