Improving HPV vaccine delivery at school-based health centers

Abstract

Objective: To identify characteristics associated with human papillomavirus (HPV) vaccination rates, describe barriers and facilitators to vaccine uptake and the potential role for clinician-to-clinician Assessment, Feedback, Incentives, and eXchange (AFIX) visits in school-based health centers (SBHCs). Methods: We conducted clinician-to-clinician AFIX visits at 24 New York City (NYC) high-school and middle-school SBHCs with up-to-date adolescent vaccination rates below 40%. Using NYC's immunization information system, we assessed HPV initiation and series completion rates at the time of AFIX visit and follow-up three to five months later. We analyzed responses to a questionnaire and summarized interviews to identify barriers and facilitators to HPV immunization practices and quality improvement (QI) implementation. Results: Baseline initiation and completion rates were 76% and 43% for high schools, and 81% and 45% for middle schools. SBHCs that allowed adolescent self-consent or did not require separate vaccine consent had higher baseline rates, but was not statistically significant. Barriers to series completion included challenges with scheduling and appointment compliance. At follow-up, high school SBHCs increased HPV vaccine initiation by 2.9 percentage points (p < 0.01) and series completion by 2.7 percentage points (p < 0.05). There was no statistically significant increase at middle school SBHCs. Most SBHCs (88%) chose reminder/recall systems as a QI strategy. Fewer than half (42%) implemented their QI strategy. Conclusions: We identified barriers to HPV vaccine series completion at our sample of SBHCs. Clinicianto-clinician AFIX visits may help improve vaccination rates and encourage providers to address barriers, including streamlining consent processes for HPV vaccination. Abbreviations: School-based health (SBH); quality improvement (QI)

Impact of COVID-19 on cervical cancer screening: Challenges and opportunities to improving resilience and reduce disparities

“…While higher rates of HPV vaccine initiation were found among adolescents living below the federal poverty level, adolescents living outside of Metropolitan Areas ( Walker et al, 2019 ), and in the Southern U.S. have lower HPV vaccination rates ( Centers for Disease Control and Prevention, 2020b ). While school-based vaccination programs could address some of these disparities, only few schools have health centers that may provide vaccination and children attending schools with vaccination programs have vaccination rates similar to the general population ( Oliver et al, 2019 ).…”

Recommended Interventions to Improve Human Papillomavirus Vaccination Uptake among Adolescents: A Review of Quality Improvement Methodologies

“…From the papers included in this review, improving the knowledge and communication skills of healthcare providers (HCP) through education sessions was the most common QI initiative undertaken to empower the HCPs, and subsequently boost the HPV vaccination rate in healthcare settings [ 1 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. The topics covered during these sessions encompassed the global and national burden of HPV-related diseases, an updated HPV vaccination schedule, and ways to successfully communicate with parents and adolescents about the HPV vaccine.…”

Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates

“… 44 Strengthening the schools and SBHCs’ capacity to provide HPV vaccine administration and education through their expanded role during the pandemic and improving appointment compliance in SBHCs could be key for improving uptake among medically underserved adolescents. 45 , 46 …”