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Fleszar-Pavlović SE, Cameron LD. Developing a narrative communication intervention in the context of HPV vaccination. PEC INNOVATION 2024; 4:100272. [PMID: 38525313 PMCID: PMC10957452 DOI: 10.1016/j.pecinn.2024.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
Objective We outline the development of a narrative intervention guided by the Common-Sense Model of Self-Regulation (CSM) to promote Human Papillomavirus (HPV) vaccination in a diverse college population. Methods We adapted the Obesity-Related Behavioral Intervention Trials (ORBIT) model to guide the development, evaluation, and refinement of a CSM-guided narrative video. First, content experts developed a video script containing information on HPV, HPV vaccines, and HPV-related cancers. The script and video contents were evaluated and refined, in succession, utilizing the think-aloud method, open-ended questions, and a brief survey during one-on-one interviews with university students. Results Script and video content analyses led to significant revisions that enhanced quality, informativeness, and relevance to the participants. We highlight the critical issues that were revealed and revised in the iterative process. Conclusions We developed and refined a CSM guided narrative video for diverse university students. This framework serves as a guide for developing health communication interventions for other populations and health behaviors. Innovation This project is the first to apply the ORBIT framework to HPV vaccination and describe a process to develop, evaluate, and refine comparable CSM guided narrative interventions that are tailored to specific audiences.
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Affiliation(s)
- Sara E. Fleszar-Pavlović
- Department of Psychological Sciences, University of California, Merced, CA, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States of America
| | - Linda D. Cameron
- Department of Psychological Sciences, University of California, Merced, CA, United States of America
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Alarid-Escudero F, Gracia V, Wolf M, Zhao R, Easterly CW, Kim JJ, Canfell K, de Kok IM, Barnabas RV, Kulasingam S. State-level disparities in cervical cancer prevention and impact on outcomes in the U.S.: A modeling study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.11.24308795. [PMID: 38947042 PMCID: PMC11213118 DOI: 10.1101/2024.06.11.24308795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background Despite the availability of HPV vaccines for over a decade, coverage across the United States (US) is varied. While some states have made concerted efforts to increase HPV vaccination coverage, most model-based analyses have estimated vaccine impact on the US. We estimated the impact of hypothetical changes in HPV vaccination coverage at the state level for three states with varying levels of HPV vaccination coverage and cervical cancer incidence (California, New York, Texas) using a mathematical model. Methods We developed a new mathematical model of HPV transmission and cervical cancer tailored to state-level cancer incidence and mortality. We quantified the public health impact of increasing HPV vaccination coverage to 80% by 2025 or 2030 and the effect on time to elimination in the three states. Results Increasing vaccination coverage to 80% in Texas in 10 years could reduce cervical cancer incidence by 50.9% (95%-CrI: 46.6-56.1%) by 2100. In New York and California, achieving the same coverage could reduce incidence by 27.3% (95%-CrI: 23.9-31.5%) and 24.4% (95%-CrI: 20.0-30.0%), respectively. Achieving 80% coverage in 5 years will slightly increase the reduction. If 2019 vaccination coverage continues, cervical cancer elimination would be reached in the US by 2051 (95%-Crl: 2034-2064). However, the timeline by which individual states reach elimination could vary by decades. Conclusion Achieving an HPV vaccination coverage target of 80% by 2030 will benefit states with low vaccination coverage and high cervical cancer incidence the most. Our results highlight the value of more geographically focused analyses to inform priorities.
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Affiliation(s)
- Fernando Alarid-Escudero
- Department of Health Policy, School of Medicine, and Stanford Health Policy, Freeman-Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Valeria Gracia
- Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA
| | - Marina Wolf
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ran Zhao
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Caleb W. Easterly
- MD/PhD Program, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, Chapel Hill, NC
| | - Jane J. Kim
- Center for Health Decision Science, Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW
| | - Inge M.C.M. de Kok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ruanne V. Barnabas
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- School of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, T. H. Chan Harvard School of Public Health, Boston, MA, USA
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McGaffey A, Castelli G, Friedlander MP, Proddutur S, Simpkins C, Middleton DB, Spencer KO, Taormina JM, Gerlach A, Nowalk MP. Going (Anti)Viral: Improving HIV and HCV Screening and HPV Vaccination in Primary Care. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00179-X. [PMID: 38981779 DOI: 10.1016/j.jcjq.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) and hepatitis C (HCV) screening and human papillomavirus (HPV) vaccine uptake remain suboptimal. To improve HIV and HCV screening and HPV vaccination, the authors implemented a quality improvement project in three southwestern Pennsylvania family medicine residency practices. METHODS From June 1 to November 30, 2021, participating practices used universal screening and vaccination guidelines and chose from multiple strategies at the office (for example, standing orders), provider (for example, multiple forms of provider reminders), and patient (for example, incentives) levels derived from published literature and tailored to local context. Age-eligible patients for each recommendation with at least one in-person office visit during the intervention period were included. To assess the interventions' effect, the authors obtained testing and vaccination data from the electronic health record for the intervention period, contrasted it with identical data from June 1 to November 30, 2020, and used logistic regression controlling for patient age, sex, and race to determine differences in screening and vaccination between intervention and baseline periods. RESULTS A total of 14,920 and 15,523 patients were eligible in the baseline and intervention periods, respectively. Following the intervention, HIV lifetime screening but not first-time screening for patients 13-64 years old was significantly higher (78.9% vs. 76.1%, p = 0.004, and 39.6% vs. 36.6%, p = 0.152, respectively, adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.06-1.38). HCV lifetime screening for patients 18-79 years old was significantly higher postintervention (62.5% vs. 53.5%, p < 0.001, aOR 1.51, 95% CI 1.4-1.64). For patients 9-26 years old, no change in HPV initiation was observed, but the percentage of patients who completed their HPV vaccinations in the observed period was significantly higher postintervention (7.0% vs 4.6%, p = 0.006, aOR 1.58, 95% CI 1.14-2.2). During the postintervention period, the researchers identified 0 new HIV diagnoses and 48 HCV diagnoses (19 eligible for treatment). CONCLUSION Family medicine residency office-based multistrategy efforts appear to successfully increase patient uptake of HIV and HCV screenings and maintain HPV vaccination rates.
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Calvez J, Neirynck V, Marcelin AG, Jary A. Extending vaccination periods against human papillomavirus: Lessons from the SARS-CoV-2 pandemic. BJOG 2024; 131:877-879. [PMID: 38225214 DOI: 10.1111/1471-0528.17748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Juliette Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Victoire Neirynck
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Aude Jary
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, France
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Cable CE, Watson KE, Tsuyuki RT. Case-finding for HPV vaccination eligibility within a dental office with concurrent development of a dialogue tool. Vaccine X 2024; 18:100492. [PMID: 38737622 PMCID: PMC11088327 DOI: 10.1016/j.jvacx.2024.100492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024] Open
Abstract
Background Human papillomavirus (HPV) immunization can prevent cancers, but uptake has been incomplete (and worse with the COVID-19 pandemic). Dental clinicians already screen for oral cancers, many of which are caused by HPV, and could identify vaccination candidates, but this requires a case-finding strategy. Objective The purpose of this study was (1) to develop and test a case-finding approach to identify patients who were candidates for HPV vaccinations, (2) to test an HPV vaccination intervention by dental professionals on vaccination uptake. Methods Design: Prospective, non-randomized feasibility case finding study with a 4-week enrollment period and a 6 week follow up period in general dental offices.Setting: Two general and non-commercial dentistry offices in Edmonton, Alberta Canada.Subjects: Consecutive scheduled (non-emergent) patients who met the Health Canada criteria for HPV vaccination: immunocompetent males and females aged 9-45 years and those who are immunocompromised. Consent for the discussion was obtained from each subject or parent.Intervention: Scheduled dental patients meeting the inclusion criteria were flagged by a research assistant who reviewed the appointment schedule each week for 4 weeks. For these subjects, dental clinicians (dentists and dental hygienists) used our Dental Dialogue Tool to discuss HPV vaccination and answer questions. Participating patients who consented to receive the HPV vaccine were given a prescription by the attending dentist and were directed to follow-up with a local pharmacy to have the vaccine administered. Each participant that was provided with an HPV prescription was contacted after 6 weeks to identify if they received the first dose of vaccine.Outcomes: Yield of our case-finding strategy and receipt of a patient's first HPV vaccine dose during 6 weeks post vaccine prescription. Results Our case-finding strategy assessed 656 scheduled patients over 4 weeks. From this screening,179 (a case-finding yield of 20.4 %), were candidates for HPV vaccine discussion. Forty-three of these 179 patients (24 %) were already vaccinated.. Two patients (1.1 %) did not consent to be spoken with and 134 (74.8 %) consented to the HPV vaccine discussion.. Forty-eight of 134 patients (35.8 %) of patients accepted a prescription from the dentist after speaking with the dental clinician. Ultimately, 8/48 (16 %) (patients received their first dose of the HPV vaccine by the 6 week of follow-up call. However, this is only 4.5 % (8/177) of those patients who did consent for the discussion of HPV cancers and vaccination from their dentist. Conclusion We demonstrated that case-finding for HPV vaccine candidates in general dental offices was feasible, with a reasonable yield. While the dental dialogue tool was described as a great resource to explain the facts and answer questions, very few patients were vaccinated after 6 weeks of follow-up. Further work is necessary to sharpen the intervention, perhaps including follow-up discussions with the dental clinicians.
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Affiliation(s)
- Cheryl E. Cable
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada
- EPICORE, Department of Medicine, University of Alberta, Canada
| | - Kaitlyn E. Watson
- EPICORE, Department of Medicine, University of Alberta, Canada
- Faculty of Pharmacy and Pharmaceutical Sciences. University of Alberta, Canada
| | - Ross T. Tsuyuki
- EPICORE, Department of Medicine, University of Alberta, Canada
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Adeyanju GC, Essoh TA, Sidibe AR, Kyesi F, Aina M. Human Papillomavirus Vaccination Acceleration and Introduction in Sub-Saharan Africa: A Multi-Country Cohort Analysis. Vaccines (Basel) 2024; 12:489. [PMID: 38793741 PMCID: PMC11125825 DOI: 10.3390/vaccines12050489] [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: 03/25/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Cervical cancer, caused by human papillomavirus (HPV) infection, is the second-largest cancer killer of women in low- and middle-income countries. The brunt of the global burden is borne predominantly in Sub-Saharan Africa. In 2020 alone, 70,000 of the 100,000 infected women in Africa died from it, thereby making up 21% of global cervical cancer mortality. The introduction of the HPV vaccine into the National Immunization Program was expected to change the trajectory. However, uptake of the vaccination has been poor, especially for the second dose. Only about half of the countries in Africa currently provide the vaccine. Without urgent intervention, the 2030 global cervical cancer elimination targets will be undermined. The study aims to understand the key challenges facing the HPV vaccine and to develop a roadmap to accelerate the uptake. METHOD Fourteen countries were purposively included using a cohort design methodology and the investigation spanned March-July 2023. The Africa region was stratified into three focus-group discussion cohorts (Abidjan, Nairobi and Dar es Salaam), comprising pre-selected countries that have already and those about to introduce the HPV vaccine. In each country, the EPI manager, the NITAG chair or representatives and an HPV-focal researcher were selected participants. The methods involved a collaborative and knowledge-sharing format through regional and country-specific discussions, plenary discussions, and workshop-style group missions. RESULTS The study reached a total of 78 key stakeholders, comprising 30 participants in cohort one, 21 in cohort two and 27 in cohort three. Key outcomes included the prevalence of declining HPV2 vaccination across all countries in the region; country-specific barriers impeding uptake were identified and strategy for accelerating vaccination demand initiated, e.g., utilizing investments from COVID-19 (e.g., electronic registry and multisector coordination); individual countries developing their respective HPV vaccination recovery and acceleration roadmaps; the identification and inclusion of a zero-dose catch-up strategy into the vaccination roadmaps; support for a transition from multiple-doses to a single-dose HPV vaccine; the incorporation of implementation science research to support the decision-making process such as vaccine choices, doses and understanding behavior. CONCLUSION Beyond research, the study shows the significance of scientific approaches that are not limited to understanding problems, but are also solution-oriented, e.g., development of roadmaps to overcome barriers against HPV vaccination uptake.
