Vaccine Completion Rates Research Articles

Using an Inpatient Quality Improvement Curriculum for Internal Medicine Residents to Improve Pneumococcal Conjugate Vaccine Administration Rates

Pneumococcal infections are an important source of morbidity and mortality in older adults and persons with compromised immune systems. New recommendations from the Advisory Committee on Immunization Practices (ACIP) became available September 2014, which included recommendations for the use of the 13-valent pneumococcal conjugate vaccine (PCV13). A study was conducted to increase the PCV13 vaccination rates of hospitalized patients at the White River Junction Veterans Affairs Medical Center (White River Junction, Vermont) through the use of a resident-driven quality improvement (QI) project. From December 2014 through April 2016, 16 internal medicine inpatient residents addressed inpatient PCV13 vaccination rates by participating in the facility's QI curriculum. Eight Plan-Do-Study-Act cycles were used, including discharge template editing, electronic reminders, and the discovery of a vaccination administration documentation error in the record through data validation. The measure was the monthly percentage of patients who received PCV13 vaccination (vaccination completion rate) of those discharged from the hospital medicine service who were due for PCV13 vaccination. The percentage of veterans discharged with an up-to-date PCV13 vaccination on discharge increased from approximately 30% to 87% and was sustained. Despite being driven by many different residents, this project demonstrates that continuous improvement can be achieved through a structured and iterative process while providing active learning of core QI concepts to residents. It also displays a method in which new guidelines can be incorporated into practice in an effective manner. Finally, this project is an example of how resident-driven data validation can lead to further improvement.

IN1 - Using Electronic Health Records to Examine HPV Vaccine Initiation and Completion Rates

IN1 - Using Electronic Health Records to Examine HPV Vaccine Initiation and Completion Rates

Potential Predictors for HPV Vaccination Completion Rates

Background Human papillomavirus (HPV) is the most common sexually transmitted pathogen; its ease in transmission significantly contributes to its prevalence within the population. While most HPV infections are asymptomatic, a subset of infections cause genital warts, cervical cancer and various anogenital cancers. Accordingly, the vaccine Gardasil has been designed to prevent HPV infection and its associated sequelae. While Gardasil is effective against over 75% of cervical cancers, recent studies have demonstrated its limited adoption. In 2010, only 49% of females between the ages of 13-17 had received at least one dose. Moreover, Gardasil is a three-dose vaccine, and consequently, female patients that initiate the vaccination series often do not complete it in its entirety. Methods Data obtained from researchers at the Johns Hopkins Medical Institutions (JHMI) was used to determine which socioeconomic factors influence a female’s likelihood of vaccination completion. The dataset consisted of female patients between the ages of 11-26 that had received at least one of the Gardasil vaccine doses from a JHMI clinic in Baltimore, USA, between the years 2006 and 2008. First, three logistic regression models were run with vaccination regimen completion, one shot completed and two shots completed as the dependent variables. Then, three LASSO logistic regression models were run to find relationships that were not influenced by model overfitting. The two regression methods were compared to determine if different results could be achieved. Results For the logistic regression, findings revealed that black females (P = 0.006881), females between the ages of 18-26 (P = 0.000483), and females that visited urban clinics (P = 0.004582) are at an increased risk of incomplete vaccinations. In contrast, females that were treated by obstetrician-gynecologists (P = 0.006269) had increased compliance with the Gardasil vaccination regimen compared to women that visited other healthcare professionals. For the LASSO logistic regression, the model that penalized the most for overfitting showed that black females have a higher likelihood of only receiving one shot. Conclusions Due to the retrospective nature of the data, no causation can be established. However, these correlations shed light on what female populations should be studied further and potentially targeted to improve Gardasil vaccination completion rates. Moreover, the differences in vaccination completion rates can, in turn, aggravate the existing disparities in cervical cancer risk among females.

