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Klein NP, Wiesner A, Bautista O, Group T, Kanu K, Li ZL, McCauley J, Saxena K, Tota J, Luxembourg A, Bonawitz R. Immunogenicity and Safety of Extended-Interval 2-Dose Regimens of 9vHPV Vaccine. Pediatrics 2024:e2023064693. [PMID: 38978512 DOI: 10.1542/peds.2023-064693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Nine-valent human papillomavirus (9vHPV) vaccines can be administered in 2 doses 6 to 12 months apart in adolescents. The impact of extended dose intervals is unknown. We report immunogenicity and safety data in adolescents of a second 9vHPV vaccine dose administered ≥1 year after the first. METHODS This open-label safety and immunogenicity study (NCT04708041) assessed extended-interval 2-dose regimens of 9vHPV vaccine among adolescents (10 to 15 years) who received 2 9vHPV vaccine doses: the first ≥1 year before enrollment, and second, at enrollment (day 1). We measured serologic responses to vaccine-targeted human papillomavirus (HPV) types at enrollment day 1 (pre-dose 2) and 1 month post-dose 2 (month 1) using a competitive LuminexV® immunoassay. We estimated effects of dose interval on geometric mean titers (GMTs) using regression modeling. Participants reported adverse events (AEs) through 15 days after vaccination. RESULTS We enrolled 146 adolescents (mean age 13.3 years) with median 25 months since first 9vHPV vaccine dose (range: 12-53 months). Across vaccine-targeted HPV types, GMTs increased from day 1 to month 1; seropositivity at month 1 was 100%. Anti-HPV GMTs at month 1 were not affected by differences in dose interval of 12 to 53 months, based on regression modeling. The most common AEs were mild-to-moderate injection site reactions; no serious AEs were reported. CONCLUSIONS Extending the interval between first and second 9vHPV vaccine doses to 12 to 53 months did not affect antibody responses, with favorable safety profile. These results support feasibility of extended interval regimens for 9vHPV vaccine.
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | - Amy Wiesner
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
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2
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Adebola A, Charis E, Tristan N, Melinda I. Content validation of a Facebook HPV vaccination promotion intervention (#HPVvaxtalks) created for young Black adults (18-26 years old). Public Health Nurs 2024. [PMID: 38923608 DOI: 10.1111/phn.13356] [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: 08/23/2023] [Revised: 04/12/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Despite the expansion in human papillomavirus (HPV) vaccination recommendations, vaccine uptake and completion remain low among Black individuals. An 8-week Facebook intervention (#HPVvaxtalks) was developed to increase knowledge and awareness of HPV risk factors, risk perceptions, and vaccination intention and uptake. This article details the formative phase of experts' feedback and participants' satisfaction on the components of the #HPVvaxtalks for content useability, acceptability, relevance, and visual appeal to inform further refinements. METHOD A convenience sample of 5 experts and 13 young Black adults were invited to provide feedback on #HPVvaxtalks intervention content. The experts reviewed and provided feedback via a survey and open-ended questions. After incorporating suggestions from experts' feedback, 13 participants viewed #HPVvaxtalks posts, took part in a virtual focus group, and completed a survey. Qualitative data were thematically analyzed and integrated with survey results. RESULTS Experts and participants mean age were 41.9 ± 2.3 and 21.2 ± 1.9 years, respectively. Experts and participants reported positive ratings for intervention posts, including useability, acceptability, relevance, and visual appeal. Data provided areas for improvements of #HPVvaxtalks. CONCLUSION: Experts indicated strong content validity and participants showed satisfaction with #HPVvaxtalks content. Ensuring acceptability, relevance, and appeal of the intervention for the target population is an integral part of intervention development.