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Affiliation(s)
- Gbadebo Collins Adeyanju
- Center for Empirical Research in Economics and Behavioural Science (CEREB), University of Erfurt, 99089 Erfurt, Germany
- Psychology and Infectious Disease Lab (PIDI), University of Erfurt, 99089 Erfurt, Germany
- Media and Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | - Tene-Alima Essoh
- Agence de Médecine Préventive (AMP) Afrique, Abidjan 08 BP 660, Côte d’Ivoire;
| | - Annick Raissa Sidibe
- National Immunization Technical Advisory Groups (NITAGs), Ouaga 06, Ouagadougou 06 BP 9096, Burkina Faso;
| | - Furaha Kyesi
- Ministry of Health, S.L.P. 743, Dar es Salaam P.O. Box 9083, Tanzania;
| | - Muyi Aina
- Executive Secretary, National Primary Healthcare Development Agency (NPHCDA), Area 11, Abuja P.O. Box 123, Nigeria
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Rand CM, Stephens-Shields AJ, Kelly MK, Localio R, Hannan C, Grundmeier RW, Shone LP, Steffes J, Davis K, Albertin C, Humiston SG, McFarland G, Abney DE, Szilagyi PG, Fiks AG. Clinician Prompts for Human Papillomavirus Vaccination: A Cluster Randomized Trial. Acad Pediatr 2024; 24:579-586. [PMID: 37925070 PMCID: PMC11056302 DOI: 10.1016/j.acap.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE We assessed the impact of an online intervention using clinician prompts for human papillomavirus (HPV) vaccination with a cluster randomized controlled trial. METHODS The randomized trial occurred July 2021-January 2022 in 48 primary care pediatric practices (24 intervention, 24 control) across the US. We trained clinicians via two online learning modules, plus weekly ''quick tips'' delivered via text or email. The training taught practices to implement a staff prompt to the clinician (e.g., printed reminders placed on the keyboard) plus electronic health record (EHR) prompts (if not already done) at well and acute/chronic visits for initial and subsequent HPV vaccination. We assessed missed opportunities for HPV vaccination using logistic regression models accounting for clustering by practice on an intent to treat basis. Surveys assessed facilitators and barriers to using prompts. RESULTS During the 6-month intervention, missed opportunities for HPV vaccination increased (worsened) in both intervention and control groups. However, at well child care visits, missed opportunities for the initial HPV vaccine increased by 4.5 (95% CI: -9.0%, -0.1%) percentage points less in intervention versus control practices. Change in missed opportunities for subsequent doses at well child care and non-well child care visits did not differ between trial groups. An end-of trial survey found understaffing as a common challenge. CONCLUSIONS Clinician prompts reduced missed opportunities for HPV vaccination at well child care visits. Understaffing related to the COVID-19 pandemic may have led to worsening missed opportunities for both groups and likely impeded practices in fully implementing changes.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics (CM Rand), University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Alisa J Stephens-Shields
- Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Mary K Kelly
- Clinical Futures (MK Kelly and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Russell Localio
- Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Chloe Hannan
- Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Robert W Grundmeier
- Department of Biostatistics (AJ Stephens-Shields, R Localio, C Hannan, and RW Grundmeier), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Biomedical and Health Informatics (RW Grundmeier and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa
| | | | - Jennifer Steffes
- Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill; Primary Care Research (J Steffes and K Davis), American Academy of Pediatrics, Itasca, Ill
| | - Kristin Davis
- Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill; Primary Care Research (J Steffes and K Davis), American Academy of Pediatrics, Itasca, Ill
| | - Christina Albertin
- Department of Pediatrics (C Albertin), University of California at Los Angeles, Mattel Children's Hospital, Los Angeles, Calif
| | - Sharon G Humiston
- Department of Pediatrics, Mattel Children's Hospital, UCLA, Los Angeles, CA, USA
| | - Greta McFarland
- Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill
| | - Dianna E Abney
- Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill
| | - Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, UCLA, Los Angeles, CA, USA
| | - Alexander G Fiks
- Clinical Futures (MK Kelly and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Biomedical and Health Informatics (RW Grundmeier and AG Fiks), Children's Hospital of Philadelphia, Philadelphia, Pa; Pediatric Research in Office Settings (J Steffes, K Davis, G McFarland, DE Abney, and AG Fiks), American Academy of Pediatrics, Itasca, Ill
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Lee M, Gerend MA, Whittington KD, Collins SK, McKinney SL, Franca MC, Boyer VE, McKinnies RC, Chen CC, Villegas J, Adjei Boakye E. Factors associated with HPV-associated sexual risk behaviors among sexually active college students. J Behav Med 2024; 47:334-341. [PMID: 38180576 DOI: 10.1007/s10865-023-00463-1] [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: 08/08/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024]
Abstract
High-risk sexual behavior is the primary risk factor for the acquisition and persistence of human papillomavirus (HPV) infection and the development of HPV-associated diseases including cancer. Incidence of HPV infection is high among individuals in their late teens and early 20s. Thus, college students represent a historically high-risk group for HPV infection yet are also a group with the ability to independently access HPV vaccination for HPV prevention. To inform future interventions, we examined factors associated with HPV-associated risky sexual behaviors among sexually active college students. Data (N = 741) were from an anonymous online survey distributed to students at a public Midwestern university in 2021. The outcomes were HPV-associated sexual risk behaviors-number of oral or vaginal sexual partners [high (≥ 5) or low (< 5)] and age of oral or vaginal sexual debut [early (< 18 years) or late (≥ 18 years)]. Multivariable logistic regression models estimated the association between HPV-associated risky sexual behaviors and several predictors including age, gender, relationship status, academic level, country of birth, and rural-urban status. Among sexually active students, approximately 47% and 41% had a high number of lifetime vaginal and oral partners, respectively. Among the same group, 60% and 64% had early vaginal and oral sexual debut. Students who were single and dating (aOR = 1.93; 95% CI = 1.21, 3.08) or single and not dating (2.11; 1.28, 3.48) were more likely to have a high number of vaginal lifetime partners compared with married students. Single (vs. married) students were also about twice as likely to have a high number of oral lifetime partners. Relative to graduate students, freshmen/sophomores were more likely to have an early vaginal (2.44; 1.45, 4.11) and oral (2.14; 1.26, 3.63) sexual debut. Interventions tailored to college freshmen/sophomores and unmarried students should encourage students to receive the HPV vaccine for prevention of future HPV-associated diseases.
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Affiliation(s)
- Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA
- Simmons Cancer Institute at Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Kelli D Whittington
- Department of Nursing, School of Health Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Sandra K Collins
- Department of Health Care Management, School of Health Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Stacey L McKinney
- Department of Dental Hygiene, School of Health Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Maria C Franca
- Department of Communication Disorders and Sciences, School of Health Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Valerie E Boyer
- Department of Communication Disorders and Sciences, School of Health Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Richard C McKinnies
- Department of Radiologic Sciences, School of Health Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Cheng-Chia Chen
- Department of Public Health, University of Illinois Springfield, Springfield, IL, USA
| | - Jorge Villegas
- Department of Management, Marketing, and Operations, University of Illinois Springfield, Springfield, IL, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI, 48202, USA.
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Huang E, Filograna K, Lockwood KK, Crossette J, Jenssen BP. Human Papillomavirus Vaccine Completion by 13: A Quality Improvement Initiative in a Large Primary Care Network. Acad Pediatr 2024; 24:293-301. [PMID: 37907128 DOI: 10.1016/j.acap.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Fewer than 40% of U.S. children complete the human papillomavirus (HPV) vaccine series before their 13th birthday. In our large pediatric primary care network, HPV vaccine completion rate by age 13 was 30%. We hypothesized that a phased quality improvement (QI) initiative would increase rates of HPV vaccine completion by age 13 across our network. METHODS This QI initiative was conducted in a network of 30 practices located across two states, in urban and suburban settings, consisting of teaching and non-teaching clinics, and ranging in size from three to 50 providers per office. We used a phased approach incorporating multicomponent network-wide and iterative practice-specific interventions. Key interventions included: updating clinical decision support to default order HPV vaccine due at preventive visits starting at age nine instead of 11, data audit and feedback to providers and practices, encouraging use of a strong provider recommendation, and standing orders. RESULTS From April 2019 to October 2022, HPV vaccine completion by age 13 across our network increased from 30% to 55% and met criteria for special cause variation on statistical process control charts. A gap in median HPV vaccine completion by age 13 between patients with public insurance and patients with private or commercial insurance decreased from 9% to 1%. CONCLUSION A QI initiative was associated with a sustained increase in HPV vaccine series completion by age 13 and reduced variation in care across a large network of 30 primary care practices.
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Affiliation(s)
- Elena Huang
- Children's Hospital of Philadelphia, Primary Care (E Huang, K Filograna, KK Lockwood, J Crossette, and BP Jenssen), Philadelphia,Pa; Department of Pediatrics (E Huang, KK Lockwood, and BP Jenssen), University of Pennsylvania Perelman School of Medicine, Philadelphia,Pa.
| | - Kathleen Filograna
- Children's Hospital of Philadelphia, Primary Care (E Huang, K Filograna, KK Lockwood, J Crossette, and BP Jenssen), Philadelphia,Pa
| | - Katie K Lockwood
- Children's Hospital of Philadelphia, Primary Care (E Huang, K Filograna, KK Lockwood, J Crossette, and BP Jenssen), Philadelphia,Pa; Department of Pediatrics (E Huang, KK Lockwood, and BP Jenssen), University of Pennsylvania Perelman School of Medicine, Philadelphia,Pa
| | - Jonathan Crossette
- Children's Hospital of Philadelphia, Primary Care (E Huang, K Filograna, KK Lockwood, J Crossette, and BP Jenssen), Philadelphia,Pa
| | - Brian P Jenssen
- Children's Hospital of Philadelphia, Primary Care (E Huang, K Filograna, KK Lockwood, J Crossette, and BP Jenssen), Philadelphia,Pa; Department of Pediatrics (E Huang, KK Lockwood, and BP Jenssen), University of Pennsylvania Perelman School of Medicine, Philadelphia,Pa
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Pfingstag CS. Increasing Rates of Human Papillomavirus Catch-Up Vaccination at a Sexual and Reproductive Health Clinic: A Quality Improvement Project. J Midwifery Womens Health 2024; 69:294-299. [PMID: 37766394 DOI: 10.1111/jmwh.13568] [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] [Revised: 07/17/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Catch-up human papillomavirus (HPV) vaccination of adults aged 19 to 26 who were not vaccinated as children or adolescents may decrease rates of HPV-associated cancer. The purpose of this project was to increase uptake of catch-up HPV vaccination at a sexual and reproductive health clinic through the implementation of a multicomponent, systems-based intervention. PROCESS Catch-up vaccination rates were recorded at an intervention health clinic and a comparison health clinic. A comparative, interrupted time series design was used to compare rates of catch-up vaccination pre- and postintervention. Electronic health record prompts, in-clinic education, and scheduling of a next visit at the current visit were implemented. Data were analyzed using descriptive statistics, t tests, and regression analysis. OUTCOMES The proportion of all patients aged 19 to 26 who received an HPV vaccination rose at the intervention health clinic from 0.76% preintervention to 4.42% postintervention. At the intervention clinic there was a nonsignificant increase (4.47 minutes) in average daily patient cycle times between the pre- and postintervention periods (t(13) = 1.895, P = .075). DISCUSSION Rates of catch-up HPV vaccination increased significantly following the multicomponent, systems-based intervention. Further iteration of the quality improvement process should examine the sustainability of the interventions and the effects of the intervention on vaccine series completion.
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Schelbar N, Ward CN, Phillips E, Herr MJ, Acevedo S, Conner H, Greiner A, Corriveau E. Impact of COVID-19 pandemic and vaccine perceptions on HPV vaccine hesitancy. Am J Otolaryngol 2024; 45:104172. [PMID: 38103489 DOI: 10.1016/j.amjoto.2023.104172] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This study evaluated the impact of the COVID-19 pandemic and vaccine perceptions on Human Papillomavirus (HPV) vaccine hesitancy. Secondary endpoints included comparing COVID-19 and HPV vaccination trends regarding time, community of residence, and unmet social needs. METHODS This was a survey-based, cross-sectional study that included 101 participants who were recruited through the Wyandotte County Public Health Department. Participants were eligible for inclusion in this study if they were a parent/guardian of one or more children aged 13 to 17; English- or Spanish-speaking. This study took place in Wyandotte County, Kansas. Descriptive statistics and chi-square analyses were utilized. RESULTS There was no difference in completion of COVID-19 and HPV vaccines (p = 0.0975). Significantly more individuals started and did not finish the HPV vaccine series compared to the COVID-19 vaccine series (p = 0.0004). Most participants indicated their opinion on the HPV vaccine had not changed due to the pandemic (71.3 %). Participants who felt familiar with HPV had higher rates of HPV vaccine completion. While 77 % of participants felt extremely or moderately familiar with HPV, 61.4 % were unaware of its association with oropharyngeal cancer. CONCLUSION There was minimal change in parents' perception of the HPV vaccine due to the COVID-19 pandemic despite decreased rates of vaccination during this time. HPV vaccine series completion was significantly lower than COVID-19 vaccine series completion, highlighting a need to improve HPV vaccine completion counseling. Additionally, patient education should address the knowledge gap discovered regarding the link between HPV infection and oropharyngeal cancer.
