NEED: Uptake of the human papillomavirus (HPV) vaccine has been slow in the US, especially among young adults. Vaccination rates are particularly low among the low-income, predominately Hispanic population who receive care at the Regional Maternal Child Health Program (RMCHP) clinics administered by the University of Texas Medical Branch (UTMB). These women desperately need improved access to this life-saving vaccine as their Hispanic ethnicity places them at higher risk of cervical cancer than other Texans (11.5/100,000 vs. 9.2/100,000 for all groups). Those residing in Cameron and Hidalgo counties near the US-Mexico border have even higher rates (12-13/100,000 respectively). Adults not vac...
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NEED: Uptake of the human papillomavirus (HPV) vaccine has been slow in the US, especially among young adults. Vaccination rates are particularly low among the low-income, predominately Hispanic population who receive care at the Regional Maternal Child Health Program (RMCHP) clinics administered by the University of Texas Medical Branch (UTMB). These women desperately need improved access to this life-saving vaccine as their Hispanic ethnicity places them at higher risk of cervical cancer than other Texans (11.5/100,000 vs. 9.2/100,000 for all groups). Those residing in Cameron and Hidalgo counties near the US-Mexico border have even higher rates (12-13/100,000 respectively). Adults not vaccinated at a younger age often do not know where to access the vaccine and do not have the funds to pay for it. To address this critical need, we implemented a program in 2018 that offers the HPV vaccine at no cost to women attending UTMB’s RMCHP clinics in Hidalgo County, near the US-Mexico border, and in Galveston County. This project has been highly successful and is on course to meet or exceed all goals and objectives. A 2nd cycle of funding will allow us to vaccinate even more patients who present for care at these clinics. Moreover, we will add a 3rd clinical site to increase access for women from 3 additional MUA counties (Cameron, Matagorda, and Wharton) not included in the 1st cycle. Medical records indicate that none of the RMCHP patients from Cameron County who received care between June and August 2020 had received even 1 dose of the HPV vaccine, demonstrating the critical need to expand our project to this population. OVERALL PROJECT STRATEGY: The expanded project will offer the HPV vaccine to women 18–45 years of age attending 3 RMCHP clinics in Hidalgo, Galveston, and Brazoria counties. In addition to the barriers of cost and access, women seen in these clinics often have low awareness of the HPV vaccine and face challenges to completion of the series. We will use evidence-based strategies to overcome these barriers. Patient navigators (PNs) will review medical records to identify unvaccinated or partially vaccinated patients and provide personalized counseling. They will schedule appointments for the 2nd and 3rd doses, send reminders for follow-up appointments, and reschedule missed appointments to ensure patients complete the series. To increase provider recommendation of the vaccine during and after the project has been completed, we have developed a robust professional outreach program. We will educate physicians practicing in rural and MUAs through our talks to 3 local medical societies and 1 statewide organization. UTMB medical, nursing and nurse practitioner students will also be trained on how to counsel patients and offer the vaccine at every opportunity. Information about the importance of getting vaccinated and our project will be widely disseminated throughout the communities we are targeting through our partnerships with 5 colleges serving low-income students as well as 2 community health clinics and 5 WIC offices. SPECIFIC GOALS: We will use our multicomponent approach to achieve the following goals: 1) Increase HPV vaccine series initiation and completion rates among 18-45 year old women during their initial and follow-up visits at the UTMB RMCHP clinics in Brazoria, Galveston and Hidalgo counties; 2) Counsel and provide navigation services to 18-45 year old women attending the 3 clinics to facilitate completion of the vaccine series; and 3) Educate physicians with practices in counties served by the 3 clinics and UTMB healthcare profession students on HPV vaccination to stress the importance of recommending the vaccine to eligible patients. We will counsel at least 1652 patients and educate at least 500 health care professionals and students during the project. SIGNIFICANCE AND IMPACT: The initial project has already had a positive impact on the regions it serves. During the first 2 years of the project, the number of women vaccinated and providers educated exceeded targets for that period. Moreover, almost 70% of those who initiated the vaccine through this project during Year 1 have already completed all 3 doses, which surpasses national completion rates. This success was achieved in spite of the problems created by the pandemic. Texas has experienced more deaths from COVID-19 than any other state in the US, with Hidalgo County being one of the hardest areas hit in Texas. Our expansion project promises to bring a greater impact on these regions. By adding patients from Cameron, Matagorda and Wharton counties, we will vaccinate even more underserved women. Overall, the expanded project will serve residents from 13 counties, of which 5 are MUAs and 5 are both MUA and rural. It will be an invaluable resource to these counties, as it will provide cancer prevention services to populations and geographic areas at high risk of HPV-related cancer morbidity and mortality.
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