EXECUTIVE SUMMARY

Results of a recent study indicate a training intervention to aid provider communication about HPV vaccines with teen patients and their parents increased initiation and completion of the vaccine series.

  • While vaccine for HPV prevention has been available in the United States since 2006 for girls, and 2009 for boys, in 2016, only 60.4% of those ages 13-17 had started the HPV vaccination series, and about 66% who started the series completed it.
  • Research indicates that providers’ recommendations play a crucial role in the acceptance of HPV vaccination by patients and parents of patients. Implementation of the current intervention resulted in a 9.5 percentage point increase in HPV vaccine series initiation compared with control practices, data indicate.

While a vaccine for human papillomavirus (HPV) has been available in the United States since 2006 for girls, and 2009 for boys, in 2016, only 60.4% of those 13-17 years of age had started the HPV vaccination series, and about 66% who started the series completed it.1

Results of a recent study indicate that a training intervention to aid provider communication about HPV vaccines with teen patients and their parents increased initiation and completion of the vaccine series.2

To conduct the cluster randomized clinical trial, researchers focused on 16 Denver, CO, primary care practices, with half implementing a communication training intervention and the other half serving as a control group for comparison. The study, which was conducted between February 2015 and January 2016, included 188 medical professionals and about 43,000 teens.

Five components comprised the intervention. An HPV fact sheet library was used to create customized information sheets relevant to each practice’s patient population, along with a parent education website, a set of HPV-related disease images, and an HPV vaccine decision aid. Also included was communication training on using a presumptive vaccine recommendation, followed by motivational interviewing if parents were resistant to vaccination. Participating practices were engaged in a series of two intervention development meetings over a six-month period prior to the intervention.

Researchers report that adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.31-1.62) and completion (aOR, 1.56; 95% CI, 1.27-1.92). Those in the control practices registered a 9.5 absolute percentage point increase in HPV vaccine series initiation and a 4.4 absolute percentage point increase in HPV vaccine series completion in intervention practices.2

Recommendations From Clinicians Count

What led the current research team to look at the issue of provider training when it comes to HPV vaccine uptake?

“We know that how and whether a provider recommends the vaccine is one of the most influential factors affecting HPV vaccine uptake,” says lead author Amanda Dempsey, MD, PhD, MPH, associate professor of pediatrics in the University of Colorado School of Medicine. “Studies have previously shown that providers often don’t provide high quality vaccine recommendations that accurately reflect the need and importance of the vaccine compared to other adolescent vaccines.”

Healthcare professionals who participated in the study reported that the communication training and the fact sheets were the most used and useful intervention components. The communication training consisted of a self-guided, 30-minute webinar, plus two in-person group training sessions that lasted one hour each. Providers learned how to use motivational interviewing to address parental HPV vaccine hesitancy. They also learned that it is the most effective technique for helping with such issues.2

Research indicates that providers’ recommendations play a crucial role in the acceptance of HPV vaccination by patients and parents of patients.3

What can you do to increase vaccination rates? According to the Centers for Disease Control and Prevention (CDC), receiving a recommendation for vaccination from a provider is the main reason parents choose to vaccinate their children. Clinicians can avoid missed opportunities by strongly recommending the HPV vaccine to parents of children ages 11-12 years on the same day and in the same way that they recommend Tdap and meningococcal vaccines.

Use the provider resources at the CDC’s website (http://bit.ly/2dj9dTt) to help answer patient and parent questions on the vaccine. Current recommendations now call for 11- to 12-year-olds to receive two doses of HPV vaccine at least six months apart, rather than the previously recommended three doses. Teens and young adults who start the series later, at ages 15-26, will continue to need three doses of HPV vaccine to protect against cancer-causing HPV infection. The recommendation was issued shortly after the Food and Drug Administration’s October 2016 approval to add a two-dose schedule for the nine-valent HPV vaccine for adolescents ages 9-14. (Contraceptive Technology Update reported on the change; see the January 2017 article, “Just Two HPV Shots Recommended for Younger Teens” available at http://bit.ly/2li1dma.)

If healthcare providers could increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than age 12, according to the CDC.4 For every year that the HPV vaccination rate does not increase, an additional 4,400 women will develop cervical cancer, estimates indicate.

REFERENCES

  1. Walker TY, Elam-Evans LD, Singleton JA, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years — United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:874-882.
  2. Dempsey AF, Pyrznawoski J, Lockhart S, et al. Effect of a health care professional communication training intervention on adolescent human papillomavirus vaccination: A cluster randomized clinical trial. JAMA Pediatr 2018; doi:10.1001/jamapediatrics.2018.0016. [Epub ahead of print].
  3. Zimet GD, Mays RM, Winston Y, et al. Acceptability of human papillomavirus immunization. J Womens Health Gend Based Med 2000;9:47-50.
  4. Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013 — United States. MMWR Morb Mortal Wkly Rep 2013;62:591-595.