231999 Human Papillomavirus (HPV) Vaccination in the Indian Health Service

Tuesday, November 9, 2010 : 2:45 PM - 3:00 PM

Amy V. Groom, MPH , Immunization Services Division, Program Operations Branch, Centers for Disease Control and Prevention/Indian Health Service, Albuquerque, NM
Cheyenne Jim, MS , CDC/Ncird/Isd/Pob, Indian Health Service - Immunization Program, Albuquerque, NM
Jennifer Wai Lee, BSN, RN , CDC/Cchp/Nccdphp, Center for Disease Control and Prevention, Atlanta, GA
Mona Saraiya, MD, MPH , Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, GA
David Espey, MD , CDC/Cchp/Nccdphp, IHS Division of Epidemiology, Albuquerque, NM
The Indian Health Service (IHS) provides healthcare services to approximately 1.4 million American Indian/Alaska Native (AI/AN) people in the U.S. IHS-funded services are provided in IHS, Tribal and Urban Indian (I/T/U) facilities in 35 states. Historically, AI/AN women have experienced a higher incidence of cervical cancer than non-Hispanic White women. We describe HPV vaccination uptake among AI/AN adolescents served by the IHS, and discuss how financing may affect HPV vaccination uptake among AI/AN women.

Starting in 2008, data on HPV vaccine coverage for ~ 30,000 AI/AN females aged 13 17 years were collected quarterly from I/T/U facilities. In addition, an on-line survey with a convenience sample of 268 I/T/U providers were conducted in 2009-2010 to provide insight into provider practices and perceived barriers to HPV vaccination.

Coverage with 1 dose of HPV vaccine among AI/AN females aged 13 17 years served by I/T/U facilities increased from 33% in the beginning of 2008 to 69% as of 12/31/09. Steady increases have also been seen in coverage with 2 doses (17% to 53%) and 3 doses (6% to 36%) of HPV vaccine.

While all I/T/U facilities routinely offer HPV vaccine to patients aged 11 18 years, not all offer it to women aged 19 26 years. In the online survey, 33% of the respondents indicated that their facility does not offer vaccine to 19 26 year olds. Barriers cited included upfront costs (57%) and reimbursement issues (58%). Twelve percent of providers surveyed indicated that their facility participates in the Merck Patient Assistance Program(MPAP), which provides free vaccine to uninsured, low-income women. In the IHS experience, the public financing of HPV vaccination through the Vaccines for Children (VFC) program is a key component in the uptake of HPV vaccine. AI/AN people aged < 19 years are categorically eligible to receive free vaccines through the VFC program. Because of this, all I/T/U facilities currently provide HPV vaccine to females < 19 years of age, which likely accounts for the steady increases in HPV vaccine initiation coverage to levels higher than estimates for the general U.S. population. HPV vaccine coverage rates in the IHS are also comparable to coverage rates seen in countries with school-based implementation policies. In contrast, vaccine for women aged 19 26 years is not universally available in I/T/U facilities, and those that do may limit it to women with other sources of reimbursement (e.g. Medicaid,MPAP).

Learning Areas:
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
1. Describe the current HPV vaccine coverage among AI/AN populations served by the Indian Health Service 2. Describe and contrast how financing may differentially impact coverage in younger and older female populations

Keywords: Cancer Prevention, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I oversee immunization reporting for the Indian Health Service
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.