Predictors of Three Dose On-Time Compliance with HPV4 Vaccination in a Disadvantaged, Underserved, Safety Net Population in the US Midwest

Abstract

BackgroundHPV4 is approved as a series of three timed doses expected to result in efficacy against specific HPV infections. Completion rates in the US are quite low at the same time the structure of health care delivery is changing. The aim of this study was to determine how the patient-, clinic- and systems-level characteristics facilitate or hinder the timely completion of three HPV4 doses in both adolescent and adult female populations in a high-risk safety net population.MethodsThis is a retrospective study in which patient-, clinic- and systems-level data are abstracted from the electronic medical record (EMR) for all females 10–26 years of age receiving at least one dose of HPV4 between July 1, 2006 and October 1, 2009.ResultsAdults were more likely to complete the three dose series if they had at least one health care visit in addition to their HPV4 visit, (aOR = 1.54 (95% CI:1.10, 2.15). Adults were less likely to complete the three dose series if they received their second HPV4 dose at an acute health care, preventive care or postpartum visits compared to an HPV4-only visit (aOR = 0.31 (95% CI: 0.13, 0.72), 0.12 (0.04, 0.35), 0.30 (0.14, 0.62), respectively). Hispanic adults were less likely than whites to complete the series (aOR = 0.24 (95% CI:0.10, 0.59). 39% of adolescents who completed two doses completed the series.ConclusionsHPV4 is more likely to be effectively administered to adults in a safety net population if multiple health care needs can be met within the health care system.

Quantifying Clinical HPV4 Dose Inefficiencies in a Safety Net Population

“…Although there have been millions of doses of HPV4 sold every year [38], [39], our study and others [6], [8]–[25], show that 66% of the doses are administered in an inefficient manner, making the HPV4 vaccination program unlikely to realize a measurable benefit especially in populations most at-risk, such as our safety net system. Of the inefficiencies, “less than three doses” was more common than inappropriate timing of doses.…”

“…Only female recipients 10–26 years old were targeted for vaccination. Prior research identified age, race, and parity as positive predictors of on-time three dose completion [6], and hence these person descriptors were included in this study.…”

“…Mistimed doses were classified as in previous publications as a dose given too early or too late from the prior dose [6]. The early intervals were defined as less than 4 weeks between dose 1 and dose 2; less than 12 weeks between dose 2 and dose 3; or less than 24 weeks between dose 1 and dose 3.…”

“…The early intervals were defined as less than 4 weeks between dose 1 and dose 2; less than 12 weeks between dose 2 and dose 3; or less than 24 weeks between dose 1 and dose 3. Late intervals were defined as more than 26 weeks between dose 1 and dose 2; or more than 52 weeks between dose 1 and dose 3 [6], [26]–[28], [33], [34]. Up to two mistimed doses could be recorded for each woman initiating vaccination.…”

Impact of school-entry and education mandates by states on HPV vaccination coverage: Analysis of the 2009–2013 National Immunization Survey-Teen

“…We adjusted results for covariates known to correlate with vaccination coverage: child's and parent's age, race, parent's education level, household income, parent's marital status, parent's primary language, receipt of vaccine in a private or public health facility, insurance status, number of medical visits in the past year, and provider recommendation. [41][42][43] Because HPV vaccination coverage changed over time, we considered each year separately as well as pooling data from all years together. Random effects logistic regression models were used to estimate adjusted HPV vaccination coverage rates adjusting for these covariates, year, and the systematic unobserved variation arising from clustering of observations at the state level.…”