Impact of a Multilevel Quality Improvement Intervention Using National Partnerships on Human Papillomavirus Vaccination Rates

Perkins, Rebecca B.; Foley, Shaylen; Hassan, Anna; Jansen, Emily; Preiss, Sandy; Isher-Witt, Jennifer; Fisher‐Borne, Marcie

doi:10.1016/j.acap.2021.05.018

Cited by 13 publications

(12 citation statements)

References 22 publications

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“…Recommendation prior to age 11 has been successfully implemented as part of multi-level interventions in safety net settings, federally qualified health center networks, and large private health systems. 27 , 35 , 36 These data provide additional evidence that initiation of HPV vaccination prior to other adolescent platform vaccines may be a valuable tool to improve on-time HPV vaccine series completion rates. Of note, the lowest HPV vaccine series completion rates were observed when HPV vaccination was initiated after Tdap.…”

Section: Discussionmentioning

confidence: 82%

Optimizing timing of adolescent vaccines: Impact of initiating HPV vaccination before Tdap or meningococcal vaccination on timely completion of the HPV vaccine series

Kajtezovic

Morgan

Fiascone

et al. 2023

Human Vaccines & Immunotherapeutics

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To explore the impact on timely series completion of initiating the HPV vaccine series prior to other vaccines in the adolescent platform (Tdap or meningococcal vacccines), we created a cohort of children aged 9 in 2015 who were continuously enrolled through the age of 13 (2019) from a national administrative database of employee-sponsored insurance in the United States (MarketScan). Logistic regressions were used to predict the odds of HPV vaccine series completion among those who started the series prior to, concurrent with, or after receiving Tdap or meningococcal vaccination. The cohort included 100,857 eligible children. Compared with adolescents who received their HPV and Tdap or HPV and meningococcal vaccinations concurrently, those who received HPV prior to other vaccines had higher completion (aOR = 1.38 for Tdap, aOR 1.62 for meningococcal), while those who received their HPV vaccination after other vaccines had lower odds of HPV vaccine series completion (aOR = 0.68 for Tdap, aOR = 0.62 for meningococcal). Other factors associated with series completion included female sex, residing in an urban (vs. rural) area, residing in the Northeast, and receiving primary care from a pediatrician (vs. family medicine physician). These data indicate that beginning the HPV vaccine series prior to the adolescent platform may improve on-time series completion.

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Section: Discussionmentioning

confidence: 82%

Optimizing timing of adolescent vaccines: Impact of initiating HPV vaccination before Tdap or meningococcal vaccination on timely completion of the HPV vaccine series

Kajtezovic

Morgan

Fiascone

et al. 2023

Human Vaccines & Immunotherapeutics

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“… 45 , 60 , 72 , 73 Studies attribute lower VCR within health-center-based programs to challenges in traveling to the health-center within business hours 45 and having partial reimbursement. 72 , 74 However, a few articles described situations wherein health-center-based programs achieved higher VCR, and this included full funding and having strong cooperation between education representatives, health service personnel, and municipal authorities from the beginning of the program. 47 Strategies shown to increase VCR in HCP-based programs include HPV education for parents and adolescents within schools, 73 increased availability of HPV-related resources in waiting rooms and exam rooms, 42 and HCPs providing strong recommendation for HPV vaccination to their patients.…”

Section: Resultsmentioning

confidence: 99%

“…An SLR published by Bonanni et al 2020 reported that HPV VCR tends to be highest when vaccination is fully funded, 88 , 89 hypothesized to be due to removing barriers to out-of-pocket costs. 72 Ludwikowska et al 73 and Owsianka et al 74 compared funding mechanisms in Poland and reported that HPV vaccination rates were more than 75% with full funding from health authorities, compared to 7.5% with no funding. 73 Lefevere et al reported that in Flanders (Belgium), shift from a strategy consisting of partially funded and non-school-based location to a fully funded and school-based program, not only increased HPV immunization proportions by 0.15 and 0.21 for vaccination initiation and completion, respectively, but also decreased socioeconomic disparity.…”

Section: Resultsmentioning

confidence: 99%

“…This monitoring system is crucial for achieving high VCR, 24 and incorporates records of individuals already vaccinated and those eligible for vaccination. 22–24 – 28–30 – 35 , 36-50 – 74–98 Having a dedicated taskforce comprised of multiple stakeholders to oversee HPV vaccination monitoring has been described as a key component of vaccine monitoring. 22 , 24 , 28 , 35 , 44 , 96 …”

Section: Resultsmentioning

confidence: 99%

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A systematic literature review of human papillomavirus vaccination strategies in delivery systems within national and regional immunization programs