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Affiliation(s)
- Adegboyega Adebola
- Department of Nursing, University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Ebikwo Charis
- Department of Nursing, University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Ntego Tristan
- Department of Nursing, University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Ickes Melinda
- Department of Kinesiology and Health Promotion, College of Education, University of Kentucky, Lexington, Kentucky, USA
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3
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Wheldon CW, Eaton LA, Watson RJ. Predisposing, Enabling, and Need-Related Factors Associated with Human Papillomavirus Vaccination Intentions and Uptake Among Black and Hispanic Sexual and Gender Diverse Adults in the USA. J Racial Ethn Health Disparities 2023; 10:237-243. [PMID: 34981465 PMCID: PMC8722661 DOI: 10.1007/s40615-021-01214-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
The purpose of the current study was to identify predisposing, enabling, and need-based factors associated with human papillomavirus (HPV) or HPV vaccination intentions among ethnoracial minority men who have sex with men (MSM) and gender expansive natal males. This was a secondary analysis of survey data from 299 Black and Hispanic MSM and gender expansive young (aged 18-30 years) adults living in the USA. Variable selection was informed by Anderson's model of healthcare utilization. Outcomes were self-reported HPV vaccination and vaccine intentions. Less than half of the sample (45.5%) reported initiating (i.e., receiving at least 1 dose) HPV vaccination. Hierarchical multiple regression was used to identify relevant theoretical predictors. Among those who were unvaccinated, 14.2% were unlikely, 56.3% were undecided, and 29.4% likely to initiate HPV vaccination within the next 12 months. More favorable vaccine attitudes (adjusted prevalence ratio [aPR] = 1.55; 95% CI: 1.12-2.15), past year routine check-up (aPR = 1.50; 95% CI: 1.14-1.97), and ever being diagnosed with anogenital warts (aPR = 1.55; 95% CI: 1.12-2.15) were independently associated with the probability of HPV vaccination. Several enabling factors (e.g., testing for sexually transmitted infections) were not associated with HPV vaccination, suggesting routine missed opportunities. There were no associations between predictor variables and HPV vaccine intentions. Targeted efforts are needed to decrease anal cancer disparities experienced by ethnoracial minority MSM. Leveraging enabling factors already present this population (e.g., STI testing and pre-exposure prophylaxis use) are potential targets for interventions to increase the reach of HPV vaccination.
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Affiliation(s)
- Christopher W. Wheldon
- grid.264727.20000 0001 2248 3398Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA USA
| | - Lisa A. Eaton
- grid.63054.340000 0001 0860 4915Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT USA
| | - Ryan J. Watson
- grid.63054.340000 0001 0860 4915Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT USA
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4
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Casey SM, Jansen E, Drainoni ML, Schuch TJ, Leschly KS, Perkins RB. Long-Term Multilevel Intervention Impact on Human Papillomavirus Vaccination Rates Spanning the COVID-19 Pandemic. J Low Genit Tract Dis 2022; 26:13-19. [PMID: 34928249 DOI: 10.1097/lgt.0000000000000648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the long-term sustainability of a multilevel intervention and the COVID-19 pandemic impact on adolescent human papillomavirus (HPV) vaccination coverage. MATERIALS AND METHODS In 2016, a pediatric and family medicine practice within a federally qualified health center completed a multilevel intervention, Development of Systems and Education for Human Papillomavirus Vaccination. We examined the intervention impact on HPV vaccine initiation and completion rates among adolescents 10-18 years between March 2016 and October 2020. We determined the total number of HPV vaccine doses administered monthly. Data were plotted on statistical process control charts. RESULTS Vaccine initiation increased from an average of 14% to an average of 42% for 10-year-old patients and from an average of 72% to an average of 92% for 11- to 12-year-old patients between March 2016 and January 2017 and remained stable through March 2020. Complete vaccination by age 13 years increased from 62% to 88% through October 2020. CONCLUSIONS This intervention led to continued improvement for on-time HPV vaccination coverage 4 years after intervention completion.Clinical Trial Registration: This trial has been registered at http://www.clinicaltrials.gov (identifier NCT02812732).
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Affiliation(s)
- Sharon M Casey
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - Emily Jansen
- Continuing Medical Education Office, Boston University School of Medicine, Boston, MA
| | | | | | | | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA
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5
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Vu M, Bednarczyk RA, Escoffery C, Ta D, Huynh VN, Berg CJ. U.S. Vietnamese parents' HPV vaccine decision-making for their adolescents: an exploration of practice-, provider-, and patient-level influences. J Behav Med 2021; 45:197-210. [PMID: 34792723 PMCID: PMC8600911 DOI: 10.1007/s10865-021-00265-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022]
Abstract
U.S. Vietnamese have high cervical cancer incidence and low human papillomavirus (HPV) vaccine initiation. Using the P3 model, we explored practice-, provider-, and patient-level determinants of U.S. Vietnamese parents’ HPV vaccine decision-making for their adolescents. We conducted a cross-sectional, online survey (04/2020–12/2020) with U.S. Vietnamese parents who had ≥ 1 adolescent ages 9–18. We assessed HPV vaccination outcomes (initiation, willingness to initiate, completion) and provider recommendation. Modified Poisson regressions were used to identify practice-, provider- and patient-level correlates of outcomes. The sample (n = 408) was 44 years old on average; 83% were female and 85% had a Bachelor’s degree. Around half of adolescents were female (51%) and 13–18 year old (54%). Only 41 and 23% of parents had initiated and completed the HPV vaccine series for their child, respectively. Initiation was associated with receiving provider recommendation (either low- or high-quality), while willingness to initiate was associated with receiving high-quality recommendation. Both initiation and willingness to initiate was negatively associated with parental perception that their child was too young for a “sexually transmitted infection (STI)-preventing vaccine.” Provider recommendation was associated with higher parental U.S. acculturation and the child being older and female. Provider-facing interventions should promote high-quality, age-based, gender-neutral HPV vaccine recommendation. These and population- and individual-facing interventions should recognize the need for additional parental education, particularly related to misconceptions regarding STI prevention.
