Increasing HPV vaccine uptake using a "start at 9" strategy: A pilot program

Clinical Snapshot

Key Findings

• P Value: p < 0.001 for completion rate improvements at both practices

• Effect Size: Completion rates among 9-12 year olds: urban practice 9% to 14%, suburban practice 6% to 16%

• Primary Outcome: HPV vaccine uptake among 9-10 year olds increased from 8% to 41% (urban practice) and 3% to 23% (suburban practice)

• Nnt Or Sensitivity: Approximately 3 children need exposure to intervention for one additional vaccination (based on urban practice data)

• Confidence Interval: Not reported

Clinical Application

Requires multi-level organisational commitment including policy changes, staff training, and EHR modifications HPV vaccination available free under National Immunisation Program from age 9; strategy could complement existing school-based programs and address coverage gaps Children aged 9-12 years in primary care settings with established immunisation programs

Abstract

BACKGROUND: Human papillomavirus (HPV) vaccine completion rates by 13 years remain suboptimal. Earlier HPV vaccination may result in improved timely completion rates. We aim to describe the impact of recommending HPV vaccine at 9 years of age on vaccine completion rates. METHODS: We implemented a multi-level program (including policy development, provider and office personnel education, electronic health record changes, and use of vaccine promotional items) to facilitate routine HPV vaccine recommendation at 9 years at 2 pediatric practices. Monthly chart reviews were performed 6 months before through 18 months after program implementation. Outcome measures included rates of HPV vaccination and documentation of HPV vaccine during the visit. Quarterly data (age, HPV vaccination status, gender, race, ethnicity, insurance, and primary care provider type) were obtained from the electronic health records of 9-12-year-olds served by the practice from baseline through 18 months after program implementation. RESULTS: Following program implementation, the median percentage of HPV vaccine uptake among 9-10-year-olds increased from 8% to 41% at the urban practice and from 3% to 23% at the suburban practice. Similarly, HPV vaccine completion rates among 9-12 year olds increased from 9% to 14%, p < 0.001 and from 6% to 16%, p < 0.001, respectively. Documentation of provider vaccine recommendation strongly correlated with HPV vaccination. CONCLUSION: Implementation of a multi-level program to routinely recommend the HPV vaccine at 9 years of age is feasible and effective in increasing in HPV vaccine completion by 13 years of age.