Researchers seek best ways to increase HPV vaccination rates

Tennessee has one of the lowest human papillomavirus (HPV) vaccination rates in the nation, and investigators at Vanderbilt University Medical Center (VUMC) hope to change this by improving the way medical providers present these vaccines to patients and by improving patient and patient family education.

“HPV is the most commonly sexually transmitted infection in the United States, with an estimated four out of five adults infected with the virus during their lifetime,” said Pamela Hull, PhD, a medical sociologist with the Vanderbilt Epidemiology Center. “Many infections are asymptomatic and resolve without long-term consequences; however, infection with some types of HPV can cause cancer, including cancers of the cervix, vagina, vulva, penis, anus, rectum and of the head and neck.”

Last year, Hull received a five-year $2.7 million grant from the National Cancer Institute aimed at increasing HPV vaccinations at community-based pediatric practices. She is working in partnership with the Cumberland Pediatric Foundation (CPF), a nonprofit organization that supports scientific, charitable and educational efforts to improve children’s healthcare services.

An HPV vaccine was first licensed in the United States for females in 2006 and for males beginning in 2009. It’s recommended for ages 11 or 12 years, and through age 26 for those who have not been previously vaccinated. Initially, the HPV vaccine was given in a three-dose series, but in 2016, the Centers for Disease Control and Prevention (CDC) recommended a revised two-dose schedule for those under age 15.

The CDC’s 2014 National Immunization Survey-Teen showed Tennessee ranked poorly in HPV vaccination rates for both males and females, ages 13–17. Tennessee’s rate of adolescents beginning the vaccine series was approximately 30.5 percent in males and 47.8 in females, with only about 14 percent of males and 20 percent of females completing the vaccine series.

Improving the HPV vaccination rate has been a focus of the CPF for several years, said CPF Executive Director Lora Harnack, MSN, RN, and the organization has teamed with VUMC and other organizations in efforts to do so, including community-based educational events and quality improvement initiatives with CPF member practices. CPF currently has 77 community-based pediatric practice locations in its membership.

“Pediatricians want to take the best possible care of their patients,” said Harnack. “In having conversations with them, we learned that a lot of physicians perceived that they were doing a lot better than they were, in terms of getting these vaccinations completed.”

The grant is helping fund a quality improvement project at 22 CPF-affiliated pediatric practices in Tennessee, in which two methods of coaching are tested for their efficacy in increasing vaccination rates.

One method used is a nurse educator who travels to 11 of the pediatric offices to conduct a needs assessment and train staff on how the HPV vaccine should be presented to patients and their families. The second method provides a web-based version of this service to the remaining 11 participating clinics. The clinics’ HPV vaccination rates will be measured at the study’s completion.

The clinics also provide patient education materials (get3shots.org) that were developed in a previous study under the Meharry Medical College, Vanderbilt-Ingram Cancer Center and Tennessee State University (TSU) Cancer Partnership led by Hull; Maureen Sanderson, MPH, PhD (Meharry); and Elizabeth Williams, PhD (TSU); in collaboration with a Community Advisory Board.

“The challenge is how to get doctors and primary care clinics to consistently make strong recommendations for HPV vaccinations and that those recommendations occur at the appropriate ages,” Hull said.

– by Jill Clendening