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Affiliation(s)
- Milkie Vu
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Danny Ta
- Neil Hodgson Woodruff School of Nursing, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Victoria N Huynh
- Emory College of Arts and Sciences, Emory University, Atlanta, GA, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, DC, USA.,George Washington Cancer Center, George Washington University, Washington, DC, USA
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6
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Acampora A, Grossi A, Barbara A, Colamesta V, Causio FA, Calabrò GE, Boccia S, de Waure C. Increasing HPV Vaccination Uptake among Adolescents: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7997. [PMID: 33143171 PMCID: PMC7663345 DOI: 10.3390/ijerph17217997] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/02/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Human Papillomavirus (HPV) vaccination is a well-known fundamental strategy in the prevention of cervical cancer, as it is always caused by HPV infection. In fact, primary prevention of the infection corresponds to primary prevention of HPV-related cancers and other diseases. Since an effective prevention at the population level is the final goal, it is mandatory for healthcare systems to achieve a high HPV vaccination coverage among the adolescents to reduce the circulation of the virus and the burden of HPV-related diseases. This research identified, through a systematic literature review, 38 papers on strategies adopted to increase HPV vaccination coverage among adolescents. The evaluated strategies targeted adolescents/parents and/or healthcare providers and could be grouped in three main types: (1) reminder-based, (2) education, information, and communication activities, and (3) multicomponent strategies. Several types of strategy, such as those relied only on reminders and integrating different interventions, showed a positive impact on vaccination coverage. Nonetheless, the heterogeneity of the interventions suggests the importance to adapt such strategies to the specific national/local contexts to maximize vaccination coverage.
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Affiliation(s)
- Anna Acampora
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Adriano Grossi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Andrea Barbara
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Vittoria Colamesta
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
- Unità Operativa Complessa Direzione Sanitaria S. Spirito e Nuovo Regina Margherita, Local Health Unit ASL RM1, 00193 Rome, Italy
| | - Francesco Andrea Causio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.A.); (A.G.); (A.B.); (V.C.); (F.A.C.); (S.B.)
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Chiara de Waure
- Department of Experimental Medicine, University of Perugia, 06132 Perugia, Italy;
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7
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Rand CM, Concannon C, Wallace-Brodeur R, Davis W, Albertin CS, Humiston SG, Szilagyi PG. Identifying Strategies to Reduce Missed Opportunities for HPV Vaccination in Primary Care: A Qualitative Study of Positive Deviants. Clin Pediatr (Phila) 2020; 59:1058-1068. [PMID: 32597722 DOI: 10.1177/0009922820930357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were to assess the contextual factors, practice strategies, and sustainability of interventions implemented during a national quality improvement (QI) project to raise human papillomavirus (HPV) vaccination rates. We conducted semistructured interviews with positive deviant practices that successfully reduced missed opportunities by ≥20% for HPV vaccination in the prior year. We assessed leadership support, motivators, interventions used, and sustainability. Key themes related to QI teams included strong leadership support, multidisciplinary teams, having a practice champion, and a collaborative environment. Themes related to the interventions included using a presumptive bundled recommendation for all appropriate vaccines at age 11, previsit planning, and reminders for preventive visits, which were sustainable for most practices 1-year postintervention. Both internal practice-level factors (multidisciplinary teams, collaboration, and previsit planning) and organizational factors (institutional support and health system-level reminders for preventive visits) were key to a successful QI intervention to improve HPV vaccination.