Early Outcomes of a Multilevel Human Papillomavirus Vaccination Pilot Intervention in Federally Qualified Health Centers

ObjectiveHuman papillomavirus (HPV) vaccine coverage in the United States remains low compared with other adolescent vaccines. As the largest primary care network in the United States, safety net clinics such as federally qualified health centers (FQHCs) serve patients at a disproportionate risk of HPV-related cancers. In this pilot project, the American Cancer Society (ACS) leveraged its primary care workforce to implement quality improvement interventions in the unique context of 30 FQHC systems across the country, including 130 clinic sites reaching >20,000 adolescents in a variety of geographic settings. MethodsFQHC systems were randomly selected to receive either a $90,000 2-year grant, a $10,000 3-month grant, or training and technical assistance without funding. All 3 intervention groups conducted provider training and education, completed a capacity assessment tool, and measured HPV vaccination rates. Annual HPV vaccine series initiation and completion rates for active, 11- to 12-year-old patients were measured to evaluate project outcomes. ResultsHPV vaccine series initiation rates among 11- to 12-year-old patients increased by 14.6 percentage points from a baseline of 41.2% before the intervention (2014) to the intervention year (2015). Changes in HPV second dose and series completion rates were not statistically significant. Meningococcal and tetanus, diphtheria, and acellular pertussis vaccination rates also increased significantly, by 13.9 and 9.9 percentage points from baseline rates of 49.1% and 52.5%, respectively. ConclusionsThe first year of this pilot project showed early success, particularly with HPV vaccine series initiation. On the basis of these promising results, ACS is expanding clinical quality improvement projects to increase HPV vaccination across the country.

Male Undergraduates' HPV Vaccination Behavior: Implications for Achieving HPV-Associated Cancer Equity.

Despite the availability of the human papillomavirus (HPV) vaccine for males, uptake of the vaccine has been low, particularly among young adult males. This study aimed to investigate the levels of HPV vaccination and predictors of HPV vaccine completion in college men ages 18-26. We analyzed data from the 2015 College Student Health Survey, which was administered at 17 post-secondary institutions in Midwest areas. We included only responses from male participants who were ages 18-26years old, resulting in a sample size of 2516. We used Andersen's Behavioral Model of Health Services Utilization to guide our study design. Multivariate logistic regression was used to examine predictors of HPV vaccine receipt. College-aged males in our sample had a HPV vaccine completion rate of 50.0%. Male students who were younger, had at least one parent who held a graduate degree, had initiated sex, and were enrolled at a private 4-year institution were more likely to have been vaccinated. These findings suggest that HPV vaccination in college-aged men are low. Efforts are needed to increase HPV vaccination in male students who are older, from lower socioeconomic statuses, have not initiated sex, and enrolled at public institutions. Findings also indicate important gender disparities in vaccine uptake that must be addressed in order to achieve optimal vaccine uptake in college-aged males.

Improving the Hpv Vaccine Completion Rate in Children Aged 12 Years in a Pediatric Resident-staffed Patient Centered Medical Home

Improving the Hpv Vaccine Completion Rate in Children Aged 12 Years in a Pediatric Resident-staffed Patient Centered Medical Home

Immunization effects of a communication intervention to promote preteen HPV vaccination in primary care practices

ObjectivesHPV vaccination at the recommended ages of 11–12 is highly effective yet has stalled well below the goal of 80% of the population. We evaluated a statewide practice-based communication intervention (tools: brochures, posters, online training for providers and resources for parents, video game for preteens) to persuade parents, preteens and providers to vaccinate against HPV. The 9-month intervention started May 1, 2015. MethodsWe compared vaccine initiation and completion rates over three 9-month periods (baseline, intervention, post-intervention) between practices enrolled in the intervention and a comparable comparison group. All practices reported to the North Carolina Immunization Registry (NCIR) and had at least 100 11- and 12-year-olds who had not completed the HPV vaccine series. Of 175 eligible practices, the 14 intervention practices included 19,398 individuals and the 161 comparison practices included 127,896 individuals. An extended Cox model was used to test the intervention effect. ResultsThe intervention had a significant effect on both initiation and completion during the intervention and post-intervention periods; the estimated hazard ratio (HR) for initiation was 1.17 (p = .004) during the intervention and 1.11 (p = .005) post-intervention. Likewise, completion during the intervention period was 17% higher in intervention practices, after controlling for baseline differences. This effect increased in the post-intervention period to 30% higher (p = .03). ConclusionsIndividuals in the intervention practices were 17% more likely to initiate and complete HPV vaccination than in the comparison practices during the intervention period and the effect was sustained post-intervention. This intervention is promising for increasing rates of HPV vaccination at ages 11–12.

Efficacy of a community-based participatory and multilevel intervention to enhance hepatitis B virus screening and vaccination in underserved Korean Americans.

