1
|
Mansfield LN, Kahn BZ, Kokitkar S, Kritikos KI, Brantz SN, Brewer NT. HPV vaccine standing orders and communication in primary care: A qualitative study. Vaccine 2024; 42:3981-3988. [PMID: 38816304 PMCID: PMC11242613 DOI: 10.1016/j.vaccine.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Standing orders may improve HPV vaccination rates, but clinical staff's readiness to use them has not been well-explored. We sought to explore benefits and challenges to using HPV vaccine standing orders for adolescents ages 9 to 12, understand clinical staff roles in communication about HPV vaccine, and how standing orders can reduce barriers contributing to vaccine disparities among racial and ethnic marginalized groups. METHODS Participants were a sample of 16 U.S. nurses, medical assistants, and healthcare providers working in primary care, recruited from June to September 2022. Trained staff conducted virtual, semi-structured qualitative interviews. We analyzed the resulting data using reflexive thematic analysis. RESULTS Themes reflected benefits and challenges to using HPV vaccine standing orders and strategies to address clinic barriers to improve vaccine access and HPV vaccine communication. Benefits included faster and efficient clinic flow; fewer missed vaccine opportunities and promotion of early vaccination; and normalization of HPV vaccination as routine care. Challenges included possible exacerbation of existing HPV vaccine communication and recommendation barriers; and how the complexity of the vaccine administration schedule lessens nurses' and medical assistants' confidence to use standing orders. Strategies to address vaccine access barriers included using nurse-only visits to empower nurse autonomy and catch up on HPV vaccination; engaging clinical staff to follow up with overdue children; and educating parents on HPV vaccine before their child is vaccine eligible. CONCLUSION Using HPV vaccine standing orders can promote autonomy for nurses and medical assistants and address vaccine access barriers. Clinical staff engagement and clinic support to mitigate existing vaccine communication barriers are needed to empower staff to use of HPV vaccine standing orders.
Collapse
Affiliation(s)
- Lisa N Mansfield
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Saayli Kokitkar
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine I Kritikos
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sierra N Brantz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
2
|
Saxena K, Patterson-Lomba O, Gomez-Lievano A, Zion A, Cunningham-Erves J, Kepka D. Assessing the long-term implications of age 9 initiation of HPV vaccination on series completion by age 13-15 in the US: projections from an age-structured vaccination model. Front Pediatr 2024; 12:1393897. [PMID: 38993325 PMCID: PMC11238570 DOI: 10.3389/fped.2024.1393897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction Routine human papillomavirus (HPV) vaccination in the US is recommended at ages 11 or 12 years and can be given at age 9. Vaccination completion rates among adolescents 13-15 years in the US remain below the 80% goal. This study evaluated the long-term effects of increasing proactive HPV vaccination initiation rates at age 9 years in completion rates of adolescents. Methods An age-structured vaccination model was developed and parametrized based on the National Immunization Survey-Teen (NIS-Teen) survey data. The model projected vaccination coverage (by vaccination status and age group), for 20 years, for a routine initiation scenario (no increase in initiation rates of 9-year-olds) and different proactive initiation (increased age 9 initiation) scenarios. The time to reach a completion rate of 80% for 13-15-year-olds was estimated. The model also generated projections stratified for subgroups of interest. Results Results indicated that vaccine completion rates of 80% in 13-15-year-olds may not be achieved by 2040 under current trends of routine initiation at ages 11 or 12 years. However, increasing initiation rates in 9-year-olds by 1% and 3% annually could shorten the time to achieve 80% completion by 4 and 8 years, respectively. Stratification analyses showed that increasing initiation rates in 9-year-olds can also reduce disparities across subgroups in the time to achieve vaccination completion targets. Discussion Increasing HPV vaccination initiation rates in 9-year-olds by as little as 1%-3% annually may be an effective strategy to improve HPV vaccination completion rates in adolescents by age 15 and reach the Healthy People goal of 80% completion much earlier.
Collapse
Affiliation(s)
| | | | | | | | - Jennifer Cunningham-Erves
- Department of Internal Medicine, School of Medicine, Meharry Medical College, Nashville, TN, United States
| | - Deanna Kepka
- College of Nursing and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
3
|
Orya EE, Bello KK, Sampson S, Envuladu EA, Okagbue HI. Varying behavioral differences and correlates of HPV infection among young adolescents in Benue state, Nigeria. BMC Public Health 2024; 24:1548. [PMID: 38849788 PMCID: PMC11162061 DOI: 10.1186/s12889-024-19068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) infection is a significant public health concern globally, especially in low- and middle-income countries. In Africa, including Nigeria, HPV prevalence is high, contributing to a substantial burden of cervical cancer. Despite challenges, massive HPV vaccination campaigns in Africa show promise for preventing cervical cancer cases. In Benue State, Nigeria, limited research exists on several aspects of HPV knowledge and attitudes towards HPV among secondary school students. This study aims to bridge this gap by assessing HPV knowledge, prevention practices, willingness to uptake HPV vaccination, and associated attitudes and behaviors among secondary school students in the state. METHODS The cross-sectional study was conducted among adolescents aged 10-19 years in six secondary schools in three local government areas (LGAs) in Benue State, Nigeria. Two-stage sampling was used to select the LGAs and schools, with a final sample size of 591 students. The selected schools represent both junior and senior secondary school levels and span across the three senatorial districts of the state. Data were collected using a self-administered questionnaire covering sociodemographic characteristics, HPV knowledge, prevention practices, and willingness for HPV vaccination. Statistical analyses included univariate analyses and tests of association, with significance set at p < 0.05 or 0.001 depending on the level of the stringency of the evidence required. Data were analyzed using SPSS version 25. RESULTS Only 35.4% of the participants were males, and 86.8% were between the ages of 10 and 16. Only 24.7% acknowledged that HPV can be transmitted during sexual intercourse, and 36.2% recognized that HPV can be transmitted via skin-to-skin contact. 48.1% noted that HPV can cause cervical cancer. Half (50.9%) acknowledged that early sexual debut increases the risk of acquiring HPV, while only 28.1% recognized vaccination as a preventive strategy against HPV infection. Only 35% correctly stated the best time for the HPV vaccine. In assessing the practice of HPV prevention, 14.9% are in a sexual relationship and 10.3% admitted to not using condoms during sexual intercourse. Also, 11.8% have had STIs, and 27.2% have previously undergone HIV screening. Various bivariate analyses showed some varying behavioral differences and correlates of HPV infection among young adolescents in Benue State, Nigeria. CONCLUSIONS This study provides valuable insights into HPV knowledge, prevention practices, and willingness to uptake HPV vaccination among secondary school students in Benue State, Nigeria. The significance of the differences and correlates was discussed using themes. The research has unpacked complex relationships that could have public health implications for researchers and policymakers. Moreover, ten actionable policy recommendations were prescribed. Several interventions and areas for further study were proposed.