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Affiliation(s)
- Cynthia M Rand
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Wendy Davis
- University of Vermont Medical Center, Burlington, VT, USA
| | | | | | - Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, CA, USA
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8
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Berenson AB, Hirth JM, Kuo YF, Starkey JM, Rupp RE. Use of patient navigators to increase HPV vaccination rates in a pediatric clinical population. Prev Med Rep 2020; 20:101194. [PMID: 32963935 PMCID: PMC7490555 DOI: 10.1016/j.pmedr.2020.101194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 11/01/2022] Open
Abstract
A patient navigator (PN) program was implemented in pediatric clinics to increase uptake of the human papillomavirus (HPV) vaccine. The purpose of this study is to examine the impact of this program. All visits between April 1, 2013 and December 31, 2017 for 9-17 year old patients at 3 program and 5 non-program clinics were examined using electronic medical records. These dates included patient visits before and after program initiation (February 1, 2015). Visits including 1 dose of the HPV vaccine were assessed as a proportion of total visits for each month. Multivariable binary logistic regression was used to examine the odds of HPV vaccination across time, between program and non-program clinics, and age group. A total of 128,051 visits by 21,395 patients were examined. HPV vaccines were administered during 12,742 visits (10.0%). Odds of HPV vaccination during visits by 13-17 year olds was greater than during visits by 9-12 year olds in the pre-intervention period (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04-1.19). However, this association changed during the intervention period, with odds of HPV vaccination among visits by 13-17 year olds lower compared to visits by 9-12 year olds (OR: 0.78, 95% CI: 0.75-0.82). The odds of HPV vaccination were elevated among 9-12 year olds in program clinics as compared to 2014, the year before the program was implemented. Having on-site PNs can increase the frequency of HPV vaccination in pediatric clinics, particularly among patients 9-12 years of age.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Yong-Fang Kuo
- Preventive Medicine & Population Health, Office of Biostatistics and Epidemiology, University of Texas Medical Branch, USA
| | - Jonathan M Starkey
- Preventive Medicine & Population Health, Institute for Translational Sciences, Center for Interdisciplinary Research on Women's Health, University of Texas Medical Branch, USA
| | - Richard E Rupp
- Department of Pediatrics, University of Texas Medical Branch, USA
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9
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Dang JHT, Stewart SL, Blumberg DA, Rodriguez HP, Chen MS. "There's Always Next Year": Primary Care Team and Parent Perspectives on the Human Papillomavirus Vaccine. Hum Vaccin Immunother 2020; 16:1814-1823. [PMID: 32048896 DOI: 10.1080/21645515.2019.1710410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Acceptance of the human papillomavirus (HPV) vaccination among parents and clinicians is high, but uptake remains low. Little is known about organizational and primary care team factors that influence the uptake of the HPV vaccine. Interviews with clinicians, clinic support staff, and parents of adolescent patients were conducted to better understand the interrelationships among the people and the organizational processes that influence HPV vaccine uptake at the point of care. Between July 2016 and February 2017, semi-structured interviews of 40 participants (18 clinicians, 12 clinic support staff, and 10 parents of adolescent patients) in a primary care network were conducted. Organizational structures and processes, such as electronic provider reminders, availability of "vaccination only" appointments, and knowledgeable primary care team members contributed to HPV vaccine uptake. Consistently high support of HPV vaccination was found among key informants; however, rather than refuse HPV vaccination, parents are opting to delay vaccination to a future visit. When parents express the desire to delay, clinicians and care team members described often recommending addressing HPV vaccination at a future visit, giving parents the impression that receiving the vaccine was not time-sensitive for their child. Discordance in HPV vaccination recommendations among providers and clinic support staff may contribute to delayed HPV vaccination. Strong, high-quality HPV vaccine recommendations are needed from all primary team members. Clinic interventions to accelerate HPV vaccine uptake may benefit from a team-based approach where every member of the primary care team is delivering the same consistent messaging about the importance of timely HPV vaccination.
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Affiliation(s)
- Julie H T Dang
- Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
| | - Susan L Stewart
- Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, University of California , Sacramento, CA, USA
| | - Dean A Blumberg
- Davis Health Department of Pediatrics, University of California , Sacramento, CA, USA
| | - Hector P Rodriguez
- Berkeley, School of Public Health, Division of Health Policy and Management, University of California , Berkeley, CA, USA
| | - Moon S Chen
- Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
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10
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Italian Health Care Workers' Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Infection and Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155278. [PMID: 32707867 PMCID: PMC7432815 DOI: 10.3390/ijerph17155278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023]
Abstract
Objective: To assess healthcare workers’ knowledge and attitudes about human papillomavirus (HPV) infection, related diseases, and prevention. Methods: A cross-sectional multicenter survey about HPV and its prevention, targeted to healthcare workers involved in HPV vaccine counseling, was performed from May 2017 to December 2018. Results: The overall median knowledge and attitude scores were 69.2% (25–75, p = 61.5–84.6) and 5 (25–75, p = 4–5), respectively. Both knowledge and attitudes statistically significantly differ between physicians and healthcare professions. The median propensity score before and after the educational intervention was stable and high, at 10 (25–75, p = 9–10). The predictors of statistically significantly high knowledge scores are to be a physician, general practitioner, or pediatrician, attending courses/congresses, and consulting technical product characteristics and scientific literature to obtain information about the HPV vaccine. Being a physician and consulting scientific literature to obtain information about the HPV vaccine were found also as predictors of statistically significantly different attitude scores among study participants. Conclusions: Although healthcare workers showed overall positive attitudes towards the relevance of HPV burden and prevention tools, demonstrated knowledge was largely suboptimal, particularly that shown by healthcare professions. Obtained results allow highlighting knowledge gaps, and thus improving counselling to HPV vaccine targets.
