141st APHA Annual Meeting

In This section

A state health department-led RCT to improve adolescent immunization using the AFIX model

Monday, November 4, 2013 : 11:10 AM - 11:30 AM

Melissa Gilkey, PhD , Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
Jennifer Moss, MSPH , Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
Alicia Sparks, MPH , Bloomberg School of Public Health, Department of Health, Behavior & Society, Johns Hopkins University, Baltimore, MD
Amanda Dayton, MA , Immunization Branch, North Carolina Division of Public Heatlh, Raleigh, NC
Amy Grimshaw, MS, MSW , Immunization Branch, North Carolina Division of Public Heatlh, Raleigh, NC
Noel T. Brewer, PhD , Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC
Purpose. CDC's AFIX (Assessment, Feedback, Incentives, and eXchange) program improves the provision of early childhood vaccines via brief quality improvement consultations with primary care providers. We sought to evaluate whether a modified AFIX program could also boost uptake of under-used adolescent vaccines, including human papillomavirus (HPV) vaccine.

Methods. The North Carolina Immunization Branch randomly selected 91 high-volume primary care clinics in North Carolina serving 107,443 adolescents ages 11-18. They randomly assigned clinics to receive no consultation or an in-person or webinar AFIX consultation focused on adolescent immunization. The state's immunization registry provided 5-month-post-intervention coverage data. In logistic regressions stratified for younger and older adolescents, we assessed coverage for: tetanus, diphtheria, and pertussis (Tdap); meningococcal vaccine; and HPV vaccine initiation.

Results. In-person AFIX consultations led to higher coverage among adolescents ages 11-12 for Tdap (OR=1.50, 95% CI, 1.36-1.65) and meningococcal vaccine (OR=1.22, 95% CI, 1.13-1.33), but not HPV vaccine. Webinar AFIX consultations led to higher coverage for Tdap and meningococcal vaccine as well as HPV vaccine (OR=1.12, 95% CI, 1.03-1.23). AFIX consultations did not affect “catch up” vaccination for adolescents ages 13-18. Both in-person and webinar consultations received high scores on participant satisfaction, but webinar consultations were more cost effective.

Conclusions. Webinar AFIX consultations were at least as effective as in-person consultations in modestly increasing vaccine coverage for adolescents ages 11-12. Using AFIX nationally to address low adolescent vaccination rates is promising, but the program needs improvements to have greater impact on HPV vaccine initiation and catch-up vaccination.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health or related public policy
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Explain the AFIX model of immunization quality improvement. Describe the outcomes of a trial to assess the effect of the AFIX model on adolescent immunization. Discuss benefits and barriers state health departments can expect when implementing AFIX for adolescents.

Keywords: Immunizations, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a behavioral scientist whose research focuses on the individual and organizational determinants of adolescent immunization.
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.