Recommending Human Papillomavirus Vaccination at Age 9: A National Survey of Primary Care Professionals

Huang, Qian; Thompson, Peyton; Grabert, Brigid K; Brewer, Noel T.; Gilkey, Melissa B.

doi:10.1016/j.acap.2022.01.008

Cited by 16 publications

(13 citation statements)

References 23 publications

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“…Primary health care providers are now being encouraged to recommend the vaccine as early as 9 years of age to increase likelihood of “on time” vaccination. 55 Similar to our findings, Kong et al 56 found that over two-thirds of the providers in a national sample were willing to or recommended the vaccine at ages nine and ten years. Lack of clear clinic protocols to address HPV parental vaccine hesitancy has been found to influence provider advocacy for the vaccine, 57 and could reflect the varying strategies applied by providers in our study.…”

Section: Discussionsupporting

confidence: 87%

Healthcare providers’ practice protocols, strategies, and needed tools to address parental HPV vaccine hesitancy: An exploratory study

Cunningham-Erves

Hull

Wilkins

et al. 2022

Human Vaccines & Immunotherapeutics

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Parental hesitancy related to human papillomavirus (HPV) vaccines has increased during the pandemic, and there is a call to action by the National HPV Vaccination Roundtable to improve vaccination rates. While there are evidence-based strategies available to address parental hesitancy, there are few clear guidelines on how to engage parents to build confidence in the HPV vaccine within the clinical settings. The purpose of this investigation is to explore practice protocols, individual provider strategies, and perceived tools needed to address HPV vaccine hesitant parents from the perspective of providers during the COVID-19 pandemic in the United States. Fifteen healthcare providers participated in qualitative, semi-structured interviews between May 2021 and March 2022. An inductive, qualitative content analysis approach was used to analyze the data. Five themes were described: 1) Provider experiences engaging with HPV vaccine hesitant parents; 2) Existing protocols in the clinics to address HPV vaccine hesitant parents; 3) Strategies used by providers to address parental HPV vaccine hesitancy; 4) Sample message content used by providers to address parental HPV vaccine concerns; and 5) Perceived strategies and tools needed to address parental vaccine hesitancy. Recommendations to address parental hesitancy include recommending HPV vaccinationat 9 years, using a strong recommendation and continued discussion, applying evidence-based approaches and/or promising strategies, linking parents to credible outside sources, and ongoing follow-up if delayed or declined. These findings can be used by researchers and clinicians to improve strategies and messages to inform the development of a protocol to standardize encounters and communication for patient-parent-provider encounters that can influence parental decision-making around HPV vaccine uptake.

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Section: Discussionsupporting

confidence: 87%

Healthcare providers’ practice protocols, strategies, and needed tools to address parental HPV vaccine hesitancy: An exploratory study

Cunningham-Erves

Hull

Wilkins

et al. 2022

Human Vaccines & Immunotherapeutics

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“… 17 , 19 , 20 Several studies of physician attitudes to proactive initiation of HPV vaccination have concluded that additional provider education may be needed to encourage timely uptake of HPV vaccines among the target age group. 21 , 24 , 25 , 42 , 48 A recent survey indicated that willingness to recommend proactive HPV vaccination series initiation may be lower among pediatricians than among family medicine practitioners, and also among providers with ≥20 years of practice experience compared to those with ≤9 years of experience. 42 It has also been reported that adolescents from racial/ethnic minorities are less likely than White adolescents to complete an HPV vaccination series and to receive an HPV vaccination recommendation from a physician; encouraging universal provider recommendations may thus also help to mitigate some of the systemic barriers to HPV vaccination faced by racial and ethnic minorities.…”

Section: Discussionmentioning

confidence: 99%

“… 21 , 24 , 25 , 42 , 48 A recent survey indicated that willingness to recommend proactive HPV vaccination series initiation may be lower among pediatricians than among family medicine practitioners, and also among providers with ≥20 years of practice experience compared to those with ≤9 years of experience. 42 It has also been reported that adolescents from racial/ethnic minorities are less likely than White adolescents to complete an HPV vaccination series and to receive an HPV vaccination recommendation from a physician; encouraging universal provider recommendations may thus also help to mitigate some of the systemic barriers to HPV vaccination faced by racial and ethnic minorities. 49 Examples of interventions that successfully encouraged physicians to recommend proactive HPV vaccination series initiation have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…41 Around one-fifth of respondents to a 2021 provider survey indicated that they are already following the updated AAP guidelines and routinely recommend vaccination at 9–10 years of age. 42 In a previously published analysis, vaccination initiation at 9–10 years of age and series completion by 13 years of age were both associated with female gender, race or ethnicity, and government insurance. 43 …”