Collapse
Affiliation(s)
| | | | | | | | - Hilary I Okagbue
- Sydani Institute for Research and Innovation, Sydani Group, Abuja, Nigeria.
| |
Collapse
|
4
|
HPV vaccine initiation at 9 or 10 years of age and better series completion by age 13 among privately and publicly insured children in the US. Hum Vaccin Immunother 2023; 19:2161253. [PMID: 36631995 PMCID: PMC9980633 DOI: 10.1080/21645515.2022.2161253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The US Advisory Committee on Immunization Practice recommends routine human papillomavirus (HPV) vaccination at 11-12 years of age, but states that vaccination may be initiated as early as 9 years. Our primary goal was to assess whether initiating HPV vaccination at 9-10 years of age, compared to 11-12, was associated with a higher rate of series completion by 13 years of age, and to identify factors associated with series completion by age 13. The study used vaccine claims and other data from the IBM MarketScan Commercial Claims and Encounters (privately insured) and IBM MarketScan Multi-State Medicaid (publicly insured) databases. Participants were 9-12 years of age and initiated HPV vaccination between January 2006 and December 2018 (publicly insured) or February 2019 (privately insured). Among 100,117 privately insured individuals, those initiating the HPV vaccination series at 9-10 years of age had a significantly higher series completion rate by 13 years of age than did those initiating at 11-12 years of age (76.2% versus 48.1%; p < .001). The same pattern was observed for 115,863 publicly insured individuals (70.4% versus 40.0%; p < .001). Provider and health care plan type, female sex, race/ethnicity, and wellness checks or non-HPV vaccinations during the baseline period were significantly associated with series completion by 13 years of age. Proactive initiation of HPV vaccination at 9-10 years of age was associated with higher rates of series completion by 13 years of age. These findings can inform provider education and other interventions to encourage timely HPV vaccination series completion.
Collapse
|
5
|
Kahn BZ, Reiter PL, Kritikos KI, Gilkey MB, Queen TL, Brewer NT. Framing of national HPV vaccine recommendations and willingness to recommend at ages 9-10. Hum Vaccin Immunother 2023; 19:2172276. [PMID: 36749614 PMCID: PMC10012934 DOI: 10.1080/21645515.2023.2172276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023] Open
Abstract
Proactive HPV vaccination at age 9 better prevents infection and improves vaccine series completion. Because national organizations recommend starting the vaccine at different ages, we sought to understand the impact of these recommendation frames. In 2022, we surveyed 2,527 US clinical staff (45% physicians) who provide HPV vaccine for children. We randomized respondents to one of three frames based on HPV vaccine recommendations of national organizations or a no-recommendation control, and assessed willingness to recommend HPV vaccine for children ages 9-10. Respondents also reported perceived benefits of HPV vaccination at ages 9 or 12. Recommending HPV vaccination "at ages 11-12" led to lower willingness to vaccinate at ages 9-10 than control (37% vs. 54%, p < .05). Recommending vaccination "at ages 9-12" led to similar willingness as control. However, "starting at age 9" led to higher willingness than control (63% vs. 54%, p < .05). Results were similar across respondents' training, specialty, or years in practice, or their clinic's rurality or healthcare system membership. More common benefits of recommending at age 9 than 12 were avoiding the topic of sex (24% vs. 10%, OR = 2.78, 95%CI: 2.23, 3.48) and completing the vaccine series before age 13 (56% vs. 47%, OR = 1.44, 95%CI: 1.23, 1.68). Less common benefits for age 9 were having parents ready to talk about HPV vaccine and agreeing to vaccination (both p < .05). An effective way to encourage proactive HPV vaccination is to say that it starts at age 9. Aligning national recommendations to start at age 9 can promote timely vaccination.
Collapse
Affiliation(s)
- Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Paul L Reiter
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Katherine I Kritikos
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Tara L Queen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
6
|
Minihan AK, Bandi P, Star J, Fisher-Borne M, Saslow D, Jemal A. The association of initiating HPV vaccination at ages 9-10 years and up-to-date status among adolescents ages 13-17 years, 2016-2020. Hum Vaccin Immunother 2023; 19:2175555. [PMID: 36748322 PMCID: PMC10026883 DOI: 10.1080/21645515.2023.2175555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Recent guidelines from the American Cancer Society stress HPV vaccination series initiation at the youngest opportunity, i.e., age 9 years. There are limited data on the association between initiating HPV vaccination at ages 9-10 years and up-to-date (UTD) status. In this study, we compare nationally representative UTD HPV vaccination rates between adolescents who initiated the series younger (ages 9-10 years) vs. older (≥ age 11 years). Five years of pooled data (2016-2020) from National Immunization Survey-Teen were used to estimate the UTD HPV vaccination prevalence among younger vs. older initiating 13-17-year-olds. Adjusted logistic regression models estimated prevalence ratios (aPRs), differences (aDs), and difference in differences (aDDs) in prevalence of being UTD to assess the overall association of age at initiation with being UTD and differences in sociodemographic predictors of being UTD among younger vs. older initiators. UTD prevalence for younger initiators was 93% compared with 72% among older initiators (aPR: 1.27,95%CI: 1.24,1.31). Among older initiators, UTD prevalence was significantly different by sex, insurance status, and current age; no such differences were observed among younger initiators. Results indicate that younger initiation is associated with a 27% higher UTD prevalence, highlighting the importance of promoting younger initiation, particularly among those with health-care barriers.
Collapse
Affiliation(s)
- Adair K Minihan
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA, USA
| | - Priti Bandi
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA, USA
| | - Jessica Star
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA, USA
| | | | - Debbie Saslow
- Prevention and Early Detection, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA, USA
| |
Collapse
|
7
|
Brandt HM, Footman A, Adsul P, Ramanadhan S, Kepka D. Implementing interventions to start HPV vaccination at age 9: Using the evidence we have. Hum Vaccin Immunother 2023; 19:2180250. [PMID: 36803261 PMCID: PMC10026886 DOI: 10.1080/21645515.2023.2180250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Human papillomavirus (HPV) vaccination is routinely recommended for adolescents aged 11 or 12 years but can begin at age 9. On-time HPV vaccination by the thirteenth birthday has proven to be effective in preventing HPV cancer and pre-cancer. However, HPV coverage rates continue to lag behind other routinely recommended vaccinations for adolescents. A promising approach to improving coverage is to start HPV vaccination at age 9. This approach has been endorsed by the American Academy of Pediatrics and the American Cancer Society. Benefits of this approach include increased time to complete vaccination series by the thirteenth birthday, additional spacing of recommended vaccines, and a more concentrated focus on cancer prevention messaging. While promising, little is known about how and if existing evidence-based interventions and approaches can be used to promote starting HPV vaccination at age 9. Implementation science frameworks offer scientific direction in how to adapt current and develop new interventions to promote starting HPV vaccination at age 9 and accelerate dissemination and prevent HPV cancers.
