Need: The human papillomavirus (HPV) vaccine reduces morbidity and mortality of HPV-associated diseases (cervical, oropharyngeal, vulvar, vaginal, penile, anal cancer, anogenital warts) [1-9]. 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 [11]. 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 [9,12]. Barriers to HPV vaccina...
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Need: The human papillomavirus (HPV) vaccine reduces morbidity and mortality of HPV-associated diseases (cervical, oropharyngeal, vulvar, vaginal, penile, anal cancer, anogenital warts) [1-9]. 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 [11]. 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 [9,12]. Barriers to HPV vaccination include limited HPV/HPV vaccine knowledge, lack of insurance, logistical problems (cost, shortage of alternative settings), and no provider recommendation [9,13]. Schools have a high ability to reach adolescents and have demonstrated success in providing other vaccines [9,14,15]. HPV vaccination is recommended for girls and boys aged 11–12, with catch-up doses for those aged 13–26 [7,9], but US completion rates are low (49.5% for girls aged 13–17 years; 49.3% for boys) [16]. Raising US rates to the Healthy People 2020 goal of 80% of 13–15-year-olds fully vaccinated against HPV [17] would prevent 53,000 more cervical cancer cases over the lifetime of those >12 years [18,19]. Since HPV-associated diseases disproportionately affect low-income, rural, and minority individuals, the vaccine is particularly important for RGV [9], where women have a 30% higher cervical cancer incidence and mortality rate than the rest of Texas and the country [20,21]. 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) [22], low HPV vaccination uptake, and a high proportion of uninsured residents [20,22,23]. 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. Overall Project Summary: 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. Significance & Impact: 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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