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Affiliation(s)
- Natalie Schelbar
- University of Kansas School of Medicine, Kansas City, KS, United States of America.
| | - Christina N Ward
- University of Tennessee Health Science Center, Department of Otolaryngology-Head & Neck Surgery, Memphis, TN, United States of America
| | - Elaine Phillips
- University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Michael J Herr
- University of Alabama at Birmingham Heersink School of Medicine, Department of Cell, Developmental, and Integrative Biology, United States of America
| | - Sarah Acevedo
- University of Virginia, Department of Medicine, Charlottesville, VA, United States of America
| | - Hannah Conner
- Wyandotte County Unified Government Public Health Department, Kansas City, KS, United States of America
| | - Allen Greiner
- Wyandotte County Unified Government Public Health Department, Kansas City, KS, United States of America; University of Kansas Medical Center Department of Family Medicine & Community Health, Kansas City, KS, United States of America
| | - Erin Corriveau
- Wyandotte County Unified Government Public Health Department, Kansas City, KS, United States of America; University of Kansas Medical Center Department of Family Medicine & Community Health, Kansas City, KS, United States of America
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Del Pino M, Vorsters A, Joura EA, Doorbar J, Haniszewski M, Gudina IA, Kodjamanova P, Velicer C, Drury R. Risk factors for human papillomavirus infection and disease: A targeted literature summary. J Med Virol 2024; 96:e29420. [PMID: 38377121 DOI: 10.1002/jmv.29420] [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: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 02/22/2024]
Abstract
Adolescents are the primary cohort for routine human papillomavirus (HPV) vaccination, but unvaccinated adults may also benefit. A lack of consensus on which adults to target and the presence of reimbursement barriers likely contribute to the lag in adult vaccinations, highlighting missed prevention opportunities. Understanding factors contributing to risk of HPV infection and disease could help in decision making on vaccination. This review summarizes existing literature on risk factors for HPV infection and disease and includes 153 studies reporting relative risks or odds ratios for factors associated with HPV infection or disease in adults, published between 2009 and 2020. Despite inconsistent design and reporting of risk factors across studies, this review confirmed several risk factors associated with adult infection, including human immunodeficiency virus positivity, number of sex partners, and smoking. These findings can support policymaking, guideline development, and clinical decision making for HPV vaccination and screening of high-risk adult groups.
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Affiliation(s)
- Marta Del Pino
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alex Vorsters
- Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
| | - Elmar A Joura
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - John Doorbar
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, UK
| | | | | | | | - Christine Velicer
- Global Medical and Scientific Affairs, Merck & Co., Inc., Rahway, New Jersey, USA
| | - Rosybel Drury
- Global Medical and Scientific Affairs, MSD, Lyon, France
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Bower M, Kothari U, Akerman M, Krilov LR, Fiorito TM. Impact of COVID-19 on HPV Vaccination Rates in New York City and Long Island. Pediatr Infect Dis J 2024; 43:84-87. [PMID: 37963272 DOI: 10.1097/inf.0000000000004149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND In the United States, uptake of human papillomavirus (HPV) vaccination has been exceptionally low as compared with other vaccines. During the coronavirus disease (COVID-19) pandemic, routine vaccinations were deferred or delayed, further exacerbating HPV vaccine hesitancy. The specific effect of the pandemic on HPV vaccination rates in the United States has not been yet described. METHODS We aimed to determine the percentage of children achieving full HPV vaccination (2 doses) by age 15 years and to compare prepandemic to pandemic rates of HPV vaccination at pediatric practices across our institution. A retrospective chart review was performed to compare HPV vaccination rates in the "prepandemic" and "pandemic" periods for all children 9 through 14 years of age. Additionally, peaks in COVID-19 positivity were compared with HPV vaccination rates. RESULTS Of children 9-14 years old, 49.3% received at least 1 dose of HPV vaccine in the prepandemic period, compared with 33.5% during the pandemic ( P < 0.0001). Only 33.5% of patients received the full 2-dose series of HPV prepandemic, compared with 19.0% of patients during the pandemic ( P < 0.0001). When COVID-19 positivity rates peaked, HPV vaccination also declined. CONCLUSIONS The issue of low HPV vaccination rates was amplified due to the COVID-19 pandemic, as illustrated by the correlation between peaks in COVID-19 positivity and low rates of HPV vaccination.
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Affiliation(s)
- Maria Bower
- From the Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital- Long Island, Mineola, NY
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Ulka Kothari
- From the Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital- Long Island, Mineola, NY
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Meredith Akerman
- Biostatistics Core, Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY
| | - Leonard R Krilov
- From the Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital- Long Island, Mineola, NY
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Theresa M Fiorito
- From the Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital- Long Island, Mineola, NY
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
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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.
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Isher-Witt J, Foley S, Hassan A, Sloan A, Nkonga J, Fisher-Borne M. Age nine is possible: Improving age 9 HPV initiation through a national quality improvement initiative during the COVID-19 pandemic. Hum Vaccin Immunother 2023; 19:2284359. [PMID: 37994120 PMCID: PMC10760390 DOI: 10.1080/21645515.2023.2284359] [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: 08/17/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
The American Cancer Society collaborated with a range of healthcare partners in 2020-2022 to implement quality improvement clinical interventions with the goal of improving HPV vaccination rates among adolescents' ages 9-13. 2020 was the first cohort for which partners had been asked to submit HPV rate data for patients' ages 9-12. At least 80% of the partners across all reported project years were able and willing to report HPV rates for these ages. Partners submitted HPV initiation rates at the beginning and end of the 12-month project year along with project activities, including evidence-based interventions (EBIs) implemented. Mean initiation rates for ages 9-10 significantly increased 4.1% during 2020 compared to non-significant rate increases of 2.6% and 2.0% for ages 11-12 and age 13, respectively. In 2021, ages 9-10 initiation saw a non-significant increase of 2.2%, whereas ages 11-12 and age 13 decreased non-significantly by 0.3% and 0.1%, respectively. The 2022 cohort saw significant initiation rate increases of at least 4% across all ages, potentially a promising result of the myriad back on track HPV vaccination campaigns designed to reverse the damage of the COVID-19 pandemic on adolescent immunizations. These findings demonstrate an effective adaptation of quality improvement in increasing HPV vaccination coverage among younger ages even during a national pandemic.
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Affiliation(s)
- Jennifer Isher-Witt
- Interventions and Implementation, American Cancer Society, Kennesaw, GA, USA
| | - Shaylen Foley
- Interventions and Implementation, American Cancer Society, Kennesaw, GA, USA
| | - Anna Hassan
- Interventions and Implementation, American Cancer Society, Kennesaw, GA, USA
| | - Amelia Sloan
- Interventions and Implementation, American Cancer Society, Kennesaw, GA, USA
| | - Jennifer Nkonga
- Interventions and Implementation, American Cancer Society, Kennesaw, GA, USA
| | - Marcie Fisher-Borne
- Interventions and Implementation, American Cancer Society, Kennesaw, GA, USA
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Elfström M, Gray PG, Dillner J. Cervical cancer screening improvements with self-sampling during the COVID-19 pandemic. eLife 2023; 12:e80905. [PMID: 38085566 PMCID: PMC10715724 DOI: 10.7554/elife.80905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Background At the onset of the COVID-19 pandemic cervical screening in the capital region of Sweden was canceled for several months. A series of measures to preserve and improve the cervical screening under the circumstances were instituted, including a switch to screening with HPV self-sampling to enable screening in compliance with social distancing recommendations. Methods We describe the major changes implemented, which were (1) nationwide implementation of HPV screening, (2) switch to primary self-sampling instead of clinician sampling, (3) implementation of HPV screening in all screening ages, and (4) combined HPV vaccination and HPV screening in the cervical screening program. Results A temporary government regulation allowed primary self-sampling with HPV screening in all ages. In the Stockholm region, 330,000 self-sampling kits were sent to the home address of screening-eligible women, instead of an invitation to clinician sampling. An increase in organized population test coverage was seen (from 54% to 60% in just 1 year). In addition, a national campaign for faster elimination of cervical cancer with concomitant screening and vaccination for women in ages 23-28 was launched. Conclusions The COVID-19 pandemic necessitated major changes in the cervical cancer preventive strategies, where it can already be concluded that the strategy with organized primary self-sampling for HPV has resulted in a major improvement of population test coverage. Funding Funded by the Swedish Association of Local Authorities and Regions, the Swedish Cancer Society, the European Union's Horizon 2020 Research and Innovation Program, the Swedish government, and the Stockholm county.
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Affiliation(s)
- Miriam Elfström
- Center for Cervical Cancer Elimination, F46, Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital and Division of Cervical Cancer Elimination, CLINTEC, Karolinska InstitutetStockholmSweden
- Regional Cancer Center of Stockholm-Gotland, Cancer Screening Unit, SwedenStockholmSweden
| | - Penelope Grace Gray
- Center for Cervical Cancer Elimination, F46, Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital and Division of Cervical Cancer Elimination, CLINTEC, Karolinska InstitutetStockholmSweden
| | - Joakim Dillner
- Center for Cervical Cancer Elimination, F46, Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital and Division of Cervical Cancer Elimination, CLINTEC, Karolinska InstitutetStockholmSweden
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Zhang C, Greengold J, Tackett S, Lentz C, Bennett W, McGuire M. Evaluation of online educational curriculum on HPV vaccination practices among adult primary care providers. BMC MEDICAL EDUCATION 2023; 23:923. [PMID: 38053126 DOI: 10.1186/s12909-023-04807-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. While HPV is a vaccine-preventable illness, vaccine utilization rates in the United States remain low, particularly among adults. METHODS The objective of this study was to assess the impact of an online, asynchronous educational module on HPV vaccination for adult primary care providers. We designed and implemented the module for family medicine, internal medicine, medicine/pediatrics, and obstetrics/gynecology providers in a community practice network affiliated with a large academic health system. We evaluated the effect of the module on provider knowledge, attitudes, and self-reported behaviors with pre-, post-, and delayed post-tests, using Likert-scales for measurement. We summarized data with descriptive statistics and compared changes in individuals using paired t-tests. RESULTS One hundred forty-four out of 223 providers completed the module (response rate of 65%). At baseline, internists had the lowest knowledge scores compared to other specialties (pre-test mean of 3.6, out of 5, SD 1.2). Internists were also the least likely to counsel patients on HPV vaccination (mean 1.6, SD 0.9). There was a statistically significant improvement in knowledge from pre-test to post-test (from mean of 3.8 to 4.6, out of 5, p < .001) across all specialties. There was also statistically significant improvement in mean confidence for all providers from pre-test to post-test to identify patients aged 19-26 (3.3 to 3.7, p < .001) and patients aged 27-45 (2.7 to 3.5, p < .001) who needed vaccination. There was a statistically significant improvement in likelihood to counsel eligible patients on the risks of HPV infection (mean 2.3 to 2.8, p-value 0.002). The delayed post-test demonstrated retention of improved knowledge, confidence, and self-reported behavior. CONCLUSIONS This study demonstrated that an asynchronous online module was effective at improving confidence, knowledge, and self-reported behavior of adult primary care providers in recommending HPV immunization. Given the important role that healthcare providers play in vaccine uptake, this study suggests that an online educational intervention can be a powerful tool to encourage increased utilization and delivery of the HPV vaccine. Further efforts are needed to educate internists and providers who take care of the adult population on HPV vaccination.