Collapse
Affiliation(s)
- Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alison Footman
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deanna Kepka
- Huntsman Cancer Institute and College of Nursing, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
8
|
Kajtezovic S, Morgan JR, Fiascone S, Brandt HM, Perkins RB. Optimizing timing of adolescent vaccines: Impact of initiating HPV vaccination before Tdap or meningococcal vaccination on timely completion of the HPV vaccine series. Hum Vaccin Immunother 2023; 19:2175541. [PMID: 36798049 PMCID: PMC10026864 DOI: 10.1080/21645515.2023.2175541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
To explore the impact on timely series completion of initiating the HPV vaccine series prior to other vaccines in the adolescent platform (Tdap or meningococcal vacccines), we created a cohort of children aged 9 in 2015 who were continuously enrolled through the age of 13 (2019) from a national administrative database of employee-sponsored insurance in the United States (MarketScan). Logistic regressions were used to predict the odds of HPV vaccine series completion among those who started the series prior to, concurrent with, or after receiving Tdap or meningococcal vaccination. The cohort included 100,857 eligible children. Compared with adolescents who received their HPV and Tdap or HPV and meningococcal vaccinations concurrently, those who received HPV prior to other vaccines had higher completion (aOR = 1.38 for Tdap, aOR 1.62 for meningococcal), while those who received their HPV vaccination after other vaccines had lower odds of HPV vaccine series completion (aOR = 0.68 for Tdap, aOR = 0.62 for meningococcal). Other factors associated with series completion included female sex, residing in an urban (vs. rural) area, residing in the Northeast, and receiving primary care from a pediatrician (vs. family medicine physician). These data indicate that beginning the HPV vaccine series prior to the adolescent platform may improve on-time series completion.
Collapse
Affiliation(s)
- Sidika Kajtezovic
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Stephen Fiascone
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| |
Collapse
|
9
|
Lake P, Fuzzell L, Brownstein NC, Fontenot HB, Michel A, McIntyre M, Whitmer A, Rossi SL, Perkins RB, Vadaparampil ST. HPV vaccine recommendations by age: A survey of providers in federally qualified health centers. Hum Vaccin Immunother 2023; 19:2181610. [PMID: 36882951 PMCID: PMC10054304 DOI: 10.1080/21645515.2023.2181610] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Clinician recommendation remains a critical factor in improving HPV vaccine uptake. Clinicians practicing in federally qualified health centers were surveyed between October 2021 and July 2022. Clinicians were asked how they recommended HPV vaccination for patients aged 9-10, 11-12, 13-18, 19-26, and 27-45 y (strongly recommend, offer but do not recommend strongly, discuss only if the patient initiates the conversation, or recommend against). Descriptive statistics were assessed, and exact binomial logistic regression analyses were utilized to examine factors associated with HPV vaccination recommendation in 9-10-y-old patients. Respondents (n = 148) were primarily female (85%), between the ages of 30-39 (38%), white, non-Hispanic (62%), advanced practice providers (55%), family medicine specialty (70%), and practicing in the Northeast (63%). Strong recommendations for HPV vaccination varied by age: 65% strongly recommended for ages 9-10, 94% for ages 11-12, 96% for ages 13-18, 82% for age 19-26, and 26% for ages 27-45 y. Compared to Women's Health/OBGYN specialty, family medicine clinicians were less likely to recommend HPV vaccination at ages 9-10 (p = .03). Approximately two-thirds of clinicians practicing in federally qualified health centers or safety net settings strongly recommend HPV vaccine series initiation at ages 9-10. Additional research is needed to improve recommendations in younger age groups.
Collapse
Affiliation(s)
- Paige Lake
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Lindsay Fuzzell
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Naomi C Brownstein
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Holly B Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Alexandra Michel
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | - McKenzie McIntyre
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Ashley Whitmer
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Sarah L Rossi
- Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston University, Boston, MA, USA
| | - Rebecca B Perkins
- Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston University, Boston, MA, USA
| | - Susan T Vadaparampil
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| |
Collapse
|
10
|
Zorn S, Darville-Sanders G, Vu T, Carter A, Treend K, Raunio C, Vasavada A. Multi-level quality improvement strategies to optimize HPV vaccination starting at the 9-year well child visit: Success stories from two private pediatric clinics. Hum Vaccin Immunother 2023; 19:2163807. [PMID: 36798976 PMCID: PMC10054168 DOI: 10.1080/21645515.2022.2163807] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
HPV vaccination rates remain far below goal, leaving many adolescents unprotected against future HPV-related cancers. Starting HPV vaccine at age 9 may improve timely preteen vaccination. The "HPV Vax at 9" Quality Improvement intervention paired HPV vaccination with 9- and 10-year well child visits and was piloted at two pediatric clinics (n = 9 sites) in Washington between 2018 and 2022. Supporting interventions included standardized immunization schedule posters in exam rooms, electronic medical record supports, provider and staff training, strong provider recommendations, printed educational resources, and peer-to-peer champion coaching. Provider and clinic acceptance was high with HPV vaccine administration occurring at 68-86% of the 9- and 10-year well child visits. During the first year, HPV initiation rates at age 9-10 increased by 30% or more at each clinic. Sustained improvements in initiation and series completion were seen with completion at age 11-12 rising as much as 40% from 22 to 62%. Downward pressure of the COVID-19 pandemic on HPV vaccination rates was mitigated. Pairing HPV vaccine with 9- and 10-year well child visits, posting the standardized immunization schedule, and instituting EMR supports for HPV at 9 may be effective and sustainable strategies to simplify clinic workflows and increase timely HPV vaccination.
