Study examines strategies to increase HPV vaccine uptake
A trial designed to evaluate the effectiveness of strategies to increase the use of the HPV vaccine is underway.
The Patient-Centered Outcomes Research Institute has awarded $6.6 million to researchers at UCLA Jonsson Comprehensive Cancer Center in hopes of identifying the most effective and efficient health care interventions to increase HPV vaccination rates.
The 5-year study will include patients who receive care across a large, multisite federally qualified health center that provides care to a primarily uninsured or publicly insured, low-income, Latino population in Los Angeles County. More than 17,000 adolescents eligible for the HPV vaccine will be included in one of three study arms:
A multilevel, multicomponent point-of-care approach that targets physicians, staff and patients, as well as clinic-level policies, procedures and practices;
Text or mailed reminders sent to parents of the Northeast Valley Health Corporation adolescent patients who are due for a dose of the HPV vaccine; and
A combined clinic-based and parent-reminder approach.
“We are very excited to receive this award from the Patient-Centered Outcomes Research Institute,” Roshan Bastani, PhD, professor in the UCLA Fielding School of Public Health and director for disparities and community engagement at UCLA Jonsson Comprehensive Cancer Center, said in a press release. “By determining the comparative effectiveness and efficiency of our intervention strategies for increasing HPV vaccination in the Northeast Valley Health Corporation adolescent population, we have tremendous potential to improve the prevention of HPV-related cancers in other low resource clinical settings across the country. We greatly look forward to implementing this study and sharing its results.”
HemOnc Today spoke with Bastani about the study and the potential that the insights gleaned from this study will increase HPV vaccination uptake.
Question: What prompted this research?
Answer: We have been conducting research on the HPV vaccine since it was introduced more than a decade ago. Before this, the main approach to preventing and controlling cervical cancer was the Pap smear, which greatly decreased cervical cancer incidence and mortality in the United States. Then came the discovery of HPV as a causal agent in cervical cancer. This prompted the research that led to the development of the vaccine. This was a major breakthrough in cancer prevention.
However, despite the wide availability of the vaccine in the United States and its proven safety and efficacy, uptake of the vaccine has remained quite low. We have tried to identify why uptake is so low and have conducted other studies on this subject, but this particular study stemmed from us working in safety net settings that see large proportions of adolescents who are at risk for HPV infection and cervical cancer, which tends to be more prevalent in certain populations. It is particularly important for these populations to be vaccinated. These populations sometimes do not have the same access to care as others do. We wanted to seek out new ways to improve vaccination rates.
Q: Can you describe the importance of this research?
A: Instead of targeting individuals, we are targeting the system. If we change the system, then any patient now and any patient who comes into the system in the future has the opportunity to be vaccinated. I believe that the approaches that will have the biggest impact are those focused on the entire system that is providing health care vs. focusing on the individuals seeking care. We need to change the entire health system (eg, physicians, nurses, administrative staff, computer systems, policies, procedures, etc.).
Q: How will you conduct the study?
A: Our study will include 17,000 vaccine-eligible adolescent patients from the seven participating clinics in Northeast Valley Health Corporation system. We will study the comparative effectiveness of the three different strategies in increasing HPV vaccine rates. There are seven clinics included in the study. Two of the clinics will use texts or mailed reminders to mothers stating their child is due for a vaccine and urging them to call the clinic for an appointment. Three additional clinics will not utilize parent reminders but will implement a clinic-based intervention that targets multiple levels of the system, including physicians, nurses, administrative staff, clinic policies, procedures and documentation. The two final clinics will employ a combination of the two methods. For roughly 4 years, any patient who walks into these clinics or is a registered patient will be involved in the interventions. We will review electronic health records of all eligible patients during the entire study period to see which patients in which clinics actually received the HPV vaccine. This will allow us to understand which of the three strategies was the most effective and make some judgements regarding ease of implementing each of the strategies in the Northeast Valley Health Corporation system.
Q: How can the insights gleaned from this study potentially increase HPV vaccination uptake and, in turn, reduce cancer incidence?
A: We think these interventions can have a very large effect on vaccine uptake based upon similar interventions that we have done for other types of health outcomes studied. If we are able to change the functioning and culture of the system and the specific clinic so it provides the vaccine to every patient who needs the vaccine — offer it routinely, provide important information on it and have adequate stock of the vaccine available — then we expect a large effect. If we find that our interventions are effective, then these same interventions can be adopted nationally by other clinic systems where the rates are also low.
Q: What do you suspect the findings will show?
A: We hypothesize that the combined method will be the most effective, but also the most complicated to implement and sustain. We are dealing with human beings, and all human beings respond to different things in different ways.
Q: Is there anything else that you would like to mention?
A: HPV vaccination rates have been very disappointing, which is why this research is very exciting for us. We have a vaccine that can prevent cancer. Yet, some people are finding reasons to not be vaccinated because they are afraid of things that have been shown to not be true. Moreover, our health systems have not done a good job at routinely providing the vaccine to all eligible patients. – by Jennifer Southall
For more information:
Roshan Bastani, PhD, can be reached at UCLA Jonsson Comprehensive Cancer Center, 8-684 Factor Building, Los Angeles, CA 90095-1781.
Disclosure: Bastani reports no relevant financial disclosures.