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Comparative effectiveness of system interventions to increase HPV vaccine receipt in federally qualified health centers (FQHCs)
Investigator (PI): Bastani, Roshan
Performing Organization (PO): (Current): University of California, Los Angeles, Fielding School of Public Health, Department of Health Policy and Management / (310) 825-2594
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2018
Final Year: 2024
Record Source/Award ID: PCORI/PCS-2017C1-6482
Funding: Total Award Amount: $6,476,899
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Human papillomavirus (HPV) is a major cause of several types of cancers affecting both women and men. The development of vaccines to prevent HPV infection marked a major breakthrough in cancer prevention. However, after 10 years of wide availability, use of the HPV vaccine among U.S. adolescents remains unacceptably low. HPV-related cancers disproportionately affect ethnic minority, immigrant, and low-income groups in the United States. In Los Angeles, for example, cervix cancer rates are substantially higher among Latinos compared to non-Latino whites. Federally qualified health centers (FQHCs) provide much needed health care to underserved groups and tend to have stable infrastructures that can support implementation of evidence-based strategies for increasing HPV vaccine receipt among high-risk groups. Therefore, the University of California, Los Angeles (UCLA) Fielding School of Public Health and the Jonsson Comprehensive Cancer Center are partnering with the Northeast Valley Health Corporation (NEVHC) to address the heavy burden of HPV-related cancers in their patient population. NEVHC is a large multi-site FQHC in Los Angeles County. The majority of NEVHC's patient population is Latino (87%), low income (81% live below 100% of the federal poverty level), publicly insured or uninsured (>75%), and most live in Spanish-speaking households (60%). Although the HPV vaccine is recommended for all adolescents, only about 35% of adolescents in NEVHC have completed the HPV vaccine series. This is somewhat surprising given NEVHC has consistently observed a high level of acceptance and support for vaccination in their patient population. For example, over 90% of young children who receive services from NEVHC get all recommended early childhood vaccinations by the age of 3. Prior research has shown that Latinos are generally receptive to vaccination and would be willing to get their child the HPV vaccine if it were offered by their health care provider. Our overall intervention strategy is guided by best practice recommendations from the American Cancer Society and the American Academy of Pediatrics. We will compare the effectiveness of two strategies designed to increase use of the HPV vaccine: parent reminders and clinic-based strategies. Parent reminders will include text message or mailed letters sent to parents of NEVHC adolescent patients who are due for a dose of the HPV vaccine. Clinic-based strategies will include educating clinic providers and staff about the importance of HPV vaccination and approaches to discussing and recommending the vaccine to parents. In addition, clinics will establish new policies that prioritize HPV vaccination and ensure that the vaccine is offered to all eligible patients. During the project period, we expect that 17,000 adolescents age-eligible for the HPV vaccine will receive services at a participating NEVHC clinic. We will examine the electronic health records of these patients to determine whether or not the interventions produce an increase in HPV vaccination. Study results will help NEVHC determine which strategy best meets the needs of their patients and may also inform similar efforts to increase HPV vaccination in other low-resource clinical settings across the country. To inform the development of this proposal, UCLA and NEVHC worked together to solicit input from NEVHC patients, staff, and providers about our proposed project, including the target population, intervention strategies, and data collection protocols. During the project period, we will regularly convene two committees to solicit stakeholder feedback. Our project advisory committee will include parents of NEVHC adolescents, NEVHC providers, leaders, and staff, and representatives from local organizations with a shared interested in HPV vaccination. We will also convene a patient advisory committee consisting of parents of NEVHC adolescent patients. This group will be critical to ensuring that patient preferences and concerns shape all project activities. These stakeholders will also play an active role in the dissemination of study findings. Results will be shared through lay summaries, presentations at community events and scientific meetings, formal reports, and publications in the peer-reviewed literature.
MeSH Terms:
  • Adolescent
  • American Cancer Society
  • Comparative Effectiveness Research
  • Guidelines as Topic
  • Health Policy
  • Hispanic Americans
  • Humans
  • Immunization Programs
  • Los Angeles
  • Multicenter Studies as Topic
  • * Papillomaviridae
  • Papillomavirus Vaccines /*therapeutic use
  • Poverty
  • Safety-net Providers
  • United States
  • Universities
  • Uterine Cervical Neoplasms /*ethnology
  • /therapy /*virology
  • Vaccination
Country: United States
State: California
Zip Code: 90095
UI: 20184426
CTgovId: NCT03726151
Project Status: Ongoing