The primary objective of the current study was to evaluate the efficacy of a community-based participatory intervention program in improving hepatitis B virus (HBV) screening and vaccination among Korean Americans who were not previously screened. A cluster randomized trial involving 32 Korean church-based community organizations (1834 participants) was conducted. Sixteen churches were randomly assigned to an HBV screening and vaccination multicomponent intervention condition (972 participants) and 16 were assigned to a general cancer education control condition (862 participants). The main components of the intervention program included interactive group education; patient navigation; and the engagement of health care providers, church leadership, and church members in the medical field. The application of community-based participatory research principles was monitored and evaluated. HBV screening and vaccination rates (self-reported and medical record verification) were assessed at 6-month and 12-month follow-ups, respectively. The results of the current study demonstrated significant efficacy in the HBV screening rate (92.5% in the intervention group vs 5.5% in the control group), 3-series HBV vaccination completion rate (84% in the intervention group vs 17.6% in the control group), and overall screening and vaccination compliance rate (87% in the intervention group vs 3.8% in the control group). Participants in the intervention group were significantly more likely to receive HBV screening (92.5%) compared with those in the control group (5.5%). In multivariate mixed-effect logistic regression analysis, the odds ratio for an intervention effect on HBV screening was 512.3 after adjusting for cluster effect and other demographic variables. With regard to vaccination rates, of the 332 participants who were screened with no immunity in the intervention group, 308 (92.8%) received at least 1 HBV vaccination, 300 (90.4%) received at least 2 shots, and 279 participants (84%) received all 3 shots. A combination of community-based participatory research and a multilevel approach may produce the most optimal results and be essential in producing a considerable effect for enhancing HBV screening and vaccination, particularly for Korean American populations with limited language proficiency and insurance coverage. Cancer 2018;124:973-82. © 2017 American Cancer Society.

A Behavioral Economic Approach to Improving Human Papillomavirus Vaccination

PurposeThe objectives of this study were to measure the impact of a behavioral economic intervention on human papillomavirus (HPV) vaccine initiation and series completion rates for adolescents and to measure the impact of the intervention on the receipt of a nonincentivized influenza vaccine. MethodsWe conducted a quasi-randomized trial to compare the impact of an escalating delayed cash incentive (intervention), compared with usual care (control), on HPV vaccination initiation and series completion rates among adolescents (11–17 years) at an urban medical center. We measured HPV vaccine initiation and completion rates during the 12 months after enrollment and subsequent influenza vaccination rates for 24 months after enrollment. ResultsA total of 85 participants were actively enrolled in the intervention arm and 103 were passively enrolled in the control arm. Participants were predominantly publically insured African-American and Hispanic adolescents. The majority (75%) of the intervention group received one or more doses of the HPV vaccine, with 36% completing the three-dose series, compared with 47% of the control group receiving one or more doses and only 13% completing the series. The odds of HPV p-value vaccine initiation (odds ratio 4.19 [95% confidence interval 1.84–10.10], p < .01) and HPV vaccine series completion (OR 4.16 [95% confidence interval 1.64–11.28], p < .01) were greater among the intervention group compared with the control group. There was no difference in influenza vaccination rates between the intervention group and the control group during the 2013–2014 season (p = .138) and during the 2014–2015 influenza season (p value .683). ConclusionsAn incentive-based approach to HPV vaccination was effective in increasing vaccine initiation and series dose completion.

HPV literacy and its link to initiation and completion of HPV vaccine among young adults in Minnesota

ObjectivesThis study identifies whether, and how, human papillomavirus (HPV) literacy and predisposing, enabling, and need factors are associated with HPV vaccine initiation and completion among young adults in Minnesota. Study designCross-sectional survey design. MethodsUsing a sample of 170 young adults (aged 18–26 years), we used logistic regression models to identify factors associated with HPV vaccination initiation and completion, including HPV literacy, adjusting for relevant predisposing, enabling, and need factors. ResultsConsistent with national estimates, we found relatively low rates of HPV vaccination initiation (46%) and completion (36%). Better HPV literacy was significantly associated with higher rates of both initiation and completion, as was being female and having an annual check-up. Being married/partnered was significantly associated with lower odds of HPV vaccination. ConclusionsPublic health programs, policy-makers, and healthcare providers can use these results to increase HPV vaccination rates by making concerted efforts to improve HPV vaccination literacy through individual and public education campaigns and by improving access to annual check-ups.