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Affiliation(s)
- Christiana Zhang
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Judy Greengold
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Johns Hopkins Community Physicians, Baltimore, USA
| | - Sean Tackett
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, USA
| | | | - Wendy Bennett
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Johns Hopkins Community Physicians, Baltimore, USA
| | - Maura McGuire
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Johns Hopkins Community Physicians, Baltimore, USA
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Wähner C, Hübner J, Meisel D, Schelling J, Zingel R, Mihm S, Wölle R, Reuschenbach M. Uptake of HPV vaccination among boys after the introduction of gender-neutral HPV vaccination in Germany before and during the COVID-19 pandemic. Infection 2023; 51:1293-1304. [PMID: 36763286 PMCID: PMC9913033 DOI: 10.1007/s15010-023-01978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND HPV vaccination has been recommended and reimbursed for girls in Germany since 2007. In June 2018 the German Standing Committee on Vaccination (STIKO) recommended the gender-neutral vaccination of adolescents aged 9 to 14 years with catch-up through age 17. Objectives of this study were to describe the uptake of vaccination in boys before and during the COVID-19 pandemic. METHODS The study used data from a proprietary electronic medical record database and a database with information on nationally dispensed vaccine doses. The monthly number of first doses of HPV vaccinations in boys and girls aged 9-17 years in the period from 01/2018 to 12/2021 was determined. In addition, for boys the cumulative vaccination rates were calculated for initiated and completed vaccination series. RESULTS Four months after the introduction of mandatory reimbursement for boys, the monthly numbers of first doses were comparable to that of girls. Compared to the same month in 2019, the number of first doses declined by up to 49% (girls) in 2020 and 71% (boys) in 2021. At the end of 2021, the vaccination rate for 15-year-old boys (2006 birth cohort) reached 44.4% for initiated and 26.4% for completed series. CONCLUSION After an initial dynamic increase in HPV vaccinations in boys, the impact of COVID-19 was particularly strong in the second year of the pandemic. At the end of 2021 vaccination rates were still low. Efforts are needed to catch-up on adolescents that missed doses during the pandemic and to increase uptake.
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Affiliation(s)
- Cornelia Wähner
- Medical Affairs Department, MSD Sharp and Dohme GmbH, Munich, Germany
| | - Johannes Hübner
- Dr. Von Hauner Children's Hospital of Ludwig Maximilian University, Munich, Germany
| | - Dörte Meisel
- Wettin Gynecological Practice, Wettin-Löbejün, Germany
| | - Jörg Schelling
- Medizinische Klinik IV, Hospital of Ludwig Maximilian University, Munich, Germany
| | | | - Sarah Mihm
- Market Access Department, MSD Sharp and Dohme GmbH, Munich, Germany
| | - Regine Wölle
- Market Access Department, MSD Sharp and Dohme GmbH, Munich, Germany
| | - Miriam Reuschenbach
- Global Medical and Scientific Affairs, MSD Sharp and Dohme GmbH, Levelingstrasse 4a, 81673, Munich, Germany.
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Ryan GW, Charlton ME, Scherer AM, Ashida S, Gilbert PA, Daly E, Askelson NM. Understanding Implementation of Evidence-Based Interventions to Address Human Papillomavirus Vaccination: Qualitative Perspectives of Middle Managers. Clin Pediatr (Phila) 2023; 62:1193-1200. [PMID: 36762821 DOI: 10.1177/00099228231154661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Engaging individuals in middle management positions (eg, nurse or clinic managers) could facilitate implementation of evidence-based interventions (EBIs) to improve uptake of human papillomavirus (HPV) vaccination. Our goal was to understand middle managers' role in and perspectives on implementation of EBIs for HPV vaccination. We conducted qualitative interviews with middle managers in pediatric and family practice clinics. We used constructs from the Consolidated Framework for Implementation Research (CFIR) to design the interview guide and as a coding framework. Participants (n = 19) reported overseeing implementation related to HPV vaccination. Across interviews, CFIR inner setting constructs (eg, structural characteristics and implementation climate) were identified as being both barriers and facilitators. As evidenced in this study, middle managers have a deep understanding of organizational factors, and they have the ability to facilitate implementation efforts related to HPV vaccination. Future efforts could focus on engaging middle managers and leveraging their expertise and understanding of barriers and facilitators.
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Affiliation(s)
- Grace W Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mary E Charlton
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Aaron M Scherer
- Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Sato Ashida
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Paul A Gilbert
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Eliza Daly
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
- Public Policy Center, The University of Iowa, Iowa City, IA, USA
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CONTARINO FABIO, DI PIETRO ERMINIO, RANDAZZO CONCETTA, BELLA FRANCESCA, CONTRINO MARIALIA. Effectiveness of a vaccine recovery plan after the COVID-19 pandemic in the Siracusa Local Health Authority, Italy. Results of one year follow-up. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E289-E297. [PMID: 38125998 PMCID: PMC10730062 DOI: 10.15167/2421-4248/jpmh2023.64.3.3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/15/2023] [Indexed: 12/23/2023]
Abstract
Introduction The COVID-19 pandemic has strongly impacted on the immunization services around the world, threatening the gains made in the control of vaccine-preventable diseases. Methods A vaccination recovery plan of missed vaccinations has been put in place in the LHA of Siracusa after the pandemic. We compared 2021 and 2020 vaccination coverage by age group and vaccine type after one year of follow-up of the recovery plan. The Chi-square test was executed on proportions for the years 2021 vs 2020. Results were considered statistically significant at a two-tailed p-value ≤ 0.05. Results 36-month coverage rates were 92.5% for polio and 93.7% for measles-containing-vaccine, representing -0.3% and -1.8% decreases, respectively, as compared to 2020. By 8 years of age (booster doses), immunisation coverage was 80.7% for polio and 80.1% for measles, representing a -5.7% and -3.7%, respectively, compared to 2020. 36-month coverage was 56.6% for Men B (-5.0% as compared to 2020), 73.2% for Men ACW135Y/C (+1.1% as compared to 2020) and 86.9% for PNC vaccine (-1.7%, as compared to 2020). Regarding HPV vaccination, in 2021, vaccine coverage was 44.2% (-4.4% compared to 2020). Compared to the previous report, the VC difference among the cohorts narrowed for all almost vaccinations, except for the anti-men B and the anti-HPV vaccination, for which we recorded an increase in VC difference, and for men ACW135Y/C, for which a significant increase has been recorded. Conclusions Despite the efforts to organize and realize an extensive and well-designed vaccination recovery, our data show that even after the 1-year follow-up, globally deficits in coverage for these routine vaccinations persist, although there has been a substantial and significant recovery of missed vaccinations, especially among younger children and for primary cycles.
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Affiliation(s)
- FABIO CONTARINO
- Department of Public Health, Epidemiology Unit,
Provincial Health Authority of Siracusa,
Italy
| | - ERMINIO DI PIETRO
- Department of Public Health, Epidemiology Unit,
Provincial Health Authority of Siracusa,
Italy
| | - CONCETTA RANDAZZO
- Department of Public Health, Epidemiology Unit,
Provincial Health Authority of Siracusa,
Italy
| | - FRANCESCA BELLA
- Siracusa Cancer Registry, Provincial Health Authority of
Siracusa, Italy
| | - MARIA LIA CONTRINO
- Head of Department of Public Health,
Provincial Health Authority of Siracusa,
Italy
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Cantatore F, Agrillo N, Camussi A, Origoni M. HPV Opportunistic Vaccination: A Literature Review and a Single-Center Experience in Northern Italy through the COVID-19 Pandemic. Vaccines (Basel) 2023; 11:1435. [PMID: 37766112 PMCID: PMC10535071 DOI: 10.3390/vaccines11091435] [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: 07/21/2023] [Revised: 08/20/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
The World Health Organization (WHO) set the goal of 90% HPV vaccination coverage in the population to eliminate cervical cancer. Opportunistic vaccination is performed outside the free vaccination or catch-up programs. Both free and opportunistic HPV vaccination programs experienced slowdowns during the COVID-19 pandemic. In this retrospective study, we aimed to identify the benefits and the obstacles of opportunistic vaccination among male and female individuals who took advantage of the "on-demand" service offered by San Raffaele Hospital in Milan from April 2018 to May 2023. The impact that the COVID-19 pandemic had on vaccination adherence was also analyzed. Data on a total of 527 subjects were collected from an in-house database and through personal interviews. Women in the cohort of older patients (over 25) adhered to the vaccination schedule more than younger women. Opportunistic vaccination request is influenced by the need of a gynecologist, a general practitioner, or public health clinic availability. Women also showed good adherence to screening, demonstrating awareness of the importance of cervical cancer secondary prevention despite vaccination. Opportunistic vaccination offers the possibility of including individuals excluded from the free vaccination campaigns, often already affected by lesions caused by HPV, providing increased viral clearance and faster lesion regression. The main limit remains the economic burden.
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Affiliation(s)
- Francesco Cantatore
- Department of Gynecology & Obstetrics, Vita Salute San Raffaele University School of Medicine, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Nadia Agrillo
- Department of Gynecology & Obstetrics, Vita Salute San Raffaele University School of Medicine, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Alessandro Camussi
- Department of Gynecology & Obstetrics, Vita Salute San Raffaele University School of Medicine, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Massimo Origoni
- Department of Gynecology & Obstetrics, Vita Salute San Raffaele University School of Medicine, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy
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22
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Garcia S, Shin M, Sloan K, Dang E, Garcia CO, Baezconde-Garbanati L, Palinkas LA, Crabtree BF, Tsui J. Disruptions to and Innovations in HPV Vaccination Strategies within Safety-Net Healthcare Settings Resulting from the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:2380. [PMID: 37685414 PMCID: PMC10486876 DOI: 10.3390/healthcare11172380] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
The COVID-19 pandemic disrupted healthcare delivery within safety-net settings. Barriers to and facilitators of human papillomavirus (HPV) vaccination during the pandemic can inform future HPV vaccine strategies for underserved communities. Qualitative interviews (n = 52) between December 2020 and January 2022 in Los Angeles and New Jersey were conducted with providers, clinic leaders, clinic staff, advocates, payers, and policy-level representatives involved in the HPV vaccine process. Using the updated Consolidated Framework for Implementation Research we identified (1) outer setting barriers (i.e., vaccine hesitancy driven by social media, political views during the pandemic) and facilitators (e.g., partnerships); (2) inner setting clinic facilitators (i.e., motivation-driven clinic metrics, patient outreach, vaccine outreach events); (3) individual characteristics such as patient barriers (i.e., less likely to utilize clinic services during the pandemic and therefore, additional outreach to address missed vaccine doses are needed); (4) innovations in HPV vaccination strategies (i.e., clinic workflow changes to minimize exposure to COVID-19, leveraging new community partnerships (e.g., with local schools)); and (5) implementation strategies (i.e., multisectoral commitment to HPV goals). Pandemic setbacks forced safety-net settings to develop new vaccine approaches and partnerships that may translate to new implementation strategies for HPV vaccination within local contexts and communities.
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Affiliation(s)
- Samantha Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (S.G.); (K.S.); (E.D.); (C.O.G.); (L.B.-G.)
| | - Michelle Shin
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA 98195, USA;
| | - Kylie Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (S.G.); (K.S.); (E.D.); (C.O.G.); (L.B.-G.)
| | - Emily Dang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (S.G.); (K.S.); (E.D.); (C.O.G.); (L.B.-G.)
| | - Carlos Orellana Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (S.G.); (K.S.); (E.D.); (C.O.G.); (L.B.-G.)
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (S.G.); (K.S.); (E.D.); (C.O.G.); (L.B.-G.)
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Lawrence A. Palinkas
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA;
| | - Benjamin F. Crabtree
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA;
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (S.G.); (K.S.); (E.D.); (C.O.G.); (L.B.-G.)
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
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23
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Cunniff L, Alyanak E, Fix A, Novak M, Peterson M, Mevis K, Eiden AL, Bhatti A. The impact of the COVID-19 pandemic on vaccination uptake in the United States and strategies to recover and improve vaccination rates: A review. Hum Vaccin Immunother 2023; 19:2246502. [PMID: 37671468 PMCID: PMC10484032 DOI: 10.1080/21645515.2023.2246502] [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: 05/12/2023] [Revised: 07/17/2023] [Accepted: 08/06/2023] [Indexed: 09/07/2023] Open
Abstract
The COVID-19 pandemic disrupted routine healthcare delivery, causing declines in CDC-recommended vaccination rates across the life-course in the United States (US). Ensuring protection against disease outbreaks and associated morbidity and mortality depends on improving vaccine coverage rates (VCRs) and uptake. The authors conducted a targeted literature review to assess the pandemic's effects on routine vaccination rates across different populations, evaluating VCR recovery and improvement efforts. The review highlights articles published with data measuring or evaluating VCR decline across the US during the COVID-19 pandemic from January 2020 to April 2022, associated health impacts, and policy and programmatic strategies to recover routine VCRs. While vaccination rates stagnated or declined across some populations pre-pandemic, the review indicated there were further VCR declines in 2020 and 2021 compared to 2019 across numerous CDC-recommended vaccines, ages, and geographies, with some vaccines and sub-populations disproportionally impacted. The review additionally identified declines in patient healthcare visit frequency and increases in morbidity and mortality associated with vaccine-preventable disease (VPD) complications. Reviewed publications highlighted multifaceted strategies that could aid in recovering VCRs. Overall, findings demonstrate a significant reduction in VCRs across all age groups and highlight promising solutions to inform vaccine uptake efforts and ensure broader protection against VPDs.
