Assessing the need for and acceptability of a free-of-charge postpartum HPV vaccination program

Berenson, Abbey B.; Male, Eneida; Lee, Toy G.; Barrett, Alan D.T.; Sarpong, Kwabena; Rupp, Richard; Rahman, Mahbubur

doi:10.1016/j.ajog.2013.11.036

Cited by 10 publications

(19 citation statements)

References 23 publications

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“…At our institution, only 13% among 500 pregnant patients seen in public clinics in 2012 had initiated the HPV vaccine. 12 These low rates may be due to a lack of routine care among low-income adolescents and young adult women. 13 Most US women do obtain medical care during pregnancy, 14 but the HPV vaccine is not usually discussed during prenatal care as it is not administered during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

A human papillomavirus vaccination program for low-income postpartum women

Berenson

Rahman

Hirth

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Effective interventions are needed to address the low rate of human papillomavirus vaccination in the United States, particularly among girls and women 16 – 26 years old. Counseling and offering the vaccine to postpartum patients could be an effective strategy to increase uptake among young women who did not complete the 3-dose series at an earlier age. Objective The purpose of this evaluation was to assess the effectiveness of a multi-component program designed for postpartum women that used patient navigators and reminders for follow-up visits to improve uptake and completion of the human papillomavirus vaccine series. Design As part of standard care, patients ≤26 years of age from Galveston County, Texas who delivered an infant between November 2012 and June 2014 at a public hospital were counseled and offered the human papillomavirus vaccine postpartum. Patient navigators assisted with scheduling follow-up injections during postpartum or well-child visits. A program evaluation was conducted after 20 months. Results Of 1,038 patients approached, only 161 (15.5%) had previously completed the vaccine series. Of the 877 patients who had not completed the series, 661 (75.4%) received at least one dose postpartum, with 575 patients receiving their first dose and 86 receiving their second or third doses. By April 2015, initiation rates had increased as a result of this program from 25.4% before the program was initiated to 80.8% and completion rates from 15.5% to 65.1%. Missed appointments for injections were less likely among those who received text message reminders and more likely among those with ≥2 prior pregnancies. Those who were Hispanic or had received an influenza vaccination in the last year were more likely to initiate and complete the series through this program. Patients who missed 1 or more follow-up appointments were less likely to complete the vaccine series. Conclusions Offering the human papillomavirus vaccine postpartum dramatically increased initiation rates among postpartum patients. Patient navigation and text messages ensured that a high percentage completed all 3 doses.

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Section: Introductionmentioning

confidence: 99%

A human papillomavirus vaccination program for low-income postpartum women

Berenson

Rahman

Hirth

et al. 2016

American Journal of Obstetrics and Gynecology

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“…Also, programs such as Vaccine for Children may have contributed to the relatively higher vaccination coverage that is seen in low-income groups. Other studies have found that Hispanic women have low levels of HPV knowledge and HPV vaccine awareness and low HPV vaccination rates compared to non-Hispanic women in the US [15, 18–20]. Meanwhile, data from the US 2010 National Health Interview Survey show that non-Hispanic whites, English-speaking parents, individuals born in the US, and individuals from relatively higher income families were more likely to be aware of the HPV vaccine [21].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with HPV Vaccine Awareness in a Population-Based Sample of Hispanic Women in Puerto Rico