Improving Hepatitis Vaccination Series Completion in Patients Awaiting Liver Transplantation

The aim of this quality improvement project was to improve hepatitis A and B vaccination rates by 20% in patients listed for liver transplant by improving vaccine tracking, ordering/scheduling practices, out-of-network vaccinations, and flagging electronic health records. We audited 101 records; 44 patients were vaccine-deficient. Combined vaccine completion rates improved 94.6% (44.7%-87.0%) after implementing the educational and health record interventions. We believe the results of this study have implications for improving survival and decreasing complication rates for patients with chronic liver disease.

Pharmacists' Attitudes and Perceived Barriers to Human Papillomavirus (HPV) Vaccination Services.

Use of non-traditional settings such as community pharmacies has been suggested to increase human papillomavirus (HPV) vaccination uptake and completion rates. The objectives of this study were to explore HPV vaccination services and strategies employed by pharmacies to increase HPV vaccine uptake, pharmacists’ attitudes towards the HPV vaccine, and pharmacists’ perceived barriers to providing HPV vaccination services in community pharmacies. A pre-piloted mail survey was sent to 350 randomly selected community pharmacies in Alabama in 2014. Measures included types of vaccines administered and marketing/recommendation strategies, pharmacists’ attitudes towards the HPV vaccine, and perceived system and parental barriers. Data analysis largely took the form of descriptive statistics. 154 pharmacists completed the survey (response rate = 44%). The majority believed vaccination is the best protection against cervical cancer (85.3%), HPV is a serious threat to health for girls (78.8%) and boys (55.6%), and children should not wait until they are sexually active to be vaccinated (80.1%). Perceived system barriers included insufficient patient demand (56.5%), insurance plans not covering vaccination cost (54.8%), and vaccine expiration before use (54.1%). Respondents also perceived parents to have inadequate education and understanding about HPV infection (86.6%) and vaccine safety (78.7%). Pharmacists have positive perceptions regarding the HPV vaccine. Barriers related to system factors and perceived parental concerns must be overcome to increase pharmacist involvement in HPV vaccinations.

Primary care team- and clinic level factors affecting HPV vaccine uptake.

This study examined patient-, care team- and clinic-level factors associated with human papillomavirus (HPV) vaccine initiation and completion. HPV vaccine initiation and completion rates among adolescents aged 9-18years were assessed using administrative data (n=38,277) from a large federally qualified health center serving predominantly Latino patients. Four clinics with particularly high and low adolescent HPV vaccine uptake were selected for in-depth case study analyses. Semi-structured interviews with clinic leaders, providers, and support staff in these clinics (n=36) examined multilevel factors perceived as affecting vaccine initiation and completion. On average, less than half (45%) of patients had initiated the HPV vaccine; of these, 52% of patients completed all recommended doses. Vaccine uptake varied significantly across clinics but was higher among patients seen by providers specializing in pediatrics. Qualitative findings confirmed the importance of provider communication strategies but indicated that other health care team structures and processes also play an important role in vaccine uptake. Care team members in higher performing clinics were more likely to describe vaccination as a team effort rather than solely the provider's responsibility. Support staff in higher performing clinics also spent more time reviewing patient preventive care needs and preparing patients for the provider encounter. Clinic-level factors such as performance management systems and the use of immunization champions were described as important for developing an organizational climate supportive of vaccination. Tracking and reminder systems were described as important but insufficient for ensuring vaccine uptake in the absence of other supports. Efforts to improve HPV initiation and completion could benefit from additional attention to factors at the health care team and clinic levels. Interventions that target factors at multiple levels of influence are most likely to achieve higher vaccination rates. Quality monitoring programs may influence clinic investment in improving vaccination rates.

Abstract 268: Tracking HPV vaccination of young boys: is parental recall as dependable as physician records