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Affiliation(s)
- Luke Cunniff
- Global Vaccines Public Policy and Partnerships, Merck & Co., Inc., . Rahway, NJ, USA
| | | | | | | | | | - Kate Mevis
- Global Vaccines Public Policy and Partnerships, Merck & Co., Inc., . Rahway, NJ, USA
| | - Amanda L. Eiden
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA
| | - Alexandra Bhatti
- Global Vaccines Public Policy and Partnerships, Merck & Co., Inc., . Rahway, NJ, USA
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24
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Bogani G, Ghelardi A, Sopracordevole F, Annoni M, Ciavattini A, Giannella L, De Vincenzo R, Cattani P, Barbero M, Vercellini P, Raspagliesi F, Bonanni P, Scambia G. Human papillomavirus (HPV) vaccination: a call for action in Italy. Int J Gynecol Cancer 2023; 33:1132-1139. [PMID: 36918227 DOI: 10.1136/ijgc-2023-004275] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection. The implementation of primary prevention aims to reduce the burden of HPV infection and HPV-related disease. However, HPV-related diseases are still a concern, even in high-income countries. Approximately 570 000 new cervical cancer cases are diagnosed in Italy every year. Prophylactic HPV vaccines have been developed to minimize the spread of HPV. Growing evidence supports the administration of HPV vaccines (even just one dose) in reducing the prevalence of HPV infection and HPV-related disease including cancers. HPV vaccines are characterized by a high level of efficacy (>95%) in women who are naïve to HPV; however, they do not increase clearance in patients with ongoing HPV infection. With more than 200 million doses administered to date, HPV vaccines are considered to be safe and effective at preventing HPV-related infections and cancers. In this review we aim to review the current evidence regarding HPV vaccination and to describe trends in HPV vaccination coverage in Italy. In Italy, vaccination against HPV has been included in the National Immunization Plan (NIP) since 2007-2008. Using data abstracted from the Italian Ministry of Health, we analyzed changes in HPV vaccination coverage. We observed that HPV vaccines are underutilized and coverage rates are decreasing. Looking at the target population (females and males aged 11-12 years) in Italy, a decrease in coverage rates was observed. A call for action, improved HPV awareness, and education are the key elements to enhance the widespread adoption of HPV vaccination.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Marco Annoni
- National Research Council of Italy, Roma, Italy
- Fondazione Umberto Veronesi, Milano, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Polytechnic University of Marche, Ancona, Italy
| | - Luca Giannella
- Woman's Health Sciences Department, Polytechnic University of Marche, Ancona, Italy
| | - Rosa De Vincenzo
- Gynecologic Oncology, Catholic University of the Sacred Heart, Roma, Italy
| | - Paolo Cattani
- Italian Society of Colposcopy and Cervico-Vaginal Pathology, Roma, Italy
| | - Maggiorino Barbero
- Department of Obstetrics and Gynecology, Azienda Sanitaria Locale di Asti, Asti, Italy
| | - Paolo Vercellini
- Department of Obstetrics and Gynecology, Policlinico of Milan Mangiagalli Center, Milano, Italy
| | | | - Paolo Bonanni
- Department of Obstetrics and Gynecology, Università degli Studi di Firenze, Firenze, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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25
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Escoffery C, Petagna C, Agnone C, Perez S, Saber LB, Ryan G, Dhir M, Sekar S, Yeager KA, Biddell CB, Madhivanan P, Lee S, English AS, Savas L, Daly E, Vu T, Fernandez ME. A systematic review of interventions to promote HPV vaccination globally. BMC Public Health 2023; 23:1262. [PMID: 37386430 PMCID: PMC10308645 DOI: 10.1186/s12889-023-15876-5] [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: 09/22/2022] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Despite the human papillomavirus (HPV) vaccine being a safe, effective cancer prevention method, its uptake is suboptimal in the United States (U.S.). Previous research has found a variety of intervention strategies (environmental and behavioral) to increase its uptake. The purpose of the study is to systematically review the literature on interventions that promote HPV vaccination from 2015 to 2020. METHODS We updated a systematic review of interventions to promote HPV vaccine uptake globally. We ran keyword searches in six bibliographic databases. Target audience, design, level of intervention, components and outcomes were abstracted from the full-text articles in Excel databases. RESULTS Of the 79 articles, most were conducted in the U.S. (72.2%) and in clinical (40.5%) or school settings (32.9%), and were directed at a single level (76.3%) of the socio-ecological model. Related to the intervention type, most were informational (n = 25, 31.6%) or patient-targeted decision support (n = 23, 29.1%). About 24% were multi-level interventions, with 16 (88.9%) combining two levels. Twenty-seven (33.8%) reported using theory in intervention development. Of those reporting HPV vaccine outcomes, post-intervention vaccine initiation ranged from 5% to 99.2%, while series completion ranged from 6.8% to 93.0%. Facilitators to implementation were the use of patient navigators and user-friendly resources, while barriers included costs, time to implement and difficulties of integrating interventions into the organizational workflow. CONCLUSIONS There is a strong need to expand the implementation of HPV-vaccine promotion interventions beyond education alone and at a single level of intervention. Development and evaluation of effective strategies and multi-level interventions may increase the uptake of the HPV vaccine among adolescents and young adults.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA.
| | - Courtney Petagna
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Christine Agnone
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Stephen Perez
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Lindsay B Saber
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Grace Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Meena Dhir
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Swathi Sekar
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Caitlin B Biddell
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, Durham, NC, USA
| | - Purnima Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Stephanie Lee
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Amanda S English
- Institute for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Lara Savas
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Eliza Daly
- Prevention Research Center, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Thuy Vu
- Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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26
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Reiter PL, Gower AL, Kiss DE, Shoben AB, Katz ML, Bauermeister JA, Paskett ED, McRee AL. Efficacy of the Outsmart HPV Intervention: A Randomized Controlled Trial to Increase HPV Vaccination among Young Gay, Bisexual, and Other Men Who Have Sex with Men. Cancer Epidemiol Biomarkers Prev 2023; 32:760-767. [PMID: 36958851 PMCID: PMC10239352 DOI: 10.1158/1055-9965.epi-23-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Routine human papillomavirus (HPV) vaccination is recommended for young adults, yet many young gay, bisexual, and other men who have sex with men (YGBMSM) remain unvaccinated. We report the efficacy of Outsmart HPV, a web-based HPV vaccination intervention for YGBMSM. METHODS From 2019 to 2021, we recruited YGBMSM in the United States who were ages 18-25 and unvaccinated against HPV (n = 1,227). Participants were randomized to receive either: (i) Outsmart HPV content online and monthly interactive text reminders (interactive group); (ii) Outsmart HPV content online and monthly unidirectional text reminders (unidirectional group); or (iii) standard information online about HPV vaccine (control group). Regression models compared study groups on HPV vaccination outcomes. RESULTS Overall, 33% of participants reported initiating the HPV vaccine series and 7% reported series completion. Initiation was more common among participants in the interactive group compared with the control group [odds ratio (OR) = 1.47, 98.3% confidence interval (CI): 1.03-2.11]. Completion was more common among participants in both the interactive group (OR = 3.70, 98.3% CI: 1.75-7.83) and unidirectional group (OR = 2.26, 98.3% CI: 1.02-5.00) compared with the control group. Participants who received Outsmart HPV content reported higher levels of satisfaction with online content compared with the control group. CONCLUSIONS Outsmart HPV is an efficacious and acceptable HPV vaccination intervention for YGBMSM. Future efforts are needed to determine how to optimize the intervention and disseminate it to settings that provide services to YGBMSM. IMPACT Outsmart HPV is a promising tool for increasing HPV vaccination among YGBMSM with the potential for wide dissemination.
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Affiliation(s)
- Paul L. Reiter
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Amy L. Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Dale E. Kiss
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Abigail B. Shoben
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Mira L. Katz
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Electra D. Paskett
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
- Center for Scientific Review, National Institutes of Health, Bethesda, MD
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27
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Kahn BZ, Huang Q, Thompson P, Gilkey MB, Alton Dailey S, Brewer NT. Getting Human Papillomavirus Vaccination Back on Track: A National Survey. J Adolesc Health 2023; 72:950-957. [PMID: 36922312 PMCID: PMC10010471 DOI: 10.1016/j.jadohealth.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Adolescent human papillomavirus (HPV) vaccine uptake in the United States dropped during the COVID-19 pandemic due to a decrease in well visits. This study sought to identify opportunities for primary care professionals (PCPs) to get adolescent vaccination back on track. METHODS In early 2021, we recruited 1,047 PCPs (71% physicians) who provided adolescent vaccines in the United States from an existing panel. Participants completed an online survey about changes in adolescent HPV vaccine uptake and actions taken to promote vaccination during the pandemic, as well as intentions to engage in activities to increase adolescent vaccination in the next 3 months. RESULTS A substantial proportion of PCPs (43%) reported that HPV vaccine uptake decreased in the first year of the pandemic; few (7%) PCPs reported an increase in uptake. PCPs reporting increased uptake were more likely to have used nurse-only vaccination visits, held drop-in and drive-through vaccination clinics, and used telehealth visits to recommend vaccination (all p < .05). Nearly two-thirds (62%) of all PCPs planned to promote adolescent vaccine uptake in the next 3 months. Planning was more common among PCPs who believed HPV vaccine uptake at their clinics increased during the pandemic, who saw more than 10 adolescent patients per week, who had ever reviewed their clinic's vaccination rates, and were nurses (all p < .05). DISCUSSION Many PCPs saw HPV vaccination drop during the pandemic. Several interventions could help clinics get HPV vaccination back on track, including increasing the availability of nurse-only vaccination visits and vaccination-only clinics.
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Affiliation(s)
- Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
| | - Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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28
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Gendler Y. Development and Appraisal of a Web-Based Decision Aid for HPV Vaccination for Young Adults and Parents of Children in Israel-A Quasi-Experimental Study. Vaccines (Basel) 2023; 11:1038. [PMID: 37376426 DOI: 10.3390/vaccines11061038] [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: 04/06/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND This study aimed to develop and evaluate the effectiveness of two web-based decision aids designed to help parents of children aged 10-17 years and young adults aged 18-26 years make informed decisions about the HPV vaccine. METHODS The decision aids were developed according to the International Patient Decision Aid Standards (IPDAS) criteria and included information about the vaccine, probabilities of benefits and side effects, personal narratives, and values clarification. The study utilized a quasi-experimental design and included 120 Hebrew-speaking parents and 160 young adults. Participants completed baseline surveys and, two weeks after using the decision aid, completed a follow-up survey. RESULTS Both parents and young adults experienced a reduction in decisional conflict, an increase in self-efficacy, and greater confidence in the safety and effectiveness of the vaccine. The proportion of participating parents deciding to vaccinate their children against HPV increased from 46% to 75%, and the proportion of participating young adults leaning towards receiving the HPV vaccine increased from 64% to 92%. CONCLUSIONS The study highlights the importance of using decision aids to support informed decision making about vaccination and suggests that web-based decision aids may be a useful tool for supporting Israeli parents and young adults to make HPV vaccination decisions.
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Affiliation(s)
- Yulia Gendler
- The Department of Nursing, School of Health Sciences, Ariel University, Ariel 40700, Israel
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29
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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.
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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
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Rivera-Rivera JN, Díaz-Miranda OL, Medina-Laabes DT, Suárez E, Ortiz AP, Colón-López V. Attitudes towards HPV and COVID school-entry policies among adults living in Puerto Rico. Hum Vaccin Immunother 2023:2202126. [PMID: 37095591 PMCID: PMC10294738 DOI: 10.1080/21645515.2023.2202126] [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: 04/26/2023] Open
Abstract
Prior to the COVID pandemic, Puerto Rico (PR) had one of the highest Human Papillomavirus (HPV) vaccine rates in the United States. The COVID pandemic and administration of COVID vaccines might have impacted attitudes toward HPV vaccination. This study compared attitudes toward HPV and COVID vaccines with respect to school-entry policies among adults living in PR. A convenience sample of 222 adults (≥21 years old) completed an online survey from November 2021 to January 2022. Participants answered questions about HPV and COVID vaccines, attitudes toward vaccination policies for school-entry, and perceptions of sources of information. We assessed the magnitude of association between the agreement of school-entry policies for COVID and HPV vaccination by estimating the prevalence ratio (PRadjusted) with 95% Confidence Intervals (95% CI). The most trusted source of information for HPV and COVID vaccines were healthcare providers (42% and 17%, respectively) and the CDC (35% and 55%, respectively), while the least trusted were social media (40% and 39%, respectively), and friends and family (23% n = 47, and 17% n = 33, respectively). Most participants agreed that HPV (76% n = 156) and COVID vaccines (69% n = 136) should be a school-entry requirement. Agreement with school policy requiring COVID vaccination was significantly associated with agreement of school policy requiring HPV vaccination (PRadjusted:1.96; 95% CI:1.48-2.61) after controlling for potential confounders. Adults living in PR have an overall positive attitude about mandatory HPV and COVID vaccination school-entry policies, which are interrelated. Further research should elucidate the implications of the COVID pandemic on HPV vaccine attitudes and adherence rates.
