Follow-through with the HPV vaccine is poor and has become worse over time, according to researchers from the University of North Carolina, Chapel Hill.
“Increases in HPV vaccine initiation are well-documented, but researchers have paid little attention to changes in HPV vaccine series completion,” they wrote.
In the study, Jennifer C. Spencer, MD, and colleagues used MarketScan Commercial claims data to identify 1,332,217 privately insured patients aged 9 to 26 years who started the bivalent or quadrivalent HPV vaccine series between 2006 and 2014. Researchers followed the patients through 2015. The study’s outcome of interest was the completion of the third HPV vaccine dose within 1 year of initiating the series. This was evaluated in terms of age, region, insurance plan type, provider type, and seasonal influenza vaccination.
Results of their analysis, published today in American Journal of Public Health, indicated that 70% of female patients and 62% of males received a second HPV dose within a year of the initial dose, but only 45% of females and 35% of males received all three doses within a year.
Pediatricians were among the providers who most commonly administered the initial HPV vaccine dose (48% of females, 67% of males), along with family physicians (20% of females, 15% of males). Additionally, obstetricians/gynecologists (OB-GYNs) provided 12% of initial vaccines administered to female patients.
Female patients who began the course in 2006 had high rates of follow-through (66.8%), but the rates declined each year, with 59% receiving vaccination in 2007, 50.8% receiving vaccination in 2008, and 42.1% receiving the vaccine in 2009. After 2010, the decline became less prominent but persisted, arriving at a low of 38.2% in 2014.
Male patients had a less pronounced decrease in follow-through over time (36.1% in 2011 and 33.1% by 2014), the researchers said.
The female patients who completed all three doses were more likely to have initiated the vaccine through an OB/GYN (54.7%) vs. a pediatrician (44.3%; P < .001). The lowest rate of follow-through in female patients was among those who started the vaccine through midlevel providers (41.4%). Likewise, male patients who initiated the vaccine with a midlevel provider had a lower rate of follow-through (31.3%) compared with those who received the first dose from a pediatrician (36.1%; P < .001).
In both sexes, having received an influenza vaccine within the previous year was associated with a higher rate of HPV vaccine follow-through, whereas living in the South or West was associated with lower follow-through. Patients with HMO insurance plans were less likely to follow through with HPV vaccines vs. those in preferred provider organizations (44.2% vs. 46.2% for males; 31.7% vs 36.3% for females; P < .001). In female but not male patients, being enrolled in a high-deductible health plan was associated with lower rates of follow-through vs. those in preferred provider organizations (44.2% vs. 46.2%; P < .001).
“Although HPV vaccination is improving over time, only 45% of females and 35% of males in our study completed the HPV series within 1 year of initiation,” the researchers wrote. “Programs seeking to improve vaccination should emphasize the importance of timely follow-through and should target the full range of providers who deliver HPV vaccines.” – by Jennifer Byrne
Disclosures: Spencer reports receiving funding on an unrelated grant from Pfizer. Please see the study for all other authors’ relevant financial disclosures.