Human Papillomavirus Vaccine Uptake: Increase for American Indian Adolescents, 2013–2015

  • Jasmine L. Jacobs-Wingo
    Address correspondence to: Jasmine L. Jacobs-Wingo, MPH, 42-09 28th St., Long Island City NY 11101
    Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Cheyenne C. Jim
    IHRC, Inc., Atlanta, Georgia

    Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Amy V. Groom
    Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

    Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, Maryland
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Published:February 28, 2017DOI:


      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.


      I/T/U healthcare facilities located within five Indian Health Service regions.


      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.


      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.


      A tailored multifaceted approach addressing vaccine delivery processes and patient and provider education may increase HPV vaccine coverage.
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