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Affiliation(s)
- Jessica N Rivera-Rivera
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Olga L Díaz-Miranda
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Diana T Medina-Laabes
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Erick Suárez
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Ana P Ortiz
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Vivian Colón-López
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
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Petrie K, Wells A, Eckert LO. Human Papillomavirus Vaccine. Obstet Gynecol Clin North Am 2023; 50:339-348. [PMID: 37149314 DOI: 10.1016/j.ogc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Cervical cancer is the fourth most common cancer in women worldwide with immense associated morbidity and mortality. Although most of the cervical cancer cases are caused by the human papillomavirus (HPV) and can effectively be prevented by HPV vaccination, vaccination unfortunately remains underused on a global scale with vast inequities in distribution. A vaccine as a tool to prevent cancer, cervical and others, is largely unprecedented. Then why do HPV vaccination rates globally remain so low? This article explores the burden of disease, development of the vaccine and its subsequent uptake, cost-effectiveness, and associated equity issues.
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Cruz-Valdez A, Palacio-Mejía LS, Quezada-Sánchez AD, Hernández-Ávila JE, Galicia-Carmona T, Cetina-Pérez LDC, Arango-Bravo EA, Isla-Ortiz D, Aranda-Flores CE, Uscanga-Sánchez SR, Madrid-Marina V, Torres-Poveda K. Cervical cancer prevention program in Mexico disrupted due to COVID-19 pandemic: Challenges and opportunities. Front Oncol 2023; 13:1008560. [PMID: 36969022 PMCID: PMC10034019 DOI: 10.3389/fonc.2023.1008560] [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: 08/01/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction The COVID-19 pandemic disrupted the preventive services for cervical cancer (CC) control programs in Mexico, which will result in increased mortality. This study aims to assess the impact of the pandemic on the interruption of three preventive actions in the CC prevention program in Mexico. Methods This study is a retrospective time series analysis based on administrative records for the uninsured population served by the Mexican Ministry of Health. Patient data were retrieved from the outpatient service information system and the hospital discharge database for the period 2017-2021. Data were aggregated by month, distinguishing a pre-pandemic and a pandemic period, considering April 2020 as the start date of the pandemic. A Poisson time series analysis was used to model seasonal and secular trends. Five process indicators were selected to assess the disruption of the CC program, these were analyzed as monthly data (N=39 pre-pandemic, N=21 during the pandemic). HPV vaccination indicators (number of doses and coverage) and diagnostic characteristics of CC cases were analyzed descriptively. The time elapsed between diagnosis and treatment initiation in CC cases was modeled using restricted cubic splines from robust regression. Results Annual HPV vaccination coverage declined dramatically after 2019 and was almost null in 2021. The number of positive Papanicolaou smears decreased by 67.8% (90%CI: -72.3, -61.7) in April-December 2020, compared to their expected values without the pandemic. The immediate pandemic shock (April 2020) in the number of first-time and recurrent colposcopies was -80.5% (95%CI:-83.5, -77.0) and -77.9% (95%CI: -81.0, -74.4), respectively. An increasing trend was observed in the proportion of advanced stage and metastatic CC cases. The fraction of CC cases that did not receive medical treatment or surgery increased, as well as CC cases that received late treatment after diagnosis. Conclusions Our analyses show significant impact of the COVID-19 pandemic with declines at all levels of CC prevention and increasing inequalities. The restarting of the preventive programs against CC in Mexico offers an opportunity to put in place actions to reduce the disparities in the burden of disease between socioeconomic levels.
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Affiliation(s)
- Aurelio Cruz-Valdez
- Center for Population Health Research, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - Lina Sofia Palacio-Mejía
- Consejo Nacional de Ciencia y Tecnología (CONACYT)—Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - Amado D. Quezada-Sánchez
- Center for Evaluation and Surveys Research, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | | | - Tatiana Galicia-Carmona
- Department of Clinical Research and Medical Oncology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico
| | | | - Eder A. Arango-Bravo
- Department of Clinical Research and Medical Oncology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico
| | - David Isla-Ortiz
- Department of Oncology Gynecology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico
| | | | | | - Vicente Madrid-Marina
- Chronic Infections and Cancer Division, Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - Kirvis Torres-Poveda
- Consejo Nacional de Ciencia y Tecnología (CONACYT)—Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
- Chronic Infections and Cancer Division, Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
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Cherven B, Klosky JL, Elizabeth Keith K, Hudson MM, Bhatia S, Landier W. Reasons for refusal of the human papillomavirus vaccine among young cancer survivors. Cancer 2023; 129:614-623. [PMID: 36530157 PMCID: PMC10283160 DOI: 10.1002/cncr.34521] [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: 06/23/2022] [Revised: 09/07/2022] [Accepted: 09/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancer survivors are at risk for developing subsequent human papillomavirus (HPV)-related malignancies. HPV vaccination rates among survivors remain low, and the reasons for refusal of the vaccine are unclear in this population. METHODS The authors conducted a secondary analysis of data from an open-label clinical trial evaluating the immunogenicity and safety of the HPV vaccine among vaccine-naive cancer survivors who were 9-26 years old and 1-5 years from the completion of their cancer treatment. Survivors/parents who declined trial participation were asked their reasons for declining. Refusal reasons were categorized, and multivariable logistic regression models were developed to identify associations between survivor characteristics and primary refusal reasons. RESULTS Among the 301 survivors who refused participation in the clinical trial, 215 (71.4%) refused for reasons related to the HPV vaccine. Reasons for vaccine-related refusal included safety concerns, vaccine hesitancy/disinterest, external influences, vaccine-related information deficits, and health beliefs/family decisional processes. Compared with males, females were more likely to refuse for reasons related to health beliefs/family decisional processes (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.12-3.93; p = .022) and were less likely to do so because of external influences (OR, 0.43; 95% CI, 0.19-0.92; p = .035). Survivors approached about participation during the latter years of the trial were more likely to refuse because of safety concerns (OR, 3.33; 95% CI, 1.55-7.69; p = .003). CONCLUSIONS Cancer survivors refused participation in an open-label trial evaluating the immunogenicity and safety of the HPV vaccine primarily because of vaccine-related concerns that were unrelated to the research study. Many of these concerns are potentially addressable by health care providers using evidence-based messages tailored to the cancer survivor population.
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Affiliation(s)
- Brooke Cherven
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - James L. Klosky
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - K. Elizabeth Keith
- Institute for Cancer Outcomes and Survivorship, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Turner K, Brownstein NC, Whiting J, Arevalo M, Vadaparampil S, Giuliano AR, Islam JY, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 pandemic on human papillomavirus (HPV) vaccination among a national sample of United States adults ages 18-45: A cross-sectional study. Prev Med Rep 2023; 31:102067. [PMID: 36439896 PMCID: PMC9677560 DOI: 10.1016/j.pmedr.2022.102067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
To assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18-45). The current study leverages a national, cross-sectional sample of US adults ages 18-45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of 'no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20; 95 % CI: 1.99-5.13), being a parent/guardian (OR: 1.77; 95 % CI: 1.18-2.66), having at least one healthcare visit in the past year (OR: 1.97; 95 % CI: 1.10-3.53), being up-to-date on the tetanus vaccine (OR: 1.81; 95 % CI: 1.19-2.75), and being a cancer survivor (OR: 2.57; 95 % CI: 1.52-4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN 47907, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd., Indianapolis, IN 46202, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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Gountas I, Favre-Bulle A, Saxena K, Wilcock J, Collings H, Salomonsson S, Skroumpelos A, Sabale U. Impact of the COVID-19 Pandemic on HPV Vaccinations in Switzerland and Greece: Road to Recovery. Vaccines (Basel) 2023; 11:vaccines11020258. [PMID: 36851136 PMCID: PMC9964352 DOI: 10.3390/vaccines11020258] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/06/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
The COVID-19 pandemic has caused significant disruptions to healthcare, including reduced administration of routinely recommended HPV vaccines in a number of European countries. Because the extent and trends of accumulated vaccine dose deficits may vary by country, decision-makers need country-specific information regarding vaccine deficits to plan effective catch-up initiatives. To address this knowledge gap in Switzerland and Greece, this study used a previously published COVID-19 recovery calculator and historical vaccine sales data to quantify the cumulative number of missed doses and the catch-up rate required to clear the deficit in Switzerland and Greece. The resultant cumulative deficit in HPV doses for Switzerland and Greece were 24.4% and 21.7%, respectively, of the total number of doses disseminated in 2019. To clear the dose deficit by December 2025, monthly vaccination rates must be increased by 6.3% and 6.0% compared to 2019 rates in Switzerland and Greece, respectively. This study demonstrates that administration rates of routine HPV vaccines decreased significantly among Swiss and Greek adolescents during the COVID-19 pandemic and that a sustained increase in vaccination rates is necessary to recover the HPV dose deficits identified and to prevent long-term public health consequences.
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Affiliation(s)
| | | | - Kunal Saxena
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA
| | | | | | - Stina Salomonsson
- Center for Observational and Real-World Evidence (CORE), MSD, 11330 Stockholm, Sweden
| | | | - Ugne Sabale
- Center for Observational and Real-World Evidence (CORE), MSD, 11330 Stockholm, Sweden
- Correspondence:
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Gray A, Fisher CB. Factors associated with HPV vaccine acceptability and hesitancy among Black mothers with young daughters in the United States. Front Public Health 2023; 11:1124206. [PMID: 37139381 PMCID: PMC10150885 DOI: 10.3389/fpubh.2023.1124206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Compared to other-race peers, Black women are disproportionately impacted by human papillomavirus [HPV] infection, related health outcomes, and cervical cancer mortality as a result of suboptimal HPV vaccine uptake during adolescence. Few studies in the United States have examined psychosocial determinants of HPV vaccine acceptability and hesitancy among Black parents. The current study integrated the health belief model and the theory of planned behavior to evaluate the extent to which psychosocial factors are associated with pediatric HPV vaccination intentions among this population. Methods Black mothers (N = 402; age range = 25 to 69 years, M = 37.45, SD = 7.88) of daughters ages 9 to 15 years completed an online survey assessing HPV infection and vaccine beliefs and attitudes across four domains: Mother's HPV Perceptions, Mother's Vaccine Attitudes, Cues to Action, and Perceived Barriers to HPV Vaccination. Participants indicated their willingness to vaccinate their daughter on a 5-level ordinal scale ("I will definitely not have my daughter get the vaccine" to "I will definitely have my daughter get the vaccine") which was dichotomously recoded for binomial logistic regressions. Results Half of the sample (48%) intended to vaccinate their daughter. Number of daughters, mother's HPV vaccine status, perceived HPV vaccine benefits, HPV vaccine safety concerns, pediatric HPV vaccine peer norms, and doctor recommendations emerged as independent factors of Black mothers' intentions to vaccinate their daughters against HPV when controlling for all other factors. Discussion In addition to medical training to increase doctor recommendation of the HPV vaccine for Black girls, population-tailored public health messaging aimed at promoting HPV vaccine acceptance among Black mothers is urgently needed. This messaging should engage community support and emphasize the benefits of vaccination for adolescent Black girls while also addressing parental concerns regarding the safety of pediatric HPV vaccination.
