Achieving high HPV vaccine completion rates in a pediatric clinic population

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.

Knowledge, Attitudes and Perceptions of Immigrant Parents Towards Human Papillomavirus (HPV) Vaccination: A Systematic Review

“…Parents of children who needed ≥1 dose were offered personal counselling and given handouts in English or Spanish on HPV vaccine. Following such counselling about 67% parents got their children vaccinated either immediately or at a follow-up visit soon thereafter, indicating that providing counselling in a clinic setting can improve vaccination acceptance [51].…”

Caregiver acceptance of a patient navigation program to increase human papillomavirus vaccination in pediatric clinics: a qualitative program evaluation

“…Program details have been published elsewhere. 13 In 2015, the University of Texas Medical Branch implemented a multi-component intervention utilizing patient navigators (PNs) in pediatric clinics in Southeast Texas through a grant from the Cancer Prevention Research Institute of Texas. The program has previously been described in detail.…”

“…The program has previously been described in detail. 13 Briefly, PNs approached caregivers of unvaccinated patients 9-17 years of age who were attending participating clinics and counseled them about the HPV vaccine. Children whose caregivers agreed to vaccination were given one dose, if possible that day.…”

“…It has been stated that multi-component programs addressing multiple barriers to vaccination are necessary to achieve high uptake and completion rates for the HPV vaccine series. 12 This evaluation focuses on a program 13 that utilized patient navigators (PNs) to: (1) present educational materials about the HPV vaccine to the caregivers of pediatric patients attending pediatric clinics administered by the University of Texas Medical Branch (UTMB), (2) provide strong recommendations for the vaccine by providers, (3) schedule follow-up visits for additional HPV vaccine doses, and (4) ensure patients receive reminders or are rescheduled for missed appointments to improve completion of the HPV vaccine series. Programs developed to reduce barriers to HPV vaccine series completion should be assessed qualitatively to better understand problems that patients continue to encounter.…”

There’s Much Yet to be Done: Diverse Perspectives on HPV Vaccination

“…Eight articles in this special issue focus on pre-interventional and interventional research to improve vaccine initiation and series completion, including a review of technology-based interventions (e.g., text messaging and electronic health record reminders) designed to improve vaccination rates. 25 Three papers involve evaluations of a patient navigator program, 26 a quality improvement intervention, 27 and a tablet-based tailored messaging intervention, 28 respectively, in terms of their effects on vaccine initiation and series completion. An additional article reports on the acceptability to caregivers of the patient navigator program.…”