Identification of potential missed opportunities for human papillomavirus (HPV) vaccination in women referred to an academic colposcopy clinic for evaluation of abnormal cervical cytology

Abstract

Objective: To identify possible predictors of missed opportunities for human papillomavirus (HPV) counseling and vaccination prior to presentation at an academic colposcopy clinic. Materials and Methods: We examined the characteristics of 638 vaccinated and 1,024 unvaccinated age-eligible patients using data from a patient registry of women presenting for colposcopic evaluation between 2/26/2007 and 3/10/2014 who were aged 26 or less at presentation. Demographics, smoking history, pregnancy history, sexually transmitted infections (STIs), sexual history, contraception use, immunosuppression, and medical problems were compared between HPV vaccinated and unvaccinated women. Multivariable logistic regression models included age, race, language, marital status, insurance type, lifetime number of sexual partners, other medical illnesses, number of pregnancies, contraception use, history of STIs, and smoking history to determine predictors of HPV vaccination. Results: In multivariable analysis, race, marital status, and language were not significantly associated with HPV vaccination. Women with fewer pregnancies were more likely to be vaccinated (p-trend <0 .0001). Vaccinated women were more likely to have other medical illnesses (ORD1.44, 95% CID1.13-1.83) and be aware of their HPV status (ORD1.75, 95% CID 1.40-2.18). Conclusions: In this study, greater number of pregnancies was associated with lower vaccination rates as compared to women who had never been pregnant. Reproductive health visits, such as postpartum and family planning visits, represent an ideal opportunity to educate women about HPV and the importance of vaccination, and should be an area of focus to improve current HPV vaccination rates.

HPV knowledge, vaccine knowledge, and vaccine acceptance in women with cervical cytology anomalies attending colposcopy clinics in Puerto Rico

“…However, both of these populations lacked the knowledge that HPV is the most common sexually transmitted infection in the USA . No association was recorded with gravidity, which contrasts with the association previously reported by Dorton et al . Although most of the participants at the approved ages of vaccination had not been vaccinated, the present results show that only a minority of unvaccinated woman were unwilling to get vaccinated.…”

“…Higher income and education are factors that correlate with HPV knowledge, and increased knowledge about HPV correlates with more vaccine acceptance . In one study, vaccination rates were found to be inversely associated with the number of pregnancies …”

“…4 In one study, vaccination rates were found to be inversely associated with the number of pregnancies. 5 Infection with HPV is directly related to genital warts and to cervical, vulvar, vaginal, oropharyngeal, anal, and penile premalignant and malignant conditions. 6 Three HPV vaccines are available in the USA to prevent HPV infection and the associated morbidity and mortality.…”

Evaluating the impact of multilevel evidence-based implementation strategies to enhance provider recommendation on human papillomavirus vaccination rates among an empaneled primary care patient population: a study protocol for a stepped-wedge cluster randomized trial

“…Yet, even when such visits occur, patients eligible for a dose of HPV vaccine often do not receive it. These missed opportunities occur without regard to race/ethnicity and spoken language in the USA [ 17 , 18 ].…”