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Affiliation(s)
- Aaliyah Gray
- Department of Psychology, Fordham University, Bronx, NY, United States
- Department of Epidemiology, Florida International University, Miami, FL, United States
- *Correspondence: Aaliyah Gray,
| | - Celia B. Fisher
- Department of Psychology, Fordham University, Bronx, NY, United States
- Center for Ethics Education, Fordham University, Bronx, NY, United States
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Perin L, Dal Zotto A, Savio M, Stano A, Bulegato L, Tribbia L, Donà R, Tomasi M, Fietta S, Ferro A, Baldo V, Saugo M, Cocchio S. Widening Disparities in Teen HPV Vaccinations during COVID-19 Pandemic: A Case Study from Veneto Region (Italy). Vaccines (Basel) 2022; 10:vaccines10122120. [PMID: 36560530 PMCID: PMC9782394 DOI: 10.3390/vaccines10122120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In Local Health Unit 7, human papilloma virus (HPV) vaccination campaigns for 12-year-olds have long been implemented by the vaccination services of the Department of Prevention. Due to the pressure of the COVID-19 pandemic on these services, an emergency vaccination campaign was directly managed by primary care pediatricians (PCPs). An initial evaluation of this experience was conducted. MATERIALS AND METHODS Data on 12-year-olds assisted by PCPs belonging to the 2006 (pre-pandemic) and 2008 (pandemic) birth cohorts were extracted, along with HPV vaccination data. Health district, gender, citizenship, socioeconomic status, and PCPs were evaluated as possible influencing factors in a two-level logistic regression (second level: single PCP). RESULTS The HPV vaccination gap between males and females increased significantly for the 2008 birth cohort compared to the 2006 birth cohort (11 vs. 4 percentage points). As for PCPs, the vaccination uptake range was 4-71% for the 2008 birth cohort vs. 32-85% for the 2006 cohort. The proportion of variance explained at the second level was overall equal to 9.7% for the 2008 cohort vs. 3.6% for the 2006 cohort. CONCLUSIONS The vaccination campaign carried out during the peak of the COVID-19 pandemic increased the HPV vaccination gaps among Health Districts, genders, and individual PCPs, probably due to a lack of homogeneity in professional practices and attitudes toward HPV vaccination. Catch-up interventions are required in the immediate term, while an equity-lens approach should be taken for reprogramming the vaccination campaign. Greater involvement of schools and families could ensure a more equitable approach and a better uptake.
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Affiliation(s)
- Luca Perin
- Department of Prevention of Local Health Unit n. 7, Veneto Region, 31011 Venice, Italy
| | - Alessandra Dal Zotto
- Department of Prevention of Local Health Unit n. 7, Veneto Region, 31011 Venice, Italy
| | - Marta Savio
- Post-Graduate School of Hygiene and Preventive Medicine, Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Antonio Stano
- Department of Prevention of Local Health Unit n. 7, Veneto Region, 31011 Venice, Italy
| | - Lorenzo Bulegato
- Department of Prevention of Local Health Unit n. 7, Veneto Region, 31011 Venice, Italy
| | - Luca Tribbia
- Department of Prevention of Local Health Unit n. 7, Veneto Region, 31011 Venice, Italy
| | - Roberta Donà
- Department of Prevention of Local Health Unit n. 7, Veneto Region, 31011 Venice, Italy
| | - Matilde Tomasi
- Department of Prevention of Local Health Unit n. 7, Veneto Region, 31011 Venice, Italy
| | - Silvia Fietta
- Department of Prevention of Local Health Unit n. 7, Veneto Region, 31011 Venice, Italy
| | - Antonio Ferro
- Italian Society of Hygiene, Preventive Medicine and Public Health, 10126 Torino, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padova, Italy
| | - Mario Saugo
- Department of Prevention of Local Health Unit n. 7, Veneto Region, 31011 Venice, Italy
- Correspondence:
| | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padova, Italy
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Wang WV, Kothari S, Skufca J, Giuliano AR, Sundström K, Nygård M, Koro C, Baay M, Verstraeten T, Luxembourg A, Saah AJ, Garland SM. Real-world impact and effectiveness of the quadrivalent HPV vaccine: an updated systematic literature review. Expert Rev Vaccines 2022; 21:1799-1817. [PMID: 36178094 DOI: 10.1080/14760584.2022.2129615] [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: 01/12/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) infection, which poses significant disease burden, is decreasing following implementation of vaccination programs. Synthesized evidence on HPV vaccine real-world benefit was published in 2016. However, long-term impact of vaccination, and how vaccination programs influence infection rates and disease outcomes, requires further examination. AREAS COVERED We systematically reviewed observational studies on HPV vaccination within MEDLINE, EMBASE, and Google Scholar from 2016 to 2020, involving 14 years of follow-up data. We identified 138 peer-reviewed publications reporting HPV vaccine impact or effectiveness. Outcomes of interest included rates of infection at different anatomical sites and incidence of several HPV-related disease endpoints. EXPERT OPINION The expansion of HPV vaccination programs worldwide has led to a reduction in genital infection and significant decreases in incidence of HPV-related disease outcomes. Therefore, the WHO has set goals for the elimination of cervical cancer as a public health concern. To track progress toward this requires an understanding of the effectiveness of different vaccination initiatives. However, the impact on males, and potential benefit of gender-neutral vaccination programs have not been fully explored. To present an accurate commentary on the current outlook of vaccination and to help shape policy therefore requires a systematic review of available data.
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Affiliation(s)
- Wei Vivian Wang
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Smita Kothari
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Jozica Skufca
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL USA
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Carol Koro
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Marc Baay
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | | | - Alain Luxembourg
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Alfred J Saah
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Suzanne M Garland
- Department of Obstetrics and Gynecology, The University of Melbourne, Royal Women's Hospital (RWH), Murdoch Childrens Research Institute, Melbourne, Australia
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Olusanya OA, White B, Malik F, Hester KA, Davis RL, Bednarczyk RA, Shaban-Nejad A. Healthcare professionals' perceptions and recommendations regarding adolescent vaccinations in Georgia and Tennessee during the COVID-19 pandemic: A qualitative research. PLoS One 2022; 17:e0277748. [PMID: 36399477 PMCID: PMC9674128 DOI: 10.1371/journal.pone.0277748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite its benefits, HPV vaccine uptake has been historically lower than other recommended adolescent vaccines in the United States (US). While hesitancy and misinformation have threatened vaccinations for many years, the adverse impacts from COVID-19 pandemic on preventive services have been far-reaching. OBJECTIVES To explore the perceptions and experiences of adolescent healthcare providers regarding routine vaccination services during the COVID-19 pandemic. METHODOLOGY Between December 2020 and May 2021, in-depth qualitative interviews were conducted via Zoom video conferencing among a purposively selected, diverse group of adolescent healthcare providers (n = 16) within 5 healthcare practices in the US southeastern states of Georgia and Tennessee. Audio recordings were transcribed verbatim and analyzed using a rapid qualitative analysis framework. Our analysis was guided by the grounded theory and inductive approach. RESULTS Participants reported that patient-provider communications; effective use of presumptive languaging; provider's continuing education/training; periodic reminders/recall messages; provider's personal conviction on vaccine safety/efficacy; early initiation of HPV vaccination series at 9 years; community partnerships with community health navigators/vaccine champions/vaccine advocates; use of standardized forms/prewritten scripts/standard operating protocols for patient-provider interactions; and vaccine promotion through social media, brochures/posters/pamphlets as well as outreaches to schools and churches served as facilitators to adolescent HPV vaccine uptake. Preventive adolescent services were adversely impacted by the COVID-19 pandemic at all practices. Participants highlighted an initial decrease in patients due to the pandemic, while some practices avoided the distribution of vaccine informational materials due to sanitary concerns. CONCLUSION As part of a larger study, we provided contextual information to refine an intervention package currently being developed to improve adolescent preventive care provision in healthcare practices. Our results could inform the implementation of comprehensive intervention strategies that improve HPV vaccination rates. Additionally, lessons learned (e.g. optimizing patient- provider interactions) could be adopted to expand COVID-19 vaccine acceptance on a sizable scale.
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Affiliation(s)
- Olufunto A. Olusanya
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail: (OAO); (AS-N)
| | - Brianna White
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Fauzia Malik
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Kyra A. Hester
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Robert L. Davis
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Robert A. Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Arash Shaban-Nejad
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail: (OAO); (AS-N)
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Ferrara P, Dallagiacoma G, Alberti F, Gentile L, Bertuccio P, Odone A. Prevention, diagnosis and treatment of cervical cancer: A systematic review of the impact of COVID-19 on patient care. Prev Med 2022; 164:107264. [PMID: 36150446 PMCID: PMC9487163 DOI: 10.1016/j.ypmed.2022.107264] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/07/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022]
Abstract
Worldwide, the COVID-19 pandemic disrupted healthcare services, including cervical cancer management, and an increased burden for this condition is expected. This systematic review synthetizes the available evidence on the impact of the pandemic on prevention, diagnosis and treatment of cervical cancer. Searches were performed on PubMed, Embase, and Scopus for relevant studies on these topics with the purpose of comparing service access and care delivery before and during COVID-19 pandemic. Due to the methodological heterogeneity among the studies, findings were narratively discussed. Of the 715 screened titles and abstracts, 33 articles were included, corresponding to 42 reports that covered the outcomes of interest: vaccination against human papillomavirus (HPV) (6 reports), cancer screening (19), diagnosis (8), and treatment (8). Seven studies observed reductions in HPV vaccination uptake and coverage during COVID-19. Reports on cervical screening and cancer diagnosis activities showed a substantial impact of the pandemic on access to screening services and diagnostic procedures. All but one study that investigated cervical cancer treatment reported changes in the number of women with cervical lesions who received treatments, as well as treatment delay and interruption. With a major impact during the first wave in 2020, COVID-19 and restriction measures resulted in a substantial disruption in cervical cancer prevention and management, with declines in screening and delays in treatment. Taken together, findings from this systematic review calls for urgent policy interventions for recovering cervical cancer prevention and care.
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Affiliation(s)
- Pietro Ferrara
- Center for Public Health Research, University of Milan-Bicocca, 20900 Monza, Italy; IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Giulia Dallagiacoma
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Federica Alberti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Leandro Gentile
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
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De Oliveira LH, Janusz CB, Da Costa MT, El Omeiri N, Bloem P, Lewis M, Luciani S. HPV vaccine introduction in the Americas: a decade of progress and lessons learned. Expert Rev Vaccines 2022; 21:1569-1580. [PMID: 36154390 DOI: 10.1080/14760584.2022.2125383] [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: 11/04/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) is an important public health concern due to its causative role in many cancers, especially cervical cancer, and other conditions that lead to serious health consequences in both men and women. In Latin America and the Caribbean, nearly 60,000 new cases of cervical cancer and another 7,000 HPV-associated cancers are diagnosed annually. AREAS COVERED HPV vaccination combined with comprehensive cervical cancer control programmingis paving the way for eliminating cervical cancer as a major public health problem and drastically reducing other HPV-associated diseases. To date, 44 countries and territories in the Americas have introduced HPV vaccines as part of their national immunization programs and cervical cancer control strategies. Early lessons from HPV vaccine introduction suggest that transparent and credible evidence-based decision-making, information, education and communication about HPV and cervical cancer, coordination with existing cervical cancer control initiatives, and precise planning for ensuring effective uptake of the vaccine in target groups are all critical elements of success. EXPERT OPINION There is an urgent need for strategies to increase HPV vaccine coverage, and as the integrated control programs evolve and other HPV-associated disease becomes important for public health, there will be a need for continued program and policy evaluation.
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Affiliation(s)
- Lucia H De Oliveira
- Antimicrobial Resitance Unit, Pan American Health Organization, Washington, DC, USA
| | - Cara B Janusz
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Nathalie El Omeiri
- Antimicrobial Resitance Unit, Pan American Health Organization, Washington, DC, USA
| | - Paul Bloem
- Department of Immunizations, Biologicals, and Vaccines, World Health Organization, Geneva, Switzerland
| | - Merle Lewis
- Pan American Health Organization, Washington, DC, USA
| | - Silvana Luciani
- Non-communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Rodriguez AM, Do TQN, Jibaja-Weiss ML, Chen L, Schmeler KM, Montealegre JR, Kuo YF. Human Papillomavirus Vaccinations During the COVID-19 Pandemic in Middle Schools in the Rio Grande Valley of Texas. Am J Public Health 2022; 112:1269-1272. [PMID: 35862887 PMCID: PMC9382169 DOI: 10.2105/ajph.2022.306970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/04/2022]
Abstract
This quasi-experimental study (a community-based, physician-led human papillomavirus [HPV] education campaign and school-based vaccination program) followed 6481 students at eight Pharr-San Juan-Alamo Independent School District (Rio Grande Valley, Texas) middle schools between August 2016 and March 2021. We describe the successes and challenges experienced during the COVID-19 pandemic. HPV vaccine initiation and completion rates increased 1.29-fold and 1.47-fold, respectively, between June 2019 and March 2021. Between March 2020 and March 2021, 268 HPV vaccine doses were provided through 24 school-based interventions. Our program continued successes seen in increasing HPV vaccination rates and reducing possible HPV-associated cancers. (Am J Public Health. 2022;112(9):1269-1272. https://doi.org/10.2105/AJPH.2022.306970).
