The human papillomavirus (HPV) vaccine reduces morbidity and mortality of HPV-associated diseases (cervical, oropharyngeal, vulvar, vaginal, penile, anal cancer, anogenital warts). Because vaccinations are an effective primary prevention strategy against HPV [10], the overall annual direct medical cost of routine screening and treatment of HPV-associated disease ($8 billion) could be reduced if HPV vaccination rates increase.

In medically underserved areas like the Rio Grande Valley (RGV), vaccinations in non-traditional health settings (school-located mass vaccination programs, school health centers, pharmacies) can improve HPV vaccine uptake. Barriers to HPV vaccina...

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The human papillomavirus (HPV) vaccine reduces morbidity and mortality of HPV-associated diseases (cervical, oropharyngeal, vulvar, vaginal, penile, anal cancer, anogenital warts). Because vaccinations are an effective primary prevention strategy against HPV, the overall annual direct medical cost of routine screening and treatment of HPV-associated disease ($8 billion) could be reduced if HPV vaccination rates increase.

In medically underserved areas like the Rio Grande Valley (RGV), vaccinations in non-traditional health settings (school-located mass vaccination programs, school health centers, pharmacies) can improve HPV vaccine uptake. Barriers to HPV vaccination include limited HPV/HPV vaccine knowledge, lack of insurance, logistical problems (cost, shortage of alternative settings), and no provider recommendation. Schools have a high ability to reach adolescents and have demonstrated success in providing other vaccines.

HPV vaccination is recommended for girls and boys aged 11–12, with catch-up doses for those aged 13–26, but US completion rates are low (49.5% for girls aged 13–17 years; 49.3% for boys). Raising US rates to the Healthy People 2020 goal of 80% of 13–15-year-olds fully vaccinated against HPV would prevent 53,000 more cervical cancer cases over the lifetime of those >12 years.

Since HPV-associated diseases disproportionately affect low-income, rural, and minority individuals, the vaccine is particularly important for RGV, where women have a 30% higher cervical cancer incidence and mortality rate than the rest of Texas and the country. Starr and Hidalgo Counties have high cervical cancer incidence and mortality rates (Hidalgo in 2015 had 14.6 new cases and 5.2 deaths per 100,000), low HPV vaccination uptake, and a high proportion of uninsured residents. Built upon the success of our current CPRIT-funded project in improving HPV vaccination rates in RGV, the proposed expansion aims to reduce common obstacles to HPV vaccination and prevent HPV-associated diseases.

This project aims to increase HPV vaccination uptake in Starr and Hidalgo Counties to match the NIS-Teen rates for Texas by implementing an educational campaign, a school-based HPV vaccination program, and providing support services (follow-up navigation, data collection, tracking, systems improvement). This collaboration between academic medical institutions, county health departments, and school districts employs school-based (health fairs, vaccination days, back-to-school nights, meetings) and community-based education events (health department events, regional conferences, provider training sessions/workshops). Our evidence-based intervention provides the HPV vaccine in an alternative setting (schools) and creates support for HPV vaccine by educating parents, school staff, and community healthcare providers.

Specific Goals: Goal 1: Increase HPV vaccination rates for male and female 6th–8th graders in Rio Grande City Consolidated Independent School District (RGCCISD) and Pharr-San Juan-Alamo Independent School District (PSJA ISD) to a minimum of 49.3% initiation and 32.9% completion to meet the 2016 National Immunization Survey–Teen (NIS-Teen) rates for Texas. Goal 1 objectives: Increase HPV vaccination rates in 3 RGCCISD middle schools (Starr County) and 8 PSJA ISD middle schools (Hidalgo County) to match NIS-Teen rates.

Goal 2: Increase HPV vaccine completion rates among students who receive an initial dose through our school-based vaccination program by 25%. Goal 2 objectives: Track and document at least 90% of HPV vaccinations provided through the school-based program; provide phone and mail reminders/patient navigation for 90% of parents/guardians of children who initiated through the school-based program; increase HPV vaccine completion rates among students who initiated through the school-based program by 25%.

Goal 3: Increase knowledge and awareness of HPV vaccine among RGV parents/guardians and healthcare providers by 20% compared to baseline. Goal 3 objectives: Increase the proportion of parents/guardians in attendance who identify that HPV vaccine protects against cancer by 20%; increase the proportion of healthcare partners (pediatricians, family practitioners, gynecologists) who recommend the HPV vaccine to targeted age groups by 20%. During the project period, we estimate 516 events reaching 8,063 unique individuals will result in vaccinating 3,181 children.

Our current CPRIT-funded project provides evidence in favor of school-based health programs to improve HPV vaccine uptake, mainly in low-resource border counties. Our program administers the vaccine to both genders at the ideal age, has physicians addressing the target audience—improving vaccine uptake and reducing the number of future HPV-associated cancers—and can be easily disseminated to other Texas schools.

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