Collapse
Affiliation(s)
- Sherri Zorn
- Pediatrics Department, Optum Washington, Seattle, WA, USA
| | | | - Thuy Vu
- School of Public Health, University of Washington Health Promotion Research Center, Seattle, WA, USA
| | | | - Katie Treend
- Comprehensive Cancer Control Program, Washington State Department of Health, Tumwater, WA, USA
| | - Char Raunio
- Cancer Support Strategic Partnerships, American Cancer Society, Seattle, WA, USA
| | - Anjali Vasavada
- School of Public Health, University of Washington Health Promotion Research Center, Seattle, WA, USA
| |
Collapse
|
11
|
Li Z, Chen S, Mahjabeen I, Shafique R. Nurses and doctors 's awareness and knowledge towards treatment and care of cervical cancer patients: a cross-sectional study. BMC Nurs 2023; 22:389. [PMID: 37853385 PMCID: PMC10583426 DOI: 10.1186/s12912-023-01522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
AIM The present study aimed to investigate healthcare professionals' perceptions and experiences in caring for cervical cancer patients. The present study was also designed to assess the healthcare professionals' attitudes toward cervical cancer screening and its prevention. METHODS A cross-sectional quantitative descriptive study was conducted, and 540 participants (240 nurses and 300 doctors), from different hospitals of Pakistan have been selected and interviewed. RESULTS Data was collected using structured questionnaires and SPSS was used to statistically analyze the data. Participants in the present study are questioned with respect to age, gender, and work experience. The mean age of the participants is 35 years. Among them, 41% of participants are < 35 years of age and 59% are > 35 years of age. In the case of gender, 22% of participants are males and 78% are females. 47% of the participants have work experience < 20 years and 53% have work experience > 20 years. Data from the present study showed that most of the nurses are less educated (basic education of middle and matric degree) with a simple diploma in nursing and midwifery. Nurses and doctors do not have any knowledge/experience of the patient's psychological counselling. Participants are also questioned with respect to HPV vaccination, 39% of nurses and 62% of doctors are vaccinated. The difference in vaccination frequency of participants was observed as statistically significant (p < 0.0001). In the case of treatment modalities, doctors have statistically more knowledge about the pap smear (p < 0.0001), cervical biopsy (p < 0.0001), colposcopy (p < 0.0001), and visual application after acetic acid application (p < 0.0001) compared to nurses. Data analysis showed that Pap smear was performed significantly higher in married females compared to unmarried (p < 0.0001). CONCLUSION our study provides a comprehensive and in-depth perspective of the nurses and doctors for cervical cancer patients. Cervical cancer prevalence is increasing due to inadequate knowledge and awareness among healthcare professionals. Improvement can be brought about by the regular use of treatment modalities in unmarried females also.
Collapse
Affiliation(s)
- Zhen Li
- Department of Cancer Center Day Ward, Henan Provincial Kev Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou City, Henan, 450003, China.
- People's Hospital of Zhengzhou University, Zhengzhou City, Henan, 450003, China.
- People's Hospital of Henan University, Zhengzhou City, Henan, 450003, China.
| | - Sinuo Chen
- College of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng City, Henan Province, 475004, China
| | - Ishrat Mahjabeen
- Cancer Genetics and Epigenetics Research Group, Department of Biosciences, COMSATS University Islamabad, Islamabad City, Pakistan
| | - Rabia Shafique
- Cancer Genetics and Epigenetics Research Group, Department of Biosciences, COMSATS University Islamabad, Islamabad City, Pakistan
| |
Collapse
|
12
|
Vielot NA, Lane RM, Loefstedt K, Cunningham JL, Everson J, Tiller E, Johnson Patel SE, Smith JS. Acceptability and readiness to promote human papillomavirus vaccination at ages 9-10 years: a feasibility study among North Carolina clinics. Pilot Feasibility Stud 2023; 9:153. [PMID: 37653458 PMCID: PMC10470204 DOI: 10.1186/s40814-023-01379-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/18/2023] [Indexed: 09/02/2023] Open
Abstract
While 9-valent human papillomavirus (HPV) vaccination is approved by the US Food and Drug Administration for use in adolescents as young as age 9, providers typically recommend it at ages 11-12. Studies suggest that recommending HPV vaccination at 9 or 10 years of age could increase up-to-date vaccination by age 13, which could especially benefit rural populations with reduced access to primary health care and lower HPV vaccination coverage than urban areas. This study aimed to assess the feasibility of the age-9 recommendation of HPV vaccination in rural clinics. We conducted in-depth interviews with providers and staff from two primary care clinics in central North Carolina to understand attitudes toward recommending HPV vaccination to 9- and 10-year-olds. All interviewees agreed that HPV vaccination was important for cancer prevention and should be recommended before the onset of sexual activity, agreeing that HPV vaccination could be initiated before age 11 to improve timeliness and completion of the vaccination series. However, opinions were mixed on whether HPV vaccination should be initiated as young as 9 years old. Two key informants recruited from two university-affiliated clinics described their experiences recommending HPV vaccination to 9- and 10-year-olds, including a modified vaccination schedule that promotes HPV vaccination during routine well-child visits, prior to pubertal onset, and alongside other recommended adolescent vaccines. Age-9 recommendation and administration of HPV vaccination is possible with minimal changes to current clinical practices and could increase the convenience and acceptability of HPV vaccination in under-vaccinated settings.
Collapse
Affiliation(s)
- Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, North Carolina, 27599, USA.
| | - Robyn M Lane
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, North Carolina, 27599, USA
| | - Kaitlyn Loefstedt
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Jason Everson
- Piedmont Health Services, Inc, Chapel Hill, North Carolina, USA
| | - Eli Tiller
- Piedmont Health Services, Inc, Chapel Hill, North Carolina, USA
| | | | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
13
|
Brewer NT, Kahn BZ, Kritikos KI, Heisler-MacKinnon JA, Young JD, Gilkey MB. How to make effective HPV vaccine recommendations starting at age 9. Hum Vaccin Immunother 2023; 19:2216117. [PMID: 37246871 PMCID: PMC10305488 DOI: 10.1080/21645515.2023.2216117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023] Open
Abstract
This article provides best and promising practices for recommending HPV vaccination at age 9 as a way to ensure high uptake. An effective method for recommending HPV vaccination is the Announcement Approach, which consists of 3 evidence-based steps. The first step, Announce, involves noting that the child is 9 years old, saying they are due for a vaccine that prevents 6 HPV cancers, and saying you'll vaccinate today. This adapted version of the Announce step simplifies the bundled approach used at ages 11-12 that emphasizes the prevention of meningitis and whooping cough in addition to HPV cancers. For hesitant parents, the second step, Connect and Counsel, involves finding common ground with the parent and communicating the value of starting HPV vaccination at the first opportunity. Finally, for parents who decline, the third step is to Try Again at a later visit. Using the Announcement Approach at age 9 stands to increase HPV vaccine uptake, save time, and lead to high family and provider satisfaction.
