Can School-Located Vaccination Have a Major Impact on Human Papillomavirus Vaccination Rates in the United States?

Kempe, Allison; Allison, Mandy A.; Daley, Matthew F.

doi:10.1016/j.acap.2017.08.010

Cited by 22 publications

(21 citation statements)

References 36 publications

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“…School-based vaccination has been effective in other countries. However, it is currently limited in the US due to reimbursement issues and limited availability of school-based health centers, two critical drivers of HPV vaccination rates [23].…”

Section: Introductionmentioning

confidence: 99%

Exploring attitudes of adolescents and caregivers towards community-based delivery of the HPV vaccine: a qualitative study

et al. 2020

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Background Human Papillomavirus (HPV) vaccination among adolescents is an important strategy to prevent cervical and other cancers in adulthood. However, uptake remains far below the Healthy People 2020 targets for the US. Given the barriers to population-level vaccination policies and challenges to incorporating additional action items during clinical visits, we sought to explore alternative delivery mechanisms, specifically delivery of the vaccine in community settings. Methods We conducted six focus groups (three with adolescents aged 11–14 who had not received the HPV vaccine and three with caregivers of adolescents meeting those criteria) from Black, Latino, and Brazilian communities in Massachusetts. We utilized a framework analysis approach that involved a multi-stage coding process employing both prefigured and emergent codes. Initial interpretations were refined through consultation with an advisory board. Results Adolescents and caregivers expressed a range of concerns about the HPV vaccine and also described interest in learning more about the vaccine, emphasizing the importance of a relationship with a trusted provider as a facilitator of vaccine acceptance. Regarding community-based delivery of the vaccine, reactions were mainly negative. However, adolescents and caregivers noted that receiving information in community settings that could seed a conversation with a trusted provider would be welcome. Interestingly, the notion of a trusted provider seemed to extend broadly to practitioners linked to the trusted main provider. Conclusions The study highlights an opportunity for increasing HPV vaccination among some racial and ethnic minority populations by leveraging trusted community organizations to provide information and seed conversations with a potentially broad group of trusted providers. A task-shifting approach, or reliance on staff with fewer formal credentials, may offer opportunities to support vaccination in resource-constrained settings.

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Section: Introductionmentioning

confidence: 99%

Exploring attitudes of adolescents and caregivers towards community-based delivery of the HPV vaccine: a qualitative study

et al. 2020

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“…In theory, schools could play a role in raising influenza vaccination rates by overcoming these 2 barriers—avoiding the need for additional visits to primary care practices for vaccination and providing reminders and education about the value of influenza vaccination. We tested both a low‐intensity and high‐intensity strategy that schools could use.…”

mentioning

confidence: 99%

School‐Located Influenza Vaccination: Do Vaccine Clinics at School Raise Vaccination Rates?

Szilâgyi¹,

Schaffer

Rand

et al. 2019

Journal of School Health

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BACKGROUND: Only half of US schoolchildren receive influenza vaccine. School-located influenza vaccination (SLIV) might raise vaccination rates but conducting flu vaccine clinics at schools is challenging to implement. We compared 2 school-based programs designed to raise influenza vaccination rates: parent reminder/educational messages sent to parents from schools which is a low-intensity intervention vs the combination of reminder/educational messages plus SLIV clinics which is a high-intensity intervention. METHODS:We assigned 36 schools (6 school districts, 2 per group) to 3 groups: (1) control, ie, no SLIV and no parent reminder/education, (2) parent reminder/education emailed by schools, and (3) parent reminder/education plus SLIV clinics. Some schools had SLIV clinics in prior years. Health department nurses conducted SLIV clinics. RESULTS:Among 24,832 children at 36 schools, vaccination rates were control (51.3%), parent reminder/education-only (41.2%), and reminder/education + SLIV (58.7%). On multivariate analyses which controlled for vaccination in prior seasons, children in reminder/education + SLIV schools had higher vaccination rates (OR 1.27, 95% CI 1.10-1.47), but children in reminder/education-only schools had lower rates (OR 0.87, 95% CI 0.75-1.00) than children in control schools. CONCLUSIONS:Parent reminder/education combined with SLIV clinics raise vaccination rates, but parent reminder/education alone does not.

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“…In US school-located vaccination models, parents provide consent for their children to be vaccinated by trained community vaccinators at school. 38,39 Because school-located health clinics are uncommon in the United States, we consider the model of holding mass vaccination days, which would potentially reach those ages 11 to 13 who attend a public school (87%). 40 The costs for schoollocated vaccination include time and resources to create information materials, obtain permission from parents, schedule the event, administer the vaccination, and process insurance claims for privately insured adolescents.…”

Section: School-located Vaccinationmentioning

confidence: 99%

Cost-effectiveness of Interventions to Increase HPV Vaccine Uptake

et al. 2020

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OBJECTIVES: We sought to prioritize interventions for increasing human papillomavirus (HPV) vaccination coverage based on cost-effectiveness from a US state perspective to inform decisions by policy makers. METHODS: We developed a dynamic simulation model of HPV transmission and progression scaled to a medium-sized US state (5 million individuals). We modeled outcomes over 50 years comparing no intervention to a one-year implementation of centralized reminder and recall for HPV vaccination, school-located HPV vaccination, or quality improvement (QI) visits to primary care clinics. We used probabilistic sensitivity analysis to assess a range of plausible outcomes associated with each intervention. Cost-effectiveness was evaluated relative to a conservative willingness-to-pay threshold; $50 000 per quality-adjusted life-year (QALY) . RESULTS: All interventions were cost-effective, relative to no intervention. QI visits had the lowest cost and cost per QALY gained ($1538 versus no intervention). Statewide implementation of centralized reminder and recall cost $28 289 per QALY gained versus QI visits. School-located vaccination had the highest cost but was cost-effective at $18 337 per QALY gained versus QI visits. Scaling to the US population, interventions could avert 3000 to 14 000 future HPV cancers. When varying intervention cost and impact over feasible ranges, interventions were typically preferred to no intervention, but cost-effectiveness varied between intervention strategies. CONCLUSIONS: Three interventions for increasing HPV vaccine coverage were cost-effective and offered substantial health benefits. Policy makers seeking to increase HPV vaccination should, at minimum, dedicate additional funding for QI visits, which are consistently effective at low cost and may additionally consider more resource-intensive interventions (reminder and recall or school-located vaccination).

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Can School-Located Vaccination Have a Major Impact on Human Papillomavirus Vaccination Rates in the United States?

Cited by 22 publications

References 36 publications

Exploring attitudes of adolescents and caregivers towards community-based delivery of the HPV vaccine: a qualitative study

Exploring attitudes of adolescents and caregivers towards community-based delivery of the HPV vaccine: a qualitative study

School‐Located Influenza Vaccination: Do Vaccine Clinics at School Raise Vaccination Rates?

Cost-effectiveness of Interventions to Increase HPV Vaccine Uptake

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