Romaguera

Caballero-Varona

Tortolero‐Luna

et al. 2015

J. Racial and Ethnic Health Disparities

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Objectives To investigate the factors associated with HPV awareness among women aged 16 to 64 years, among underserved minority Hispanic women living in Puerto Rico. Methods A population-based, cross-sectional sample of 566 women, ages 16 to 64 years, living in the San Juan metropolitan area were surveyed regarding sexual behavior, HPV knowledge and HPV vaccine uptake. Data was analyzed using descriptive statistics and multivariate logistic regression. Results Overall, 64.8% of the women in the sample had heard about the HPV vaccine. Among those in the recommended catch-up vaccination age range (16 – 26 years, n = 86), 4.7% had received at least 1 dose of the HPV vaccine. Of those aware of the availability of the HPV vaccine, most had learned about it through the media, whereas, only 39.6% had learned about it from a physician. Multivariate logistic regression analysis showed that HPV awareness (OR: 8.6; 95% CI: 5.0–14.8) and having had an abnormal Pap smear (OR: 2.0; 95% CI: 1.2–3.4) were associated with HPV vaccine awareness (p<0.05). Conclusion HPV vaccine awareness among Hispanic women in the San Juan metropolitan area of Puerto Rico continues to be low. Strong recommendations from physicians and participation in HPV vaccine educational efforts are essential if the rate of HPV vaccination is to increase in the targeted population. Compared to the US, and to their US Hispanic counterparts, a health disparity with regard to HPV vaccine awareness and coverage is evident in Puerto Rico; targeted action to deal with this disparity is urgently needed.

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“…Provider recommendation for HPV vaccination is associated with increased vaccination 7,12 and prior research suggests that women find it acceptable to be offered and receive the HPV vaccine postpartum. 15,16 For any pregnant woman who has not received the vaccine before pregnancy, administration postpartum should be recommended and offered.…”

Section: Discussionmentioning

confidence: 99%

“…For women who have not previously received the HPV vaccine, the postpartum period may present an opportunity to vaccinate. Two studies have shown that women find it acceptable to be offered the HPV vaccine postpartum 15,16 and the majority of those who are interested (95%) initiate the vaccine. 16 The extent to which eligible women are initiating HPV vaccination postpartum is unknown.…”

mentioning

confidence: 99%

“…2 In the United States, the rates of HPV vaccine initiation and completion are low. The Advisory Committee on Immunization Practices (ACIP) recommends vaccination of adolescents age 11-12 with a catch up period for females during the ages of [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. 3 Despite recommendations, in a 2013 nationwide survey of 2077 women aged 19-26 years of age, only 37% reported previously receiving at least one HPV vaccine.…”

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confidence: 99%

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Low Uptake of Human Papillomavirus Vaccine Among Postpartum Women, 2006–2012

Kilfoyle

Rahangdale

Dusetzina

2016

Journal of Women's Health

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Background: Young adult women find it acceptable to be offered the human papillomavirus (HPV) vaccine postpartum. Little is known about the practice of administering the HPV vaccine during the postpartum period. Materials and Methods: The Truven Health Analytics MarketScan Commercial Claims and Encounters database was used to develop a cohort of privately insured 18 to 26-year-old women with uncomplicated live-born pregnancies. Eligibility required no previous doses of HPV vaccine before delivery and continuous insurance enrollment from June 2006 through 1 year postpartum. Descriptive statistics were performed. Results: A total of 51,913 women meet age and enrollment criteria, with 3912 (7.5%) having received any doses of vaccine before their delivery, leaving 48,001 women in this cohort. In the year postpartum, 861 women (1.8%) received any HPV vaccine. Of the women initiating the vaccine, only 337 (39%) completed the threevaccine series. Women who received the vaccine, compared with women who did not, were younger (21 vs. 23 years old), more often the dependent to the insurance beneficiary (56% vs. 30%), and were more likely to have had an abnormal pap smear in the year prior (19.6% vs. 9.1%) or postdelivery (16.4% vs. 4.9). More women completed the HPV vaccine series when initiated within 2 months postpartum compared with women initiating the vaccine series >2 months postpartum (44% vs. 38%). Conclusions: Postpartum women are eligible for the HPV vaccine, yet very few are receiving it. The postpartum period is a missed opportunity for administration of this cancer-preventing vaccine.

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Assessing the need for and acceptability of a free-of-charge postpartum HPV vaccination program

Cited by 10 publications

References 23 publications

A human papillomavirus vaccination program for low-income postpartum women

A human papillomavirus vaccination program for low-income postpartum women

Factors Associated with HPV Vaccine Awareness in a Population-Based Sample of Hispanic Women in Puerto Rico

Low Uptake of Human Papillomavirus Vaccine Among Postpartum Women, 2006–2012

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