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11
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Perkins RB, Legler A, Jansen E, Bernstein J, Pierre-Joseph N, Eun TJ, Biancarelli DL, Schuch TJ, Leschly K, Fenton ATHR, Adams WG, Clark JA, Drainoni ML, Hanchate A. Improving HPV Vaccination Rates: A Stepped-Wedge Randomized Trial. Pediatrics 2020; 146:peds.2019-2737. [PMID: 32540986 DOI: 10.1542/peds.2019-2737] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a stepped-wedge randomized trial of Development of Systems and Education for Human Papillomavirus Vaccination (DOSE HPV), a multilevel intervention. METHODS DOSE HPV is a 7-session program that includes interprofessional provider education, communication training, data feedback, and tailored systems change. Five primary care pediatric and/or family medicine practices completed interventions between 2016 and 2018; all chose to initiate vaccination at ages 9 to 10. We compared vaccination rates in the preintervention, intervention, and postintervention periods among 9- to 17-year-olds using random-effects generalized linear regression models appropriate for stepped-wedge design, accounting for calendar time and clustering of patients by providers and clinic. Outcomes included (1) the likelihood that eligible patients would receive vaccination during clinic visits; (2) the likelihood that adolescents would complete the series by age 13; and (3) the cumulative effect on population-level vaccine initiation and completion rates. Postintervention periods ranged from 6 to 18 months. RESULTS In the intervention and postintervention periods, the adjusted likelihood of vaccination at an eligible visit increased by >10 percentage points for ages 9 to 10 and 11 to 12, and completion of the vaccine series by age 13 increased by 4 percentage points (P < .001 for all comparisons). Population-level vaccine initiation coverage increased from 75% (preintervention) to 84% (intervention) to 90% (postintervention), and completion increased from 60% (preintervention) to 63% (intervention) to 69% (postintervention). CONCLUSIONS Multilevel interventions that include provider education, data feedback, tailored systems changes, and early initiation of the human papillomavirus vaccine series may improve vaccine series initiation and completion beyond the conclusion of the intervention period.
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Affiliation(s)
| | - Aaron Legler
- Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | | | - Judith Bernstein
- Department of Health Law, Policy and Management, School of Public Health
| | - Natalie Pierre-Joseph
- Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | - Terresa J Eun
- Department of Sociology, Stanford University, Stanford, California
| | - Dea L Biancarelli
- Department of Health Law, Policy and Management, School of Public Health
| | | | - Karin Leschly
- East Boston Neighborhood Health Center, Boston, Massachusetts; and
| | - Anny T H R Fenton
- Center for Outcomes, Research, and Evaluation, Maine Medical Center Research Institute, Portland, Maine
| | - William G Adams
- Pediatrics and Adolescent Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | - Jack A Clark
- Department of Health Law, Policy and Management, School of Public Health
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, School of Public Health.,Evans Center for Implementation and Improvement Sciences.,Sections of Infectious Diseases and
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12
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Pfaff N, Garnett C, Mihalek AJ, Mamey MR, Wu S. Pediatric Resident Attitudes Toward Inpatient Immunization of Children and Adolescents: Highlighting Differences in Human Papillomavirus Vaccination. Glob Pediatr Health 2019; 6:2333794X19894123. [PMID: 31840039 PMCID: PMC6900615 DOI: 10.1177/2333794x19894123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022] Open
Abstract
Over a decade after its debut, human papillomavirus (HPV) vaccine coverage
remains suboptimal. The inpatient setting presents a largely unexplored
opportunity to increase vaccination rates. This study aims to describe pediatric
resident attitudes toward inpatient immunization and compare differences by
vaccine, in particular HPV. An anonymous survey of beliefs and practices
regarding inpatient vaccines was distributed to pediatric resident physicians at
a single freestanding urban children’s hospital in September 2017. A total of 58
surveys were collected (64% response rate). We found that pediatric residents
were more likely to report that they never or rarely discuss the HPV vaccine
during hospitalization compared with the primary childhood series
(P = .001), Tdap (P = .02), and the
influenza vaccine (P < .001), and rarely offer the HPV
vaccine during hospitalization compared with childhood vaccines
(P = .003) and influenza (P = .001). This
suggests that provider hesitancy still exists for the HPV vaccine, presenting
opportunities for further education and inpatient interventions.
