Effects of an intervention promoting HPV vaccination in an urban safety-net healthcare system

BACKGROUND: HPV vaccination rates are lowest among underserved patients (uninsured, low income, racial/ethnic minorities) seen in safety-net healthcare settings. Safety-nets are a key immunization delivery site because they maintain “open door” policies.

OBJECTIVE: Assess effects of brochure and telephone recalls/reminders on HPV vaccine coverage in adolescent females attending safety-net clinics with a randomized trial.

SETTING: Parkland Health & Hospital System provides critical outreach to Dallas County, the 9th largest US county (34% White, 20% Black, 39% Hispanic). Over 14,000 adolescents are seen in 21 neighborhood- and school-based clinics annually.

METHODS: We randomized parents of unvaccinated females aged 11-18 who had an upcoming visit. Parents were mailed either a HPV vaccine-specific brochure (Intervention n=375) or a general adolescent vaccine brochure (Control n=365), and invited to complete a survey immediately before the visit. Intervention parents who completed the survey also received a telephone recall after two weeks if they declined the vaccine and telephone reminders if they initiated the series and failed to complete Dose 2 or 3. We ascertained by EMR review 1- and 3-dose coverage within 12 months of randomization.

RESULTS: Among survey completers (Int. n=164; Con. n=173), about half received Dose 1 at the visit (Int. 49.4%; Con. 44.5%). After 12 months, the 3-dose coverage rates were significantly higher in the Intervention vs. Control group (28.7% vs. 15.6%, p=0.004).

CONCLUSIONS: Our multi-component intervention improved 3-dose HPV coverage in urban safety-net adolescents. These parent-targeted outreach strategies complement Parkland's provider strategies that include a standing order policy and EMR alerts.