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Affiliation(s)
- Ana M Rodriguez
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Thuy Quynh N Do
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Maria L Jibaja-Weiss
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Lu Chen
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Kathleen M Schmeler
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Jane R Montealegre
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Yong-Fang Kuo
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
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Rao SR, Kampan N, Chew KT, Shafiee MN. The impact of the COVID-19 pandemic on the national HPV immunization program in Malaysia. Front Public Health 2022; 10:907720. [PMID: 35979457 PMCID: PMC9376674 DOI: 10.3389/fpubh.2022.907720] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
In Malaysia, the HPV immunization program has been introduced since 2010 as part of the national immunization plan for female students aged 13 years old. It was a very successful immunization program with good responses from students and parents until the start of COVID-19 pandemic in 2020. The COVID-19 pandemic caused the schools to be closed and resulted about 225000 female students aged 13 years old either missed their vaccination or have incomplete doses of HPV vaccination in 2020 and 2021. This could possibly lead to an increase in cases of cervical cancer and genital warts in the upcoming years. Hence, a wellorganized catch-up HPV vaccination program is vital in ensuring the aim of achieving zero HPV-related infections in the future.
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Khuwaja SS, Peck JL. Increasing HPV Vaccination Rates Using Text Reminders: An Integrative Review of the Literature. J Pediatr Health Care 2022; 36:310-320. [PMID: 35288016 DOI: 10.1016/j.pedhc.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) is the most common sexually transmitted infection among youth in the United States. Although HPV vaccinations are readily available, HPV immunizations remain lower than target rates. The purpose of this review is to consider text message reminder system efficacy to improve HPV vaccination rates in eligible children. METHOD A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature and PubMed databases to search articles illustrating the effect of text message reminder systems. RESULTS Research is primarily conclusive of improved HPV vaccination rates through text message reminder systems, indicating the need for practice guidelines directed at text message delivery and text message content. DISCUSSION This integrative review synthesizes and highlights available literature on implementing text message reminder systems to improve HPV vaccination rates. Once the text message reminder system is in place, automatic arrangement of preventive care service is hassle-free for practices.
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Nath S, Ferreira J, McVicar A, Oshilaja T, Swann B. Rise in oral cancer risk factors associated with the COVID-19 pandemic mandates a more diligent approach to oral cancer screening and treatment. J Am Dent Assoc 2022; 153:495-499. [PMID: 35260234 PMCID: PMC8898066 DOI: 10.1016/j.adaj.2022.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/03/2022] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
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Shimizu Y, Hirai K, Ueda Y, Yagi A, Ohtake F. Impact of the Threat of COVID-19 Infections on the Perceived Risk to HPV Vaccination. Vaccines (Basel) 2022; 10:vaccines10050829. [PMID: 35632585 PMCID: PMC9147999 DOI: 10.3390/vaccines10050829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/07/2022] Open
Abstract
Vaccination rates for human papillomavirus (HPV) in Japan are significantly lower than other countries, and Japanese people are reluctant to be vaccinated. Repeated daily reports of COVID-19 infections and restrictions have made people more health conscious and aware of the danger of infectious diseases. In this study, we used the health belief model (HBM) to examine perceived threats of cancer and infectious diseases and to ascertain whether the new COVID-19 vaccination in addition to these perceived threats would increase vaccination intention against cervical cancer. We conducted a cluster analysis to classify the segmentation regarding the perceived threat, and a logistic regression analysis to predict factors influencing people accepting vaccination. We received 1257 completed surveys during our research. We classified the participants into six clusters, and the logistic regression analysis indicated eight factors significantly associated with the willingness to get the HPV vaccine: reliable information sources such as doctors and social networking sites (SNS), the recognition of COVID-19 symptoms, the awareness of COVID-19 vaccination, the importance of HPV prevention through vaccination, one’s own intention of COVID-19 vaccination, their intention of COVID-19 vaccination toward children, and benefits of HPV vaccination. Further research on HPV and COVID-19 vaccination is encouraged.
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Affiliation(s)
- Yumi Shimizu
- Department of Clinical Psychology, Graduate School of Human Sciences, Osaka University, 1-2, Yamadaoka, Suita 565-0871, Osaka, Japan;
| | - Kei Hirai
- Department of Clinical Psychology, Graduate School of Human Sciences, Osaka University, 1-2, Yamadaoka, Suita 565-0871, Osaka, Japan;
- Correspondence: ; Tel.: +81-668-798-124
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita 565-0871, Osaka, Japan; (Y.U.); (A.Y.)
| | - Asami Yagi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita 565-0871, Osaka, Japan; (Y.U.); (A.Y.)
| | - Fumio Ohtake
- Department of Economics, Graduate School of Economics, Osaka University, 1-7, Machikaneyama-cho, Toyonaka 560-0043, Osaka, Japan;
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Mehta A, Markman B, Rodriguez-Cintron W. Don’t jump down my throat: gender gap in HPV vaccinations risk long term cancer threats. Expert Rev Vaccines 2022; 21:1045-1053. [DOI: 10.1080/14760584.2022.2075850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Armaan Mehta
- George Washington University School of Public Health and Health Services, Virginia, United States
| | - Bethany Markman
- George Washington University School of Public Health and Health Services, Virginia, United States
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Damgacioglu H, Sonawane K, Chhatwal J, Lairson DR, Clifford GM, Giuliano AR, Deshmukh AA. Long-term impact of HPV vaccination and COVID-19 pandemic on oropharyngeal cancer incidence and burden among men in the USA: A modeling study. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100143. [PMID: 34927126 PMCID: PMC8672648 DOI: 10.1016/j.lana.2021.100143] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oropharyngeal cancer (OPC) incidence is rising rapidly among men in the United States of America (USA). We aimed to project the impact of maintaining the current HPV vaccination uptake and achieving 80% national (Healthy People) goal on OPC incidence and burden. METHODS We developed an open-cohort micro-simulation model of OPC natural history among contemporary and future birth cohorts of men, accounting for sexual behaviors, population growth, aging, and herd immunity. We used data from nationally representative databases, cancer registries from all 50 states, large clinical trials, and literature. We evaluated the status quo scenario (the current HPV vaccination uptake remained stable) and alternative scenarios of improvements in uptake rates in adolescents (aged 9-17 years) and young adults (aged 18-26 years) by 2025 to achieve and maintain the 80% goal. The primary outcome was to project OPC incidence and burden from 2009 to 2100. We also assessed the impact of disruption in HPV vaccine uptake during the COVID-19 pandemic. FINDINGS OPC incidence is projected to rise until the mid-2030s, reaching the age-standardized incidence rate of 9·8 (95% uncertainty interval [UI] 9·5-10·1) per 100 000 men, with the peak annual burden of 23 850 (UI, 23 200-24 500) cases. Under the status quo scenario, HPV vaccination could prevent 124 000 (UI, 117 000-131 000) by 2060, 400 000 (UI, 384 000-416 000) by 2080, and 792 000 (UI, 763 000-821 000) by 2100 OPC cases among men. Achievement and maintenance of 80% coverage among adolescent girls only, adolescent girls and boys, and adolescents plus young adults could prevent an additional number of 100 000 (UI, 95 000-105 000), 118 000 (UI, 113 000-123 000), and 142 000 (UI, 136 000-148 000) male OPC cases by 2100. Delayed recovery of the HPV vaccine uptake during the COVID-19 pandemic could lead to 600 (UI, 580-620) to 6200 (UI, 5940-6460) additional male OPC cases by 2100, conditional on the decline in the extent of the national HPV vaccination coverage and potential delay in rebounding. INTERPRETATION Oropharyngeal cancer burden is projected to rise among men in the USA. Nationwide efforts to achieve the HPV vaccination goal of 80% coverage should be a public health priority. Rapid recovery of the declined HPV vaccination uptake during the COVID-19 pandemic is also crucial to prevent future excess OPC burden. FUNDING National Cancer Institute and National Institute on Minority Health and Health Disparities of the USA.
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Affiliation(s)
- Haluk Damgacioglu
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, 1200 Pressler Street, RAS-E 329, Houston, Texas, USA
| | - Kalyani Sonawane
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, 1200 Pressler Street, RAS-E 329, Houston, Texas, USA
- Center for Healthcare Data, Department of Management, Policy & Community Health, School of Public Health, UT Health Science Center at Houston, Houston, TX, USA
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - David R. Lairson
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, 1200 Pressler Street, RAS-E 329, Houston, Texas, USA
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, 1200 Pressler Street, RAS-E 329, Houston, Texas, USA
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Brotherton J, Hendry A, Dey A, Hull BP, Beard F. HPV vaccination coverage: slightly improved two-dose schedule completion estimates and historical estimates lower on AIR than HPV Register. Aust N Z J Public Health 2022; 46:394-400. [PMID: 35357729 DOI: 10.1111/1753-6405.13233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To compare Australian Immunisation Register (AIR) human papillomavirus (HPV) vaccination coverage against historical data from the former National HPV Vaccination Program Register and estimate two-dose vaccination coverage. METHODS Cross-sectional analysis of registry data for adolescent birth cohorts (1998-2007). Denominator populations were Medicare enrolments (AIR) and ABS estimated resident populations (HPV register). RESULTS For adolescents aged <17 years, AIR coverage estimates were several percentage points lower than HPV register estimates due to a larger Medicare enrolment denominator. Completed course coverage (two or three valid doses) for 15-year-old females in 2020 was 81.5% and for males 78.6%, higher than completed course coverage in 15-year-olds in 2019 (79.7 and 76.8% respectively). First dose coverage was similar for Indigenous adolescents but course completion was lower, although improving over time. Course completion was slightly lower (3.5-5.7%) in areas of lowest socioeconomic status and greatest remoteness. CONCLUSIONS Coverage is slightly lower using AIR than HPV register estimates. Moving from three to two doses has slightly improved completion, likely due to the wider dose spacing, but equity gaps remain. IMPLICATIONS FOR PUBLIC HEALTH An ongoing focus on equity in vaccine delivery is needed. Systems, reminders and catch-up opportunities to ensure course completion remain important.
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Affiliation(s)
- Julia Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria
| | - Alexandra Hendry
- National Centre for Immunisation Research and Surveillance, Sydney, New South Wales
| | - Aditi Dey
- National Centre for Immunisation Research and Surveillance, Sydney, New South Wales.,Discipline of Child and Adolescent Health, The University of Sydney, New South Wales
| | - Brynley P Hull
- National Centre for Immunisation Research and Surveillance, Sydney, New South Wales
| | - Frank Beard
- National Centre for Immunisation Research and Surveillance, Sydney, New South Wales.,School of Public Health, The University of Sydney, New South Wales
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Ryan G, Gilbert PA, Ashida S, Charlton ME, Scherer A, Askelson NM. Challenges to Adolescent HPV Vaccination and Implementation of Evidence-Based Interventions to Promote Vaccine Uptake During the COVID-19 Pandemic: "HPV Is Probably Not at the Top of Our List". Prev Chronic Dis 2022; 19:E15. [PMID: 35358035 PMCID: PMC8992683 DOI: 10.5888/pcd19.210378] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The COVID-19 pandemic has prevented many adolescents from receiving their vaccines, including the human papillomavirus (HPV) vaccine, on time. However, little is known about the impact of the pandemic on implementation of clinic-level evidence-based interventions (EBIs) that help to improve HPV vaccine uptake. In this qualitative study, we explored the pandemic’s impact on EBI implementation and HPV vaccine delivery. Methods During August–November 2020, we interviewed clinic managers in a rural, midwestern state about their experiences implementing EBIs for HPV vaccination during the COVID-19 pandemic. We used a multipronged sampling approach with both stratified and purposive sampling to recruit participants from Vaccines for Children clinics. We then conducted a thematic analysis of transcripts. Results In interviews (N = 18), 2 primary themes emerged: decreased opportunities for HPV vaccination and disruption to HPV-related implementation work. Most participants reported decreases in opportunities to vaccinate caused by structural changes in how they delivered care (eg, switched to telehealth visits) and patient fear of exposure to COVID-19. Disruptions to EBI implementation were primarily due to logistical challenges (eg, decreases in staffing) and shifting priorities. Conclusion During the pandemic, clinics struggled to provide routine care, and as a result, many adolescents missed HPV vaccinations. To ensure these adolescents do not fall behind on this vaccine series, providers and researchers will need to recommit to EBI implementation and use existing strategies to promote vaccination. In the long term, improvements are needed to make EBI implementation more resilient to ensure that progress does not come to a halt in future pandemic events.
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Affiliation(s)
- Grace Ryan
- College of Public Health, University of Iowa, Iowa City, Iowa.,Now with University of Massachusetts Chan Medical School, Worcester, Massachusetts.,University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA 01605.
| | - Paul A Gilbert
- College of Public Health, University of Iowa, Iowa City, Iowa
| | - Sato Ashida
- College of Public Health, University of Iowa, Iowa City, Iowa
| | - Mary E Charlton
- College of Public Health, University of Iowa, Iowa City, Iowa
| | - Aaron Scherer
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
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