231975 Systematic review of HPV vaccine initiation and completion: Surveillance data from national and local studies in the United States

Tuesday, November 9, 2010 : 2:30 PM - 2:45 PM

Jasmin Tiro, PhD , Division of Behavioral & Communication Sciences, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
The human papillomavirus (HPV) vaccine will only have an impact on cervical cancer disparities in the United States if the populations who suffer disproportionately from morbidity and mortality (minority, low-income, and medically underserved) use this primary prevention strategy. Several recent descriptive studies have examined HPV vaccine initiation (receipt of 1 dose) and completion (all 3 doses) as well as factors associated with these outcomes in national and local populations. Careful review of these surveillance efforts is critical to understand whether subpopulations most likely to benefit from the vaccine are adopting it, and whether financing and delivery policy initiatives are effective at reaching underserved groups. The aim of this systematic literature review is to provide an overview of the U.S. population subgroups that initiated and completed the HPV vaccine series during its first three years on the market. Medline searches were performed and characteristics of studies including data collection dates, study population, sample size, population subgroup (teen, young adult, mixed), race/ethnicity, data source, and correlates associated with initiation and/or completion were abstracted. Random effects models and meta-regression analyses will be applied to evaluate heterogeneity between studies and identify sources of heterogeneity. We abstracted data from 18 studies published between 2008 and 2010 covering 313,284 participants. All but one study provided initiation estimates (range: 5.0 to 63.5%) and nine reported completion estimates (range: 0.2 and 58.2%). Five studies estimated national rates, while the remaining studies investigated initiation among clinic/managed care populations (n = 10), regional populations (n = 2), and students enrolled in a university (n = 1). Few sociodemographic, health care access, and psychosocial variables were consistently examined across studies. Variables found to be positively associated with initiation in more than one study were: insurance coverage, recommendation by a health care provider, low perceived barriers, and belief that family and friends approve of the vaccine. Pattern of association between initiation and race/ethnicity was mixed; some studies found higher vaccine coverage among Caucasian girls and young women than among their Hispanic and African American counterparts, while other studies reported higher coverage among Hispanics as compared to Caucasians. Published studies suggest that initiation and completion of the HPV vaccine series in its initial years on the market has been limited to moderate. To enable identification of subgroups that might benefit from targeted vaccine promotion, researchers should investigate a consistent set of variables in local populations including race/ethnicity, socioeconomic status, and insurance status.

Learning Areas:
Chronic disease management and prevention
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
To describe initiation and completion of the HPV vaccine in the US during the first three years of its release. To discuss how future efforts to monitor vaccine uptake can be optimized to assess the vaccine's impact on disparities.

Keywords: Cancer Prevention, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted research on uptake of the HPV vacine as well as its integration into cervical cancer prevention and control.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.