Collapse
Affiliation(s)
- Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine I Kritikos
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer A Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica D Young
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
14
|
Shato T, Humble S, Anandarajah A, Barnette A, Brandt HM, Garbutt J, Klesges L, Thompson VS, Silver MI. Influences of sociodemographic characteristics and parental HPV vaccination hesitancy on HPV vaccination coverage in five US states. Vaccine 2023:S0264-410X(23)00517-0. [PMID: 37198022 DOI: 10.1016/j.vaccine.2023.04.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 04/17/2023] [Accepted: 04/30/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND In the United States (US), half of new human papillomavirus (HPV) infections occur among young people aged 15-24 years. Despite the effectiveness of HPV vaccination in protecting against HPV-associated cancers, its coverage among adolescents remains suboptimal. This study examined the association of sociodemographic characteristics and HPV vaccination hesitancy with HPV vaccination coverage in five US states with disproportionately low adolescent coverage rates compared to the national average. METHODS Responses to an online Qualtrics survey from 926 parents of children aged 9-17 years in Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois in July 2021 were analyzed using multivariate logistic regression to estimate the association of sociodemographic characteristics and HPV vaccination hesitancy with HPV vaccination coverage. RESULTS Of the parents, 78 % were female, 76 % were non-Hispanic White, 61.9 % lived in rural areas, 22 % were classified as HPV vaccine hesitant, and 42 % had vaccinated their oldest child between the ages of 9-17 years against HPV. Children of vaccine hesitant parents were less likely to have received any doses of the HPV vaccine than children of non-vaccine hesitant parents (AOR: 0.17, 95 % CI:0.11-0.27). Male children were less likely to have initiated the HPV vaccine series than female children (AOR: 0.70, 95 % CI:0.50-0.97). Older children (13-17 vs 9-12 years), receiving the meningococcal conjugate or most recent seasonal influenza vaccine were all associated with higher likelihoods of receiving any doses of the HPV vaccine (AOR: 6.01, 95 % CI:3.98-9.08; AOR: 2.24, 95 % CI:1.27-3.95; AOR: 2.41, 95 % CI:1.73-3.36, respectively). CONCLUSIONS Adolescent HPV vaccination coverage remains low in our targeted states. Children's age, sex, and parental vaccine hesitancy were significantly associated with likelihood of HPV vaccination. These findings offer the opportunity for targeted interventions among parents in regions with low vaccine uptake and underscore the importance of developing and implementing strategies to address parental HPV vaccination hesitancy to improve uptake in the US.
Collapse
Affiliation(s)
- T Shato
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, United States; Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States.
| | - S Humble
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - A Anandarajah
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States; Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110, United States
| | - A Barnette
- Saint Francis Medical Center, 211 St. Francis Drive, Cape Girardeau, MO 63703, United States
| | - H M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, United States
| | - J Garbutt
- Department of Medicine and Pediatrics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - L Klesges
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - V S Thompson
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110, United States; Department of Medicine and Pediatrics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - M I Silver
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
| |
Collapse
|
15
|
Vielot N, Lane RM, Loefstedt K, Cunningham J, Everson J, Tiller E, Patel S, Smith J. Acceptability and readiness to promote human papillomavirus vaccination at ages 9-10 years: A pilot study among rural North Carolina clinics. RESEARCH SQUARE 2023:rs.3.rs-2326137. [PMID: 36778244 PMCID: PMC9915803 DOI: 10.21203/rs.3.rs-2326137/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
While 9-valent human papillomavirus vaccination (HPV-9) is approved by the U.S. Food and Drug Administration for use in adolescents as young as age 9, providers typically recommend it at ages 11-12 per Centers for Disease Control and Prevention recommendations. Studies suggest that recommending HPV-9 at 9 or 10 years of age could increase up-to-date vaccination by age 13, which could benefit rural populations with reduced access to primary health care and lower HPV-9 coverage than urban areas. This pilot study aimed to assess the feasibility of earlier recommendation of HPV-9 in rural clinics. We conducted in-depth interviews with providers and staff from two primary care clinics in central North Carolina, to understand attitudes toward recommending HPV-9 to 9- and 10-year-olds. All interviewees agreed that HPV-9 was important for cancer prevention and should be recommended before the onset of sexual activity, and agreed that HPV-9 could be initiated before age 11 to improve timeliness and completion of the vaccination series. However, opinions were mixed on whether it should be initiated as young as 9-years-old. Two key informants recruited from two urban clinics described their experiences recommending HPV-9 to 9- and 10-year-olds, including a modified vaccination schedule that promotes HPV-9 during routine well-child visits, prior to pubertal onset, and alongside other recommended adolescent vaccines. Earlier recommendation and administration of HPV-9 is possible with minimal changes to current clinical practices and could increase convenience and acceptability of HPV-9 in under-vaccinated settings.
Collapse
Affiliation(s)
- Nadja Vielot
- The University of North Carolina at Chapel Hill School of Medicine
| | - Robyn M Lane
- The University of North Carolina at Chapel Hill Gillings School of Global Public Health
| | | | | | | | | | | | - Jennifer Smith
- The University of North Carolina at Chapel Hill Gillings School of Global Public Health
| |
Collapse
|
16
|
Aragones A, Gany F, Kaplan A, Bruno D. An opportunity to increase human papillomavirus vaccination rates: Change the guidelines. Hum Vaccin Immunother 2022; 18:2136444. [PMID: 36282533 PMCID: PMC9746429 DOI: 10.1080/21645515.2022.2136444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 02/09/2023] Open
Abstract
Given the low rates of Human Papillomavirus (HPV) vaccination initiation and timely series completion in 11- and 12-year old children, we sought to assess potential opportunities for initiating routine vaccination at a younger age. A cross-sectional study of Latino parents of HPV vaccine-eligible 9- or 10-year-old children in New York City assessed whether there were opportunities to discuss the HPV vaccine during their most recent primary care provider (PCP) visit. Parents were approached between November, 2016 and January, 2018. Of 86 parents who participated, 97% reported having visited the child's PCP in the previous year for an annual checkup and 85% reported that they had neither discussed the HPV vaccine nor received a recommendation for the vaccine during that visit. In a population of Latino parents, predominantly Mexican immigrants with less than a high school education and limited English proficiency, most 9- to 10-year-old children followed the recommendation for an annual PCP visit. Lowering the recommended age for routine vaccination with the HPV vaccine to 9 - 10 years of age should be considered as an important strategy to increase HPV vaccination rates in this and other populations.
