NEED: Our highly successful HPV vaccination program has vaccinated 2,473 boys and girls seen in 3 pediatric clinics; an impressive 99% of these adolescents completed the series, well surpassing national averages. However, the original project included adolescents from only 2 counties even though UTMB clinics serve patients from 25 counties. Our baseline data found that 76% of age-eligible adolescents from the 23 counties not included in the original project have not yet initiated the series, although many families are willing to do so. Lack of knowledge, poor access, lack of provider recommendation, and cost all contribute to these extremely low vaccination rates. These barriers must be addr...
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NEED: Our highly successful HPV vaccination program has vaccinated 2,473 boys and girls seen in 3 pediatric clinics; an impressive 99% of these adolescents completed the series, well surpassing national averages. However, the original project included adolescents from only 2 counties even though UTMB clinics serve patients from 25 counties. Our baseline data found that 76% of age-eligible adolescents from the 23 counties not included in the original project have not yet initiated the series, although many families are willing to do so. Lack of knowledge, poor access, lack of provider recommendation, and cost all contribute to these extremely low vaccination rates. These barriers must be addressed as most of these adolescents are from rural and/or medically underserved areas (MUAs) and at increased risk of HPV-related cancers. OVERALL PROJECT STRATEGY: We will offer vaccination services to patients 9–17 years of age from 25 counties who receive care in the original 3 pediatric clinics plus a family medicine clinic. Adding a new clinic will allow family medicine providers, who are usually on the front line in rural areas, to be trained on the need to offer the HPV vaccine at every opportunity, thereby increasing sustainability. Expanding to family medicine will be seamless as all UTMB clinics use similar procedures. We initiated “same day” visits in the pediatric clinics during the original project; this will be introduced into the new clinic. We will also schedule the next appointment before the patient leaves, thereby triggering an automated reminder system. Patient navigators (PNs) will identify eligible patients, educate families, obtain consent, facilitate same-day vaccinations, and schedule follow-up appointments. They will work to reduce barriers and change clinic culture so it is routine to offer the HPV vaccine at all types of visits, including specialty visits. PNs will use text, phone, and mail reminders to ensure all doses are completed. We will also reach more adolescents by asking parents at clinics about the vaccination status of siblings and sending letters to prior patients overdue for the vaccine. We will work on implementing “standing orders”. An exciting new component in the expansion will be onsite vaccination in 8 schools located in MUA and/or rural counties that lack a health department. A pediatrician with extensive experience in developing and leading school vaccination programs will lead this component, ensuring its success. This combined approach (Services Here, Services There) will more than double the number of doses given during the original project. To educate physicians, nurses, health profession students, clinic administrators, teachers, and school staff about the importance of HPV vaccination, we have established unique partnerships with the UTMB medical, nursing, and health professions schools, 3 county medical societies and major Texas professional societies for pediatricians, gynecologists and school nurses. Overall, our professional education efforts will ensure that practicing and future providers throughout the state understand how to counsel patients and reduce barriers to HPV vaccination. Finally, we will reach out to the community through print distributions, social media, UTMB and school websites, and health fairs. SPECIFIC GOALS: We will: 1) increase HPV vaccination rates among adolescents 9–17 years of age seen in 4 UTMB clinics and 8 schools; 2) use patient navigation services such as counseling, appointment setting, and reminders to facilitate these activities; and 3) increase professional knowledge and program support through in-service presentations, educational lectures for groups, and one-to-one visits with providers. We will reach 32,809 members of the public and professionals and provide 55,002 clinical, navigation, and education services to 14,495 individuals over the course of the project. SIGNIFICANCE AND IMPACT: This expansion will increase the number of counties served from 2 to 25, including 13 that are both rural and full MUAs. We will also provide onsite HPV vaccination services to adolescents in 8 schools located in 4 MUAs with very low vaccination rates. The 25 counties to be served comprise 11 Texas Senate Districts and 12 Texas House Districts ensuring that a widely dispersed, diverse constituency benefits from our program. Participants represent priority populations as they are underinsured/uninsured, reside in medically underserved areas, and are from racial/ethnic groups at higher risk for HPV-related cancers. Our dissemination efforts and extensive professional education will help others replicate our methods, thereby creating a multiplier effect. Overall, this project will have a major impact across Southeast Texas by reducing the incidence of HPV infections and HPV-related cancers for years to come.
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