Abstract Introduction: HPV vaccine is administered to young boys and girls aged 11-12 years in multiple doses rather than single dose. The interval between doses is critical as well as completion of the dose series. Moreover, the administration of the HPV vaccine in 2 doses is a recent change from the 3 doses previously recommended for children aged 11-12 years. Therefore, it is critical that HPV vaccination uptake records are accurately kept as interventions are developed to increase HPV vaccine uptake. Previous studies on the validity of parental reported HPV vaccine uptake have focused only on adolescent girls. This is because the HPV vaccine recommendation for boys came 5 years after that for girls. Currently, vaccination rates among boys lag behind those for girls across the United States. This study compared the validity of parent- vs. provider-reported HPV vaccine initiation and completion rates among a national sample of adolescent boys in the United States. Methods: We analyzed the 2014 National Immunization Survey-Teen data for adolescent boys only (n = 9,493), and obtained information on the records of HPV vaccine uptake [initiation (≥1 dose) and completion (≥ 3 doses)] for both parents (parental recall) and provider reports (electronic medical records). We compared the validity of parent- versus provider-reported HPV vaccination by computing validity measures [sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa]. Results: Rates reported by provider and parental recall were similar for HPV vaccine initiation (41.8% vs. 42.7%, respectively), and completion (19.6% vs. 21.9%, respectively). Compared to provider report, parent-reported HPV vaccine initiation had a sensitivity of 83.0%, a specificity of 88.8%, a PPV of 84.1%, a NPV of 87.9%, and a kappa coefficient of 0.72. Compared to provider report, parent-reported HPV vaccine completion had a sensitivity of 68.6%, a specificity of 92.9%, a PPV of 72.9%, a NPV of 91.4%, and a kappa coefficient of 0.63. Conclusions: Both parent- and provider-reported HPV vaccine initiation and completion rates were comparable; however, parental recall of HPV vaccine completion among boys was less sensitive. Ongoing surveillance of HPV vaccination rates among boys is important as more studies are designed to improve HPV vaccine uptake and understand parental HPV vaccine barriers. In this regard, parental recall may be used as an effective alternative in assessing HPV vaccine uptake in the United States. Note: This abstract was not presented at the meeting. Citation Format: Nosayaba Osazuwa-Peters, Betelihem B. Tobo, Meera Muthukrishnan, Daphne Lew, Betty Chen, Eric Adjei Boakye. Tracking HPV vaccination of young boys: is parental recall as dependable as physician records [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 268. doi:10.1158/1538-7445.AM2017-268

Pre-travel Health Care Utilization Among Travelers Who Visit Friends and Relatives

Introduction: Immigrants to the United States who return home to visit friends and relatives (VFRs) have high rates of travel-related infections. The data on VFR utilization of pre-travel health care is inadequate. The objective of this study was to describe the travel patterns and adherence to pre-travel recommendations of VFRs.Methods: This retrospective study compared pre-travel health care utilization between VFR and non-VFR patients in one travel clinic from 2012-2013. Study investigators reviewed patients’ electronic medical records for demographic data, travel characteristics, and rates of immunizations and preventive medication prescriptions (i.e. antimalarial prophylaxis and antibiotics for traveler’s diarrhea). Categorical variables were compared using chi-square tests. Multivariate logistic regression was used to model adjusted associations of VFR with completion of pre-travel recommendations.Results: VFRs (n = 393) were younger than non-VFRs (n = 1680), more often required interpreters for language translation, and more commonly had government insurance coverage than non-VFRs. VFRs were more likely to travel to lower-income countries in Africa, Asia, and the Middle East. VFRs had longer durations of travel: 51% for >4 weeks vs. 21% for non-VFRs (P < 0.0001). VFRs were less likely to complete tetanus, polio, and rabies vaccinations, but more likely to complete measles, mumps, and rubella vaccinations. Only the association with the rabies vaccination remained significant after adjustment (OR [95% CI] = 0.3 [0.1, 0.8]).Conclusion: VFRs had longer travel durations and lower rates of vaccine completion than non-VFRs. More research is needed to understand this disparity and to promote changes in practice.

An investigation on immunological effect of hepatitis B vaccine amongst adult population in high-labor-export rural regions, under 4 different strategies

