NEED: Many people living in east Texas near the Louisiana border are medically underserved and at great risk for cervical cancer and other HPV-related cancers. Most of the counties in this region are federally designated Medically Underserved Areas and rural. Moreover, a large percentage of residents are impoverished and underinsured. Our records indicate that patients receiving care at 2 University of Texas Medical Branch (UTMB) clinics in this region are at increased risk of cervical cancer, but have low rates of HPV vaccine uptake. In fact, only 38 percent of all age-eligible patients seen in these clinics have received one or more doses. These patients face many barriers to cancer preve...

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NEED: Many people living in east Texas near the Louisiana border are medically underserved and at great risk for cervical cancer and other HPV-related cancers. Most of the counties in this region are federally designated Medically Underserved Areas and rural. Moreover, a large percentage of residents are impoverished and underinsured. Our records indicate that patients receiving care at 2 University of Texas Medical Branch (UTMB) clinics in this region are at increased risk of cervical cancer, but have low rates of HPV vaccine uptake. In fact, only 38 percent of all age-eligible patients seen in these clinics have received one or more doses. These patients face many barriers to cancer prevention services including poor awareness, financial barriers, and lack of access. Thus, this high-risk population is in critical need of interventions to help them obtain the HPV vaccine and stay up-to-date on cervical cancer screening. OVERALL PROJECT STRATEGY: In 2015, we established a patient navigation program in the 2 clinics to increase the number of patients who received the HPV vaccine and cervical cancer screening. We vaccinated over 1,700 adolescents and adults and over 75 percent of participants completed the vaccine series. However, services in the initial program were limited to residents of Jefferson and Orange counties. In the next cycle, we will expand to include residents of 11 additional counties (Angelina, Chambers, Hardin, Jasper, Liberty, Nacogdoches, Newton, Polk, Sabine, San Jacinto, and Tyler). We will also expand the age range for vaccination following the 2018 Food and Drug Administration update on eligibility for HPV vaccination. To identify potential participants, patient navigators (PNs) will review the medical records of all incoming patients and counsel those without evidence of complete HPV vaccination. Those who agree will be vaccinated that day to avoid missed opportunities. To increase completion rates, PNs will remind participants of upcoming appointments with phone and text messages and reschedule missed appointments as needed. We will also counsel women 21 to 45 years of age on the importance of cervical cancer screening and bring patients up to date if they are due or overdue for this service. Our program includes comprehensive outreach to the community. To inform a wider swath of the population about the HPV vaccine and our program, we have partnered with 4 colleges across the region to disseminate educational materials. Additionally, we have partnered with a network of community-based clinics that will distribute educational materials to their patients and refer eligible patients to our clinics. Finally, we will educate providers in the region and UTMB health professions students on the importance of recommending the HPV vaccine to eligible patients. This will be possible through our partnerships with the Jefferson County and Nacogdoches-San Augustine County medical societies and the American College of Obstetricians and Gynecologists. All have invited us to speak to their members at their meetings on the importance of offering the HPV vaccine to all eligible patients. SPECIFIC GOALS: Our overarching goals are: 1) reduce the risk of HPV-related cancers in east Texas by increasing HPV vaccine knowledge and vaccine uptake; 2) reduce the risk of cervical cancer by increasing screening among eligible women; and 3) increase recommendation of the HPV vaccine by educating practicing physicians in the region, residents, and healthcare students. We anticipate reaching at least 3,483 patients and 400 professionals directly and many more potential patients and professionals indirectly through our outreach and dissemination efforts. SIGNIFICANCE AND IMPACT: In our first cycle, we directly reached almost 4,000 patients from largely economically disadvantaged and medically underserved backgrounds in Jefferson and Orange counties. During this second cycle, we will expand our effective cancer prevention program to include 11 additional counties. Overall, this project has great potential to reduce the incidence of HPV infections and as a result, reduce the incidence of numerous HPV-related cancers among an underserved population at increased risk for cancer-related morbidity and mortality. Thus, our project will provide cancer prevention to a population and geographic area with a great need for protection.

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