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Affiliation(s)
- Nora Pfaff
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Mary Rose Mamey
- Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Susan Wu
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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13
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Todd C, Brody-Camp S, Friedlander P. The Role of Otolaryngologists in Eradicating Human Papillomavirus. JAMA Otolaryngol Head Neck Surg 2019; 144:553-554. [PMID: 29799930 DOI: 10.1001/jamaoto.2018.0495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cameron Todd
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sabrina Brody-Camp
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Paul Friedlander
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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14
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McGaffey A, Lombardo NP, Lamberton N, Klatt P, Siegel J, Middleton DB, Hughes K, Susick M, Lin CJ, Nowalk MP. A "Sense"-ational HPV Vaccination Quality Improvement Project in a Family Medicine Residency Practice. J Natl Med Assoc 2019; 111:588-599. [PMID: 31285042 DOI: 10.1016/j.jnma.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination uptake for adolescents and young adults in the United States remains far from national goals. Using a multi-component intervention aligned with community-wide efforts, we implemented a quality improvement project to increase HPV vaccinations among 9-26 year-old male and female patients in an urban, low income, minority population family medicine residency practice. METHODS The pre-intervention year was November 2, 2014 to October 31, 2015 and the intervention year was November 1, 2015 to October 31, 2016. Based on community input and published literature, the interventions were creative, practice-specific provider-, patient-, and system-level strategies. To compare pre- and post-intervention vaccinations, HPV vaccination data were extracted from an electronic medical record request for age-eligible patients seen in the practice during the intervention year. Chi-square, McNemar's and 2-tailed, 2-sample Z tests were used to test differences in vaccination initiation (≥1 dose) and completion (3 doses) across groups and over time. RESULTS Despite high pre-intervention rates (58% and 75%), HPV vaccine initiation significantly increased 12.8 percentage points (PP) for males and 10.6 PP for females from pre- to post-intervention (P < 0.001). HPV vaccine completion also significantly increased 16 PP for males and 10.9 PP for females (P < 0.001). Young adult patients (18-26 years-old) had significant increases in completion rates (9.9 PP; P < 0.001), not observed among adolescents (20 PP; ns). CONCLUSIONS Consistent and abundant positive HPV vaccination messaging, low-cost sensory rewards, process change, and community, clinician, and nonclinical staff engagement were associated with higher HPV vaccine initiation and completion, especially among young adults.
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Affiliation(s)
- Ann McGaffey
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA.
| | - Nicole Payette Lombardo
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA
| | - Nathan Lamberton
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA
| | - Patricia Klatt
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA
| | - Jason Siegel
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and Bloomfield Garfield Family Health Center, Pittsburgh, PA, USA
| | - Donald B Middleton
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency and University of Pittsburgh School of Medicine, Department of Family Medicine, Pittsburgh, PA, USA
| | - Kristin Hughes
- Carnegie Mellon University, School of Design, Pittsburgh, PA, USA
| | - Michael Susick
- University of Pittsburgh School of Medicine, Department of Family Medicine, Pittsburgh, PA, USA
| | - Chyongchiou Jeng Lin
- University of Pittsburgh School of Medicine, Department of Family Medicine, Pittsburgh, PA, USA
| | - Mary Patricia Nowalk
- University of Pittsburgh School of Medicine, Department of Family Medicine, Pittsburgh, PA, USA
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15
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Berger MH, Haidar YM, Bitner B, Trent M, Tjoa T. Practice patterns and knowledge among California pediatricians regarding human papillomavirus and its relation to head and neck cancer. Am J Otolaryngol 2019; 40:525-529. [PMID: 31064672 DOI: 10.1016/j.amjoto.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify practice patterns regarding human papillomavirus (HPV) vaccination efforts and vaccination rates in context of head and neck cancer prevention, identify barriers to vaccination, and identify gaps in knowledge regarding the link between HPV and head and neck cancer in the pediatrician population. STUDY DESIGN/METHODS A 27-question cross-sectional survey was distributed to members of the four California chapters of the American Academy of Pediatrics. RESULTS Of the completed responses, 89.4% identified as "always" recommending the HPV vaccine to patients, but only 19.5% of pediatricians estimated that >75% of their eligible patients had completed the HPV vaccination series. 71.5% of respondents felt that further education about HPV's link to head and neck cancer them more comfortable discussing vaccination. Physicians who were in practice longer were less likely to respond that additional education about HPV and its link to head and neck cancer would make them more comfortable discussing vaccination with patients (p = 0.043). Physicians who were in practice longer were more likely to correctly respond that HPV type 16 is the most common strain linked to head and neck cancer (p = 0.021). CONCLUSION There is need to improve both the knowledge base and comfort level of pediatricians in counseling their patients during vaccine recommendations. Otolaryngologists have a critical role in providing education to physicians, trainees, and the general public in the effort to combat the epidemic of HPV-associated head and neck cancer.
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16
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Adamu AA, Uthman OA, Wambiya EO, Gadanya MA, Wiysonge CS. Application of quality improvement approaches in health-care settings to reduce missed opportunities for childhood vaccination: a scoping review. Hum Vaccin Immunother 2019; 15:2650-2659. [PMID: 30945976 DOI: 10.1080/21645515.2019.1600988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Missed opportunities for vaccination (MOV) is a poor reflection of the quality of care for children attending health facilities. It also contributes to a reduction in overall immunization coverage. Although there is a growing interest in the use of quality improvement (QI) in complex health systems to improve health outcomes, the degree to which this approach has been used to address MOV is poorly understood. We conducted a scoping review using Arksey and O'Malley's framework to investigate the extent to which QI has been used in health facilities to reduce MOV. The review followed five stages as follows: (1) identifying the research question; (2) identifying the relevant studies; (3) selecting the studies; (4) charting data; and (5) collating, summarizing, and reporting results. The search strategy included electronic databases and gray literature. A total of 12 literatures on QI projects focused on addressing MOV were identified. Eleven were published manuscripts, and one was a conference presentation. All the QI projects published were conducted in the United States and majority were between 2014 and 2018. In these projects, 45 change ideas targeting providers, clients, and health system were used. This study generated important evidence on the use of QI in health facilities to reduce MOV. In addition, the result suggests that there is a growing interest in the use of this approach to address MOV in recent years. However, no literature was found in low- and middle-income countries especially sub-Saharan Africa.