Collapse
Affiliation(s)
- Abraham Aragones
- Immigrant Health & Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- School of Public Health, Downstate Health Sciences University, State University of New York, Brooklyn, NY, USA
| | - Francesca Gany
- Immigrant Health & Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Denise Bruno
- School of Public Health, Downstate Health Sciences University, State University of New York, Brooklyn, NY, USA
| |
Collapse
|
17
|
Cunningham-Erves J, Hull PC, Wilkins CH, Edwards KM, Davis M, Jones J, Graham J, Adekunle A, Dempsey AF. Healthcare providers' practice protocols, strategies, and needed tools to address parental HPV vaccine hesitancy: An exploratory study. Hum Vaccin Immunother 2022; 18:2136862. [PMID: 36375029 DOI: 10.1080/21645515.2022.2136862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Parental hesitancy related to human papillomavirus (HPV) vaccines has increased during the pandemic, and there is a call to action by the National HPV Vaccination Roundtable to improve vaccination rates. While there are evidence-based strategies available to address parental hesitancy, there are few clear guidelines on how to engage parents to build confidence in the HPV vaccine within the clinical settings. The purpose of this investigation is to explore practice protocols, individual provider strategies, and perceived tools needed to address HPV vaccine hesitant parents from the perspective of providers during the COVID-19 pandemic in the United States. Fifteen healthcare providers participated in qualitative, semi-structured interviews between May 2021 and March 2022. An inductive, qualitative content analysis approach was used to analyze the data. Five themes were described: 1) Provider experiences engaging with HPV vaccine hesitant parents; 2) Existing protocols in the clinics to address HPV vaccine hesitant parents; 3) Strategies used by providers to address parental HPV vaccine hesitancy; 4) Sample message content used by providers to address parental HPV vaccine concerns; and 5) Perceived strategies and tools needed to address parental vaccine hesitancy. Recommendations to address parental hesitancy include recommending HPV vaccinationat 9 years, using a strong recommendation and continued discussion, applying evidence-based approaches and/or promising strategies, linking parents to credible outside sources, and ongoing follow-up if delayed or declined. These findings can be used by researchers and clinicians to improve strategies and messages to inform the development of a protocol to standardize encounters and communication for patient-parent-provider encounters that can influence parental decision-making around HPV vaccine uptake.
Collapse
Affiliation(s)
| | - Pamela C Hull
- College of Medicine Department of Behavioral Science, Department of Behavioral Science, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Consuelo H Wilkins
- Office of Health Equity, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn M Edwards
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Megan Davis
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | | | - Jenee Graham
- Meharry Medical College, School of Medicine, Nashville, TN, USA
| | - Abiola Adekunle
- Meharry Medical College, School of Medicine, Nashville, TN, USA
| | - Amanda F Dempsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.,Adult & Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA.,Merck and Company, Wales, PA, USA
| |
Collapse
|
18
|
O'Leary ST. Why the American Academy of Pediatrics recommends initiating HPV vaccine at age 9. Hum Vaccin Immunother 2022; 18:2146434. [PMID: 36404635 DOI: 10.1080/21645515.2022.2146434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American Academy of Pediatrics (AAP) recommends starting the human papillomavirus (HPV) vaccine series between 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series. This recommendation differs from the Advisory Committee on Immunization Practices (ACIP), which recommends HPV vaccination be initiated at age 11 or 12 years, stating the series can be started at age 9 years. This commentary discusses the reasoning behind AAP's decision to differ from ACIP, as the AAP and ACIP schedules are essentially harmonized for all other vaccines. Reasons include recognition that (1) vaccination uptake is suboptimal; (2) offering vaccination earlier offers provider's flexibility in introducing the vaccine; (3) initiating the vaccine at age 9 or 10 may be preferable for parents or adolescents who do not want to receive ≥3 concomitant vaccines at age 11 or 12; (4) earlier initiation may disentangle HPV recommendations from discussions of sexuality; (5) earlier recommendation might alleviate HPV vaccine hesitancy "fatigue;" (6) the immune response is robust at younger ages with no evidence of waning protection; and (7) there is a dearth of evidence supporting starting the recommendation at age 11 or 12 within the "adolescent immunization platform."
Collapse
Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO, USA
| |
Collapse
|
19
|
Efua Sackey M, Markey K, Grealish A. Healthcare professional's promotional strategies in improving Human papillomavirus (HPV) vaccination uptake in adolescents: A systematic review. Vaccine 2022; 40:2656-2666. [PMID: 35367068 DOI: 10.1016/j.vaccine.2022.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Human papillomavirus (HPV) vaccination coverage remains suboptimal with a global vaccination rate ranging from 12 to 90%. This review examined the approaches used by healthcare professionals in improving the uptake of HPV vaccine and reducing vaccine misconceptions among adolescents. METHODS A systematic review of literature between 2007 and 2021 was conducted using five databases: CINAHL, MEDLINE, PsycInfo, Scopus and ASSIA. Studies that examined healthcare professional's promotional strategies in improving the HPV vaccine uptake in adolescents were included. Two researchers independently reviewed study selection, data extraction, and study methodological quality. Results were analysed and synthesised using narrative synthesis. RESULTS Twelve studies met the inclusion criteria. Studies reported on effective approaches used by healthcare professionals to improve vaccine uptake including the use of multi-settings to target hard-to-reach vulnerable adolescents; consistently recommending the vaccine; and initiating the vaccine before the age of eleven. In addressing vaccine misconceptions, open-communication, motivational approaches, and sexual health education were effective strategies used. CONCLUSION This review found that healthcare professionals need to be better informed and educated on HPV vaccine to reduce their own vaccine hesitancy. Uptake of HPV vaccine can be improved by adopting better communication, engagement, supportive information resources, and training for healthcare professionals.
