Introduction
Although Indian Health Service, tribally-operated, and urban Indian (I/T/U) healthcare
facilities have higher human papillomavirus (HPV) vaccine series initiation and completion
rates among adolescent patients aged 13–17 years than the general U.S. population,
challenges remain. I/T/U facilities have lower coverage for HPV vaccine first dose
compared with coverage for other adolescent vaccines, and HPV vaccine series completion
rates are lower than initiation rates. Researchers aimed to assist I/T/U facilities
in identifying interventions to increase HPV vaccination series initiation and completion
rates.
Study design
Best practice and intervention I/T/U healthcare facilities were identified based on
baseline adolescent HPV vaccine coverage data. Healthcare professionals were interviewed
about barriers and facilitators to HPV vaccination. Researchers used responses and
evidence-based practices to identify and assist facilities in implementing interventions
to increase adolescent HPV vaccine series initiation and completion. Coverage and
interview data were collected from June 2013 to June 2015; data were analyzed in 2015.
Setting/participants
I/T/U healthcare facilities located within five Indian Health Service regions.
Intervention
Interventions included analyzing and providing feedback on facility vaccine coverage
data, educating providers about HPV vaccine, expanding access to HPV vaccine, and
establishing or expanding reminder recall and education efforts.
Main outcome measures
Impact of evidence-based strategies and best practices to support HPV vaccination.
Results
Mean baseline first dose coverage with HPV vaccine at best practice facilities was
78% compared with 46% at intervention facilities. Mean third dose coverage was 48%
at best practice facilities versus 19% at intervention facilities. Intervention facilities
implemented multiple low-cost, evidence-based strategies and best practices to increase
vaccine coverage. At baseline, most facilities used electronic provider reminders,
had standing orders in place for administering HPV vaccine, and administered tetanus,
diphtheria, and acellular pertussis and HPV vaccines during the same visit. At intervention
sites, mean coverage for HPV initiation and completion increased by 24% and 22%, respectively.
Conclusions
A tailored multifaceted approach addressing vaccine delivery processes and patient
and provider education may increase HPV vaccine coverage.
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Article info
Publication history
Published online: February 28, 2017
Identification
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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