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Affiliation(s)
- Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Olalekan A Uthman
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Elvis O Wambiya
- Education and Youth Empowerment Unit, African Population and Health Research Centre, Nairobi, Kenya
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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17
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Berenson AB, Rupp R, Dinehart EE, Cofie LE, Kuo YF, Hirth JM. Achieving high HPV vaccine completion rates in a pediatric clinic population. Hum Vaccin Immunother 2018; 15:1562-1569. [PMID: 30299220 DOI: 10.1080/21645515.2018.1533778] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: To evaluate the efficacy of an intervention utilizing patient navigators (PNs) to 1) educate families on human papillomavirus (HPV) vaccination in a clinic setting and 2) provide personalized reminders for follow-up. Method: Families with 9-17 year-old children who had no record of completing the HPV vaccination series receiving primary or specialty care in 3 pediatric clinics were approached by PNs between February 1, 2015 and August 31, 2016. Demographic characteristics, visit type, preferred contact method, rates and correlates of completion, and appointments missed were analyzed. In addition, qualitative interviews of 21 providers and PNs assessed their perceptions of the program. Results: 1,391 adolescents were identified out of 2,162 patients approached as unvaccinated or partially vaccinated prior starters; among the unvaccinated, 930 received the 1st dose after being counseled by the PN (66.9%), either immediately or at a follow-up visit soon thereafter. This included 118 siblings of patients who did not have an appointment that day. Of initiators approached between 2/1/2015 and 8/31/2016, 93% (864/930) completed the series by 8/31/2017. No differences in series completion among initiators were observed by gender or race/ethnicity, but older patients (15-17 years old) were less likely to complete than 11-12 year olds. Of the 688 patients identified as prior starters, 85% completed the series through the program. Qualitative interviews demonstrated that providers felt the program addressed major barriers to HPV vaccination. Conclusion: Employing PNs dramatically increased HPV vaccine series completion among boys and girls with historically low HPV vaccination rates at pediatric clinics in Texas. Clinic providers felt this program addressed many barriers they observed prior to program implementation. This approach could markedly improve HPV vaccine series completion rates in the US.
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Affiliation(s)
- Abbey B Berenson
- a Obstetrics & Gynecology, University of Texas Medical Branch , Galveston , TX , USA
| | - Richard Rupp
- a Obstetrics & Gynecology, University of Texas Medical Branch , Galveston , TX , USA
| | - Erin E Dinehart
- a Obstetrics & Gynecology, University of Texas Medical Branch , Galveston , TX , USA.,b Obstetrics & Gynecology, George Washington University , Washington , DC , USA
| | - Leslie E Cofie
- a Obstetrics & Gynecology, University of Texas Medical Branch , Galveston , TX , USA.,c Department of Health Education and Promotion, faculty at East Carolina University , Geenville, NC, USA
| | | | - Jacqueline M Hirth
- a Obstetrics & Gynecology, University of Texas Medical Branch , Galveston , TX , USA
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18
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Perez S, Zimet GD, Tatar O, Stupiansky NW, Fisher WA, Rosberger Z. Human Papillomavirus Vaccines: Successes and Future Challenges. Drugs 2018; 78:1385-1396. [DOI: 10.1007/s40265-018-0975-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Apaydin KZ, Fontenot HB, Shtasel DL, Mayer KH, Keuroghlian AS. Primary Care Provider Practices and Perceptions Regarding HPV Vaccination and Anal Cancer Screening at a Boston Community Health Center. J Community Health 2018; 43:792-801. [PMID: 29480339 PMCID: PMC6033675 DOI: 10.1007/s10900-018-0486-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Human papillomavirus (HPV) vaccination and anal cancer screening are valuable, yet underutilized, tools in prevention of HPV-related cancers among sexual and gender minority (SGM) populations. The aim of this study was to characterize primary care providers' (PCPs) practices and perceptions pertaining to HPV vaccination and anal cancer screening. A survey assessing self-reported practice characteristics related to HPV vaccination and anal cancer screening, as well as perceived barriers to vaccination and anal cancer screening at the patient-, provider-, and system-level was distributed to PCPs at a Federally-Qualified Health Center that specializes in care for SGM populations in the greater Boston area. A total of 33 PCPs completed the survey. All PCPs strongly recommended HPV vaccination to their patients by emphasizing that the vaccine is extremely important or very important. Most PCPs told their patients that the HPV vaccine prevents cervical cancer (96.9%), anal cancer (96.9%), oropharyngeal cancer (72.7%), penile cancer (57.5%), and genital warts (63.6%). There is substantial variability among providers regarding recommendations for anal cancer screening and follow-up. Most PCPs perceived that patient-level factors such as poverty, mental illness, and substance use disorders were barriers to HPV vaccination and anal cancer screening. Systems-level barriers such as lack of clinical time with each patient and lack of staffing were also described as barriers to vaccination and screening. Patient-, provider- and systems-level improvements are important to increase HPV vaccination and anal cancer screening rates.