Objective: To grope for an ideal immune strategy in grown-ups via comparison of immunological effects under 4 different vaccination schemes. Methods: Study population was selected by stratified random cluster sampling. A total of 4 different vaccination proposals, including Strategy A (3 doses, 10 μg, administrated repeatedly into the unilateral deltoid muscle at 0-1-6 months), Strategy B (2 doses, 20 μg, administrated into the bilateral deltoid muscles simultaneously), Strategy C (3 doses, 10 μg, administrated repeatedly into the unilateral deltoid muscle at 0-1-2 months) and Strategy D (2 doses, 10 μg, administrated to the bilateral deltoid muscles at the same time), were conducted in Liangzhou, Minqin Gulang, and the Tianzhu Tibetan Autonomic county respectively, in Wuwei city, Gansu province. Under 4 different strategies, post-vaccination immunological effectiveness was evaluated when blood samples of participants collected in the eighth months, post-first injection and in the third year, and tested by enzyme-linked immunoassays and electro-chemiluminescence immunoassay. Chi-squared test and Fisher exact test were used to evaluate the immunological differences between the 4 strategies. Wilcoxon' s signed rank test and Kruskal-Waillis H test were conducted to compare the differences of the geometric mean titers (GMTs) of antibody against HBV surface antigen (anti-HBs) titers. Results: A total of 1 621 eligible participants aged 16 to 60 years old, were recruited for the study. Numbers of administration and gender were testified as the presuming factors for influencing immune effectiveness. The vaccination completion rates were 53.97% and 79.82% in Strategy A and C, respectively, and the difference statistically significant (P<0.05). In the first year, the protective antibody sero-conversion rates (standardization rate) were 89.21%, 54.88%, 92.11%, and 41.63%, in Strategy A, B, C and D, respectively, and the significant statistically differences emerged (P<0.05) if Strategy B, C and D were compared with Strategy A (as the gold standard). Over a 3-year follow-up period, the levels of GMTs on protective antibody declined from 179.2 IU/L, 51.6 IU/L, 277.1 IU/L and 10.1 IU/L to 61.3 IU/L, 21.2 IU/L, 31.8 IU/L and 6.0 IU/L in Strategy A, B, C and D, respectively, and the differences of declination on GMTs showed statistically significant differences (P<0.05) when compared within or between the 4 strategies. Conclusion: The 0-1-2 months' prophylactic schedules (Strategy C) seemed superior to the others, in terms of effectively inducing the protective antibody, with shorter duration of vaccination, persisting longer immunity and having higher rate of completive vaccination, so is worth to be recommended as a feasible immune programme for adults, especially for migrants from the rural regions.

Human Papillomavirus Vaccine Uptake: Increase for American Indian Adolescents, 2013–2015

Although Indian Health Service, tribally-operated, and urban Indian (I/T/U) healthcare facilities have higher human papillomavirus (HPV) vaccine series initiation and completion rates among adolescent patients aged 13-17 years than the general U.S. population, challenges remain. I/T/U facilities have lower coverage for HPV vaccine first dose compared with coverage for other adolescent vaccines, and HPV vaccine series completion rates are lower than initiation rates. Researchers aimed to assist I/T/U facilities in identifying interventions to increase HPV vaccination series initiation and completion rates. Best practice and intervention I/T/U healthcare facilities were identified based on baseline adolescent HPV vaccine coverage data. Healthcare professionals were interviewed about barriers and facilitators to HPV vaccination. Researchers used responses and evidence-based practices to identify and assist facilities in implementing interventions to increase adolescent HPV vaccine series initiation and completion. Coverage and interview data were collected from June 2013 to June 2015; data were analyzed in 2015. I/T/U healthcare facilities located within five Indian Health Service regions. Interventions included analyzing and providing feedback on facility vaccine coverage data, educating providers about HPV vaccine, expanding access to HPV vaccine, and establishing or expanding reminder recall and education efforts. Impact of evidence-based strategies and best practices to support HPV vaccination. Mean baseline first dose coverage with HPV vaccine at best practice facilities was 78% compared with 46% at intervention facilities. Mean third dose coverage was 48% at best practice facilities versus 19% at intervention facilities. Intervention facilities implemented multiple low-cost, evidence-based strategies and best practices to increase vaccine coverage. At baseline, most facilities used electronic provider reminders, had standing orders in place for administering HPV vaccine, and administered tetanus, diphtheria, and acellular pertussis and HPV vaccines during the same visit. At intervention sites, mean coverage for HPV initiation and completion increased by 24% and 22%, respectively. A tailored multifaceted approach addressing vaccine delivery processes and patient and provider education may increase HPV vaccine coverage.

Factors associated with parental reasons for \u201cno-intent\u201d to vaccinate female adolescents with human papillomavirus vaccine: National Immunization Survey - Teen 2008\u20132012