Section: Introductionmentioning

confidence: 90%

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HPV vaccine initiation at 9 or 10 years of age and better series completion by age 13 among privately and publicly insured children in the US

Saxena

Kathe²,

Sardana³

et al. 2023

Human Vaccines & Immunotherapeutics

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The US Advisory Committee on Immunization Practice recommends routine human papillomavirus (HPV) vaccination at 11–12 years of age, but states that vaccination may be initiated as early as 9 years. Our primary goal was to assess whether initiating HPV vaccination at 9–10 years of age, compared to 11–12, was associated with a higher rate of series completion by 13 years of age, and to identify factors associated with series completion by age 13. The study used vaccine claims and other data from the IBM MarketScan Commercial Claims and Encounters (privately insured) and IBM MarketScan Multi-State Medicaid (publicly insured) databases. Participants were 9–12 years of age and initiated HPV vaccination between January 2006 and December 2018 (publicly insured) or February 2019 (privately insured). Among 100,117 privately insured individuals, those initiating the HPV vaccination series at 9–10 years of age had a significantly higher series completion rate by 13 years of age than did those initiating at 11–12 years of age (76.2% versus 48.1%; p < .001). The same pattern was observed for 115,863 publicly insured individuals (70.4% versus 40.0%; p < .001). Provider and health care plan type, female sex, race/ethnicity, and wellness checks or non-HPV vaccinations during the baseline period were significantly associated with series completion by 13 years of age. Proactive initiation of HPV vaccination at 9–10 years of age was associated with higher rates of series completion by 13 years of age. These findings can inform provider education and other interventions to encourage timely HPV vaccination series completion.

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“…In a recent national survey, only 21% of primary care professionals reported that they routinely recommend HPV-9 at ages 9-10; however, 61% reported being willing to start recommending earlier, with no differences in willingness between urban and rural providers. 14 Thus, an earlier HPV-9 strategy could possibly be feasible in rural settings where provider willingness is high.…”

mentioning

confidence: 99%

Acceptability and readiness to promote human papillomavirus vaccination at ages 9-10 years: A pilot study among rural North Carolina clinics

Vielot

Lane

Loefstedt

et al. 2023

Preprint

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While 9-valent human papillomavirus vaccination (HPV-9) is approved by the U.S. Food and Drug Administration for use in adolescents as young as age 9, providers typically recommend it at ages 11–12 per Centers for Disease Control and Prevention recommendations. Studies suggest that recommending HPV-9 at 9 or 10 years of age could increase up-to-date vaccination by age 13, which could benefit rural populations with reduced access to primary health care and lower HPV-9 coverage than urban areas. This pilot study aimed to assess the feasibility of earlier recommendation of HPV-9 in rural clinics. We conducted in-depth interviews with providers and staff from two primary care clinics in central North Carolina, to understand attitudes toward recommending HPV-9 to 9- and 10-year-olds. All interviewees agreed that HPV-9 was important for cancer prevention and should be recommended before the onset of sexual activity, and agreed that HPV-9 could be initiated before age 11 to improve timeliness and completion of the vaccination series. However, opinions were mixed on whether it should be initiated as young as 9-years-old. Two key informants recruited from two urban clinics described their experiences recommending HPV-9 to 9- and 10-year-olds, including a modified vaccination schedule that promotes HPV-9 during routine well-child visits, prior to pubertal onset, and alongside other recommended adolescent vaccines. Earlier recommendation and administration of HPV-9 is possible with minimal changes to current clinical practices and could increase convenience and acceptability of HPV-9 in under-vaccinated settings.

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Recommending Human Papillomavirus Vaccination at Age 9: A National Survey of Primary Care Professionals

Cited by 16 publications

References 23 publications

Healthcare providers’ practice protocols, strategies, and needed tools to address parental HPV vaccine hesitancy: An exploratory study

Healthcare providers’ practice protocols, strategies, and needed tools to address parental HPV vaccine hesitancy: An exploratory study

HPV vaccine initiation at 9 or 10 years of age and better series completion by age 13 among privately and publicly insured children in the US

Acceptability and readiness to promote human papillomavirus vaccination at ages 9-10 years: A pilot study among rural North Carolina clinics

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