Felsher,

Shumet,

Velicu

et al. 2024

Human Vaccines & Immunotherapeutics

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The uptake of human papillomavirus (HPV) vaccine remains suboptimal despite being a part of routine vaccination within national immunization program(s). This indicates probable challenges with the implementation of HPV immunization program(s) in various countries. The objective of this systematic literature review (SLR) was to identify implementation strategies for HPV vaccination within national and regional immunization programs worldwide with an aim to provide guidance for countries targeting to increase their HPV vaccine coverage rate (VCR). A comprehensive literature search was conducted across Medline and Embase and included articles published between January 2012 and January 2022. Of the 2,549 articles retrieved, 168 met inclusion criteria and were included in the review. Strategies shown to improve HPV vaccination uptake in the reviewed literature include campaigns to increase community awareness and knowledge of HPV, health care provider trainings, integrating HPV vaccination within school settings, coordinated efforts via multi-sectoral partnerships, and vaccination reminder and recall systems. Findings may help national authorities understand key considerations for HPV vaccination when designing and implementing programs aiming to increase HPV VCR in adolescents.

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“…Universal HPV vaccination and access to screening and treatment could eliminate disparities . In the US, clinician-focused multilevel interventions that involved strong consistent recommendations prior to age 11 years increased HPV vaccination rates by more than 20 percentage points in safety net settings of care . Mechanisms to address disparities in screening participation and management of abnormal results were outlined in the President’s Cancer Panel report and included improved communication, facilitating equitable access to screening using community outreach, promoting alternative screening techniques like HPV self-sampling when available, supporting team-based care to support cancer screening and risk assessment, and effectively using clinical decision support to ensure that each patient receives appropriate care .…”

Section: Discussionmentioning

confidence: 99%

Cervical Cancer Screening

Perkins

Wentzensen

Guido

et al. 2023

JAMA

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ImportanceEach year in the US, approximately 100 000 people are treated for cervical precancer, 14 000 people are diagnosed with cervical cancer, and 4000 die of cervical cancer.ObservationsEssentially all cervical cancers worldwide are caused by persistent infections with one of 13 carcinogenic human papillomavirus (HPV) genotypes: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. HPV vaccination at ages 9 through 12 years will likely prevent more than 90% of cervical precancers and cancers. In people with a cervix aged 21 through 65 years, cervical cancer is prevented by screening for and treating cervical precancer, defined as high-grade squamous intraepithelial lesions of the cervix. High-grade lesions can progress to cervical cancer if not treated. Cervicovaginal HPV testing is 90% sensitive for detecting precancer. In the general population, the risk of precancer is less than 0.15% over 5 years following a negative HPV test result. Among people with a positive HPV test result, a combination of HPV genotyping and cervical cytology (Papanicolaou testing) can identify the risk of precancer. For people with current precancer risks of less than 4%, repeat HPV testing is recommended in 1, 3, or 5 years depending on 5-year precancer risk. For people with current precancer risks of 4% through 24%, such as those with low-grade cytology test results (atypical squamous cells of undetermined significance [ASC-US] or low-grade squamous intraepithelial lesion [LSIL]) and a positive HPV test of unknown duration, colposcopy is recommended. For patients with precancer risks of less than 25% (eg, cervical intraepithelial neoplasia grade 1 [CIN1] or histologic LSIL), treatment-related adverse effects, including possible association with preterm labor, can be reduced by repeating colposcopy to monitor for precancer and avoiding excisional treatment. For patients with current precancer risks of 25% through 59% (eg, high-grade cytology results of ASC cannot exclude high-grade lesion [ASC-H] or high-grade squamous intraepithelial lesion [HSIL] with positive HPV test results), management consists of colposcopy with biopsy or excisional treatment. For those with current precancer risks of 60% or more, such as patients with HPV-16–positive HSIL, proceeding directly to excisional treatment is preferred, but performing a colposcopy first to confirm the need for excisional treatment is acceptable. Clinical decision support tools can facilitate correct management.Conclusions and RelevanceApproximately 100 000 people are treated for cervical precancer each year in the US to prevent cervical cancer. People with a cervix should be screened with HPV testing, and if HPV-positive, genotyping and cytology testing should be performed to assess the risk of cervical precancer and determine the need for colposcopy or treatment. HPV vaccination in adolescence will likely prevent more than 90% of cervical precancers and cancers.

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Impact of a Multilevel Quality Improvement Intervention Using National Partnerships on Human Papillomavirus Vaccination Rates

Cited by 13 publications

References 22 publications

Optimizing timing of adolescent vaccines: Impact of initiating HPV vaccination before Tdap or meningococcal vaccination on timely completion of the HPV vaccine series

Optimizing timing of adolescent vaccines: Impact of initiating HPV vaccination before Tdap or meningococcal vaccination on timely completion of the HPV vaccine series

A systematic literature review of human papillomavirus vaccination strategies in delivery systems within national and regional immunization programs

Cervical Cancer Screening

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