Background1) To identify socio-demographic factors associated with parental “no-intent” for their 13–17 year old unvaccinated daughter to receive the human papillomavirus (HPV) vaccine series within the next twelve months, 2) to describe patterns in “no-intent” by socio-demographic factors, and 3) to identify socio-demographic factors associated with parental reasons for “no-intent”.MethodsData from 2008–2012 National Immunization Survey - Teen (NIS - Teen) were examined in this study. Parents with “no-intent” to vaccinate their daughters were asked to identify reasons for their decision. All responses were categorized into five domains identified as barriers to receive the HPV vaccine series: 1) Safety and Effectiveness Concerns; 2) Systemic Barriers; 3) Vaccine Misinformation; 4) Lack of Knowledge about the Vaccine; and 5) Socio-cultural Barriers. Multivariable logistic regression models were performed to address the study objectives.ResultsNumber of people in the household, household income, mother’s age, education, health insurance, recommendation of a health care provider, and the survey year were significantly associated with parental “no-intent”. Race/ethnicity, mother’s education, marital status, recommendation of a health care provider, household income, age of the unvaccinated daughter, and the survey year, were significantly associated with one or more domains identified as barriers to receive the HPV vaccine.ConclusionsThis study identified sub-groups of parents across different socio-demographic factors with “no-intent” for their adolescent daughters to receive the HPV vaccine. Developing strategies that target educational tools towards the identified sub-groups of parents about the purpose, safety, and efficacy of the HPV vaccine, and HPV infection, may help increase HPV vaccine acceptance, initiation and completion rates.

Abstract C91: Understanding practices, perceptions, and likelihood of recommending the HPV vaccine among doctors in rural eastern North Carolina

Abstract Background: Human Papillomavirus (HPV) vaccine completion rates in the U.S. are low. Provider recommendation is the most important predictor of vaccine initiation and completion. We sought to understand current practices, perceptions, and likelihood of recommending HPV vaccines among doctors in rural eastern North Carolina. Methods: We distributed a brief 12-item survey to 90 practicing physicians and residents across two community health clinics in eastern North Carolina in March 2015 (44% response rate). The survey asked questions about the likelihood of recommending vaccines to girls and boys of varying ages, comfort in STI discussions, and reasons for not recommending HPV vaccines. Results: Doctors are significantly more likely (p&amp;lt;0.0001) to recommend HPV vaccines to 9-11 year old girls as compared to boys the same age. No significant differences were found for other age groups. Close to half of doctors in our sample (45%) reported to be slightly comfortable, neutral, or not comfortable talking with adolescents about STIs. Doctors who reported being very comfortable in talking with adolescents about STIs were 3.9 times (p&amp;lt;0.05; 1.029-14.996) more likely to recommend the vaccine to 9-11-year-old boys as compared to doctors who reported less comfort. No significant differences were found comfort in talking with adolescents about STIs for girls in the same age group. Conclusion: Results provide a better understanding about specific practices and perceptions regarding HPV vaccines among doctors that may influence their recommendation practices. Our data suggests a need for provider training regarding HPV vaccine recommendation and patient-provider STI communication strategies. Citation Format: Shawna O'Rorke, Essie torres, Alice Richman. Understanding practices, perceptions, and likelihood of recommending the HPV vaccine among doctors in rural eastern North Carolina. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C91.

UK healthcare professionals' uncertainties, barriers and facilitators to the introduction of targeted human papillomavirus vaccination for men who have sex with men.

Female-only human papillomavirus (HPV) vaccination will fail to protect men who have sex with men (MSM) against HPV and its sequelae (i.e. genital warts and anal cancers). In the absence of gender-neutral HPV vaccination, targeted vaccination at sexual health clinics for MSM offers a valuable preventive opportunity. This study aimed to identify sexual healthcare professionals' (HCPs) perceived barriers and facilitators for MSM-targeted HPV vaccination. Nineteen telephone interviews with UK-based self-referred HCPs (13 doctors, three nurses, three health advisers) were conducted in October and November 2014. The interviews were recorded and transcribed verbatim. Data were analysed thematically by two researchers. HCPs were unsure about selection criteria, acceptable healthcare settings and the source of vaccination funding for the introduction of MSM-targeted HPV vaccination. Lack of political and public support, MSMs' limited access to HPV vaccination and disclosure of sexual orientation to HCPs, identification of eligible MSM, patients' poor HPV awareness and motivation to complete HPV vaccination were perceived as significant barriers. HCPs believed that the introduction of official guidelines on HPV vaccination for MSM, awareness campaigns and integrated clinic procedures could improve vaccination coverage. HCPs recognised a need to protect MSM against HPV. However, several challenges and obstacles associated with the introduction of MSM-targeted HPV vaccination in the UK were reported. HCPs' perspectives and concerns need to be addressed when developing policies and guidelines for a potential MSM-targeted HPV vaccination. Future research needs to examine whether negative views of HCPs towards MSM-targeted HPV vaccination are associated with lower HPV vaccine uptake and completion rates in MSM.