Collapse
Affiliation(s)
- Margaret Efua Sackey
- Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland.
| | - Kathleen Markey
- Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick V94 T9PX, Ireland; King's College London, London, UK
| |
Collapse
|
20
|
Recommending Human Papillomavirus Vaccination at Age 9: A National Survey of Primary Care Professionals. Acad Pediatr 2022; 22:573-580. [PMID: 35081470 PMCID: PMC9081141 DOI: 10.1016/j.acap.2022.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Several US health organizations, including the American Academy of Pediatrics, now encourage primary care professionals to recommend human papillomavirus (HPV) vaccination before the traditionally targeted ages of 11 to 12 years as a strategy to increase vaccination timeliness. To understand the feasibility of this approach, we sought to evaluate primary care professionals' current recommendation timing and willingness to recommend HPV vaccination at age 9. METHODS A national sample of 1047 primary care professionals completed our online survey in 2021. Respondents were physicians (71%), advanced practitioners (17%), and nurses (12%). RESULTS About one-fifth (21%) of primary care professionals reported that they already routinely recommend HPV vaccination at ages 9 to 10. Among the remaining 822 respondents, over half (61%) reported being somewhat or more willing to start recommending at age 9. Willingness was higher among those working in family medicine versus pediatrics (adjusted odds ratio [aOR]: 1.40, 95% confidence interval [CI] 1.03, 1.92), but lower among those with ≥20 years of practice experience versus ≤9 years (aOR: 0.65, 95% CI 0.44, 0.96). Many primary care professionals believed age 9 recommendations would have the advantage of protecting adolescents before HPV exposure (67%) or increasing vaccination timeliness (55%). The most commonly perceived disadvantage was that parents are not ready to talk about HPV vaccination at age 9 (73%). CONCLUSION Over two-thirds of primary care professionals in our national sample reported they recommend HPV vaccination at ages 9 to 10 or are somewhat or more willing to do so. Training may be needed to help primary care professionals address perceived parental hesitancy toward age 9 recommendations.
Collapse
|
21
|
Casey SM, Jansen E, Drainoni ML, Schuch TJ, Leschly KS, Perkins RB. Long-Term Multilevel Intervention Impact on Human Papillomavirus Vaccination Rates Spanning the COVID-19 Pandemic. J Low Genit Tract Dis 2022; 26:13-19. [PMID: 34928249 DOI: 10.1097/lgt.0000000000000648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the long-term sustainability of a multilevel intervention and the COVID-19 pandemic impact on adolescent human papillomavirus (HPV) vaccination coverage. MATERIALS AND METHODS In 2016, a pediatric and family medicine practice within a federally qualified health center completed a multilevel intervention, Development of Systems and Education for Human Papillomavirus Vaccination. We examined the intervention impact on HPV vaccine initiation and completion rates among adolescents 10-18 years between March 2016 and October 2020. We determined the total number of HPV vaccine doses administered monthly. Data were plotted on statistical process control charts. RESULTS Vaccine initiation increased from an average of 14% to an average of 42% for 10-year-old patients and from an average of 72% to an average of 92% for 11- to 12-year-old patients between March 2016 and January 2017 and remained stable through March 2020. Complete vaccination by age 13 years increased from 62% to 88% through October 2020. CONCLUSIONS This intervention led to continued improvement for on-time HPV vaccination coverage 4 years after intervention completion.Clinical Trial Registration: This trial has been registered at http://www.clinicaltrials.gov (identifier NCT02812732).
Collapse
Affiliation(s)
- Sharon M Casey
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - Emily Jansen
- Continuing Medical Education Office, Boston University School of Medicine, Boston, MA
| | | | | | | | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA
| |
Collapse
|
22
|
Koskan A, Klasko-Foster L, Stecher C, Rodriguez S, Helitzer D, Yoo W. Human papillomavirus vaccine guideline adherence among Arizona's Medicaid beneficiaries. Vaccine 2020; 39:682-686. [PMID: 33358413 DOI: 10.1016/j.vaccine.2020.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/18/2022]
Abstract
Cancers caused by human papillomavirus (HPV) can be prevented with the timely uptake and completion of the HPV vaccine series. Series completion is associated with increased vaccine effectiveness and longevity of protection. Medicaid beneficiaries are among populations with higher HPV vaccine uptake; however, little research describes factors that influence their HPV vaccine series completion. This study reports on a secondary data analysis of Arizona Medicaid data (Arizona Health Care Cost Containment System) from years 2008-2016. We summarized patient data using descriptive statistics and explored relationships between demographic variables and HPV vaccine administration information using bivariate logistic regression. Results of this analysis showed that females were more likely to complete the series as compared to males, and the age group that had the greatest odd of vaccine completion were 13-17-year-olds, the catch-up vaccine population. White Medicaid beneficiaries were most likely to adhere to HPV vaccine guidelines, followed by Hispanic beneficiaries. Patients receiving care in urban settings were more likely to complete the HPV vaccine series than people receiving care in rural areas of the state. Although statistically insignificant, people living with HIV were less likely to complete the 3-dose series. Future work should focus on ensuring that HPV vaccine age-eligible Medicaid, including people living with HIV, adhere to HPV vaccine guidelines. Expanding programs such as Vaccines for Children and scope of practice for dental professionals to offer the vaccine may provide additional options for Medicaid beneficiaries to vaccinate.
Collapse
Affiliation(s)
- Alexis Koskan
- Arizona State University, College of Health Solutions, Arizona State University, 425 N 5th Street, Phoenix, AZ 85004, United States.
| | - Lynne Klasko-Foster
- Brown University, Center for Health Promotion and Health Equity, United States.
| | - Chad Stecher
- Arizona State University, College of Health Solutions, United States.
| | - Sue Rodriguez
- Arizona State University, College of Health Solutions, Arizona State University, 425 N 5th Street, Phoenix, AZ 85004, United States.
| | - Deborah Helitzer
- Arizona State University, College of Health Solutions, Arizona State University, 425 N 5th Street, Phoenix, AZ 85004, United States.