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Affiliation(s)
- Kaan Z Apaydin
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Holly B Fontenot
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- W.F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Derri L Shtasel
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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20
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Apaydin KZ, Fontenot HB, Shtasel D, Dale SK, Borba CPC, Lathan CS, Panther L, Mayer KH, Keuroghlian AS. Facilitators of and barriers to HPV vaccination among sexual and gender minority patients at a Boston community health center. Vaccine 2018; 36:3868-3875. [PMID: 29778516 DOI: 10.1016/j.vaccine.2018.02.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Young sexual minority individuals have lower human papillomavirus (HPV) vaccine completion rates than the general population, and little is known about how gender minority people perceive HPV vaccination. The aim of this study was to qualitatively identify patient-, provider-, and systems-level barriers and facilitators for HPV vaccination among sexual and gender minority (SGM) people. METHODS Fifteen SGM-identified individuals, ages 23-26, were recruited at an urban community health center in Boston, MA, that specializes in care for SGM. Participants were enrolled in a study that utilized surveys and in-person focus groups. During focus groups, participants were asked to describe their perceived barriers and facilitators for completion of HPV vaccination. RESULTS Fourteen participants reported having a sexual minority identity, and five participants reported having a gender minority identity. Participants described the following factors influencing HPV vaccination: (1) at the patient level, low HPV-related knowledge and lack of engagement in care were associated with less vaccination, whereas fear of HPV-related disease motivated vaccination; (2) at the provider level, knowledge and SGM cultural-competence related to HPV was associated with patient willingness to be vaccinated; (3) at the systems level, SGM identity-affirming healthcare settings were associated with increased vaccination, whereas historical trends in HPV vaccine marketing selectively for cisgender women and lack of public awareness of HPV-related disease among SGM were associated with decreased vaccincation. CONCLUSION Our study identified internal and external barriers for HPV vaccination related among SGM patients. These findings highlight the need to increase public awareness about the risks of HPV-related disease among SGM and educate SGM youth about HPV-related disease and vaccine importance. Finally, this study supports the need for future interventions to cultivate SGM-competent providers and SGM identity-affirming healthcare settings as a way to increase HPV vaccination.
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Affiliation(s)
| | | | - Derri Shtasel
- Harvard Medical School and Massachusetts General Hospital, United States
| | - Sannisha K Dale
- University of Miami and Massachusetts General Hospital, United States
| | - Christina P C Borba
- Boston University School of Medicine and Boston Medical Center, United States
| | | | | | - Kenneth H Mayer
- The Fenway Institute, Beth Israel Deaconess Medical Center, United States
| | - Alex S Keuroghlian
- The Fenway Institute, Harvard Medical School, and Massachusetts General Hospital, United States.
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21
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Proposal for cervical cancer screening in the era of HPV vaccination. Obstet Gynecol Sci 2018; 61:298-308. [PMID: 29780771 PMCID: PMC5956112 DOI: 10.5468/ogs.2018.61.3.298] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/19/2017] [Accepted: 10/20/2017] [Indexed: 01/23/2023] Open
Abstract
Eradication of cervical cancer involves the expansion of human papillomavirus (HPV) vaccine coverage and the development of efficient screening guidelines that take vaccination into account. In Korea, the HPV National Immunization Program was launched in 2016 and is expected to shift the prevalence of HPV genotypes in the country, among other effects. The experiences of another countries that implement national immunization programs should be applied to Korea. If HPV vaccines spread nationwide with broader coverage, after a few decades, cervical intraepithelial lesions or invasive cancer should become a rare disease, leading to a predictable decrease in the positive predictive value of cervical screening cytology. HPV testing is the primary screening tool for cervical cancer and has replaced traditional cytology-based guidelines. The current screening strategy in Korea does not differentiate women who have received complete vaccination from those who are unvaccinated. However, in the post-vaccination era, newly revised policies will be needed. We also discuss on how to increase the vaccination rate in adolescence.
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