| | - Wonsuk Yoo
- Arizona State University, College of Health Solutions, Arizona State University, 425 N 5th Street, Phoenix, AZ 85004, United States
| |
Collapse
|
23
|
Gilkey MB, Bednarczyk RA, Gerend MA, Kornides ML, Perkins RB, Saslow D, Sienko J, Zimet GD, Brewer NT. Getting Human Papillomavirus Vaccination Back on Track: Protecting Our National Investment in Human Papillomavirus Vaccination in the COVID-19 Era. J Adolesc Health 2020; 67:633-634. [PMID: 32933839 PMCID: PMC7834295 DOI: 10.1016/j.jadohealth.2020.08.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
| | - Robert A Bednarczyk
- Department of Global Health and Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, Florida
| | - Melanie L Kornides
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Debbie Saslow
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Jennifer Sienko
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Noel T Brewer
- Department of Health Behavior and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
24
|
Perkins RB, Banigbe B, Fenton AT, O’Grady AK, Jansen EM, Bernstein JL, Joseph NP, Eun TJ, Biancarelli DL, Drainoni ML. Effect of a multi-component intervention on providers' HPV vaccine communication. Hum Vaccin Immunother 2020; 16:2736-2743. [PMID: 32401592 PMCID: PMC7734092 DOI: 10.1080/21645515.2020.1747923] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022] Open
Abstract
Objective: To evaluate the effect of a multi-component intervention including communication training on provider beliefs and recommendation practices around the human papillomavirus (HPV) vaccine using both self-reports and audio-recordings of clinical interactions. Methods: We conducted a mixed method study at five family medicine and pediatric practices. Providers self-reported beliefs and practices about HPV vaccination via surveys and qualitative interviews conducted pre- and post-intervention. We also assessed provider recommendation style using audio-recordings of clinical interactions pre- and post-intervention. Content analysis was used to identify themes in qualitative interviews. Matched pre- and post-intervention surveys were analyzed for changes in provider beliefs and attitudes. Pre- and post-intervention audio recordings of clinical interactions were analyzed for observed differences in recommendation styles. Bivariate analyses of quantitative data used Chi-square and Fisher's exact tests; t-tests were used for continuous variables. Results: Providers reported in interviews that the intervention led to communication changes by increasing their knowledge, reframing the HPV vaccine as a routine vaccination, and providing tools for engaging with parents. Surveys indicated that the proportion of providers reporting that the HPV vaccine is one of the most important adolescent vaccines increased from 71% pre-intervention to 100% post-intervention (p = .03). Audio-recording analysis demonstrated that use of an indicated (presumptive) recommendation style increased from 62.5% pre-intervention to 79.6% post-intervention (p = .047). Conclusions: Educating providers about HPV vaccination and giving them tools to facilitate communication with parents can reframe HPV as a routine adolescent vaccination and motivate providers to routinely use effective recommendation styles in practice.
Collapse
Affiliation(s)
- Rebecca B. Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | | | - Anny T. Fenton
- Maine Medical Center Research Institute, Center for Outcomes, Research, & Evaluation (CORE), Portland, ME, USA
| | | | - Emily M. Jansen
- Boston University School of Medicine, Continuing Medical Education Office, Boston, MA, USA
| | - Judith L. Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Natalie P. Joseph
- Department of Pediatrics and Adolescent Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Terresa J. Eun
- Department of Sociology, Stanford University, Stanford, CA, USA
| | - Dea L. Biancarelli
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Evans Center for 10 Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
25
|
Perkins RB, Legler A, Jansen E, Bernstein J, Pierre-Joseph N, Eun TJ, Biancarelli DL, Schuch TJ, Leschly K, Fenton ATHR, Adams WG, Clark JA, Drainoni ML, Hanchate A. Improving HPV Vaccination Rates: A Stepped-Wedge Randomized Trial. Pediatrics 2020; 146:peds.2019-2737. [PMID: 32540986 DOI: 10.1542/peds.2019-2737] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a stepped-wedge randomized trial of Development of Systems and Education for Human Papillomavirus Vaccination (DOSE HPV), a multilevel intervention. METHODS DOSE HPV is a 7-session program that includes interprofessional provider education, communication training, data feedback, and tailored systems change. Five primary care pediatric and/or family medicine practices completed interventions between 2016 and 2018; all chose to initiate vaccination at ages 9 to 10. We compared vaccination rates in the preintervention, intervention, and postintervention periods among 9- to 17-year-olds using random-effects generalized linear regression models appropriate for stepped-wedge design, accounting for calendar time and clustering of patients by providers and clinic. Outcomes included (1) the likelihood that eligible patients would receive vaccination during clinic visits; (2) the likelihood that adolescents would complete the series by age 13; and (3) the cumulative effect on population-level vaccine initiation and completion rates. Postintervention periods ranged from 6 to 18 months. RESULTS In the intervention and postintervention periods, the adjusted likelihood of vaccination at an eligible visit increased by >10 percentage points for ages 9 to 10 and 11 to 12, and completion of the vaccine series by age 13 increased by 4 percentage points (P < .001 for all comparisons). Population-level vaccine initiation coverage increased from 75% (preintervention) to 84% (intervention) to 90% (postintervention), and completion increased from 60% (preintervention) to 63% (intervention) to 69% (postintervention). CONCLUSIONS Multilevel interventions that include provider education, data feedback, tailored systems changes, and early initiation of the human papillomavirus vaccine series may improve vaccine series initiation and completion beyond the conclusion of the intervention period.
Collapse
Affiliation(s)
| | - Aaron Legler
- Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | | | - Judith Bernstein
- Department of Health Law, Policy and Management, School of Public Health
| | - Natalie Pierre-Joseph
- Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | - Terresa J Eun
- Department of Sociology, Stanford University, Stanford, California
| | - Dea L Biancarelli
- Department of Health Law, Policy and Management, School of Public Health
| | | | - Karin Leschly
- East Boston Neighborhood Health Center, Boston, Massachusetts; and
| | - Anny T H R Fenton
- Center for Outcomes, Research, and Evaluation, Maine Medical Center Research Institute, Portland, Maine
| | - William G Adams
- Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | - Jack A Clark
- Department of Health Law, Policy and Management, School of Public Health
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, School of Public Health.,Evans Center for Implementation and Improvement Sciences.,Sections of Infectious Diseases and
| | | |
Collapse
|
26
|
Saslow D, Andrews KS, Manassaram-Baptiste D, Smith RA, Fontham ETH. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. CA Cancer J Clin 2020; 70:274-280. [PMID: 32639044 DOI: 10.3322/caac.21616] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 01/12/2023] Open
Abstract
The American Cancer Society (ACS) presents an adaptation of the current Advisory Committee on Immunization Practices recommendations for human papillomavirus (HPV) vaccination. The ACS recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented. Health care providers are encouraged to start offering the HPV vaccine series at age 9 or 10 years. Catch-up HPV vaccination is recommended for all persons through age 26 years who are not adequately vaccinated. Providers should inform individuals aged 22 to 26 years who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk. Catch-up HPV vaccination is not recommended for adults aged older than 26 years. The ACS does not endorse the 2019 Advisory Committee on Immunization Practices recommendation for shared clinical decision making for some adults aged 27 through 45 years who are not adequately vaccinated because of the low effectiveness and low cancer prevention potential of vaccination in this age group, the burden of decision making on patients and clinicians, and the lack of sufficient guidance on the selection of individuals who might benefit.
Collapse
Affiliation(s)
- Debbie Saslow
- Human Papillomavirus and Gynecologic Cancers, American Cancer Society, Atlanta, Georgia
| | - Kimberly S Andrews
- Guideline Development Process, American Cancer Society, Atlanta, Georgia
| | | | - Robert A Smith
- Cancer Screening, American Cancer Society, Atlanta, Georgia
| | | | | |
Collapse
|