Hispanic women in Hidalgo County have higher cervical cancer incidence (12 vs. 10/100,000) and mortality (4 vs. 3/100,000) rates compared to Hispanic women nationally. These disparities can be attributed to the underuse of cancer screening services, possibly due to cultural/linguistic barriers, low socioeconomic status, and illegal immigrant status.

Prevention of cervical cancer is possible through the use of the HPV vaccine, which protects against two strains of human papillomavirus (HPV) (16, 18) that cause 66% of cervical cancer cases. The vaccine is recommended for women (18-26), men (18-21), and girls/boys (11-17), but uptake of the HPV vaccine is low for Hispanic adolescents and ...

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Hispanic women in Hidalgo County have higher cervical cancer incidence (12 vs. 10/100,000) and mortality (4 vs. 3/100,000) rates compared to Hispanic women nationally. These disparities can be attributed to the underuse of cancer screening services, possibly due to cultural/linguistic barriers, low socioeconomic status, and illegal immigrant status.

Prevention of cervical cancer is possible through the use of the HPV vaccine, which protects against two strains of human papillomavirus (HPV) (16, 18) that cause 66% of cervical cancer cases. The vaccine is recommended for women (18-26), men (18-21), and girls/boys (11-17), but uptake of the HPV vaccine is low for Hispanic adolescents and young adults in Texas. A smaller proportion of Hispanic females (F) and males (M) in Texas aged 13-17 compared to Hispanic females and males nationwide receive one dose of the vaccine (F: 55% vs. 66%; M: 39% vs. 54%), and fewer receive all three doses (F: 39% vs. 47%; M: 18% vs. 28%).

These proportions fall short of the Healthy People 2020 target of 80% of females and males aged 13-15 receiving three doses and the Texas Cancer Plan 2016 target of 50%. Among Hispanic young adults in the recommended age groups nationwide, the proportion receiving one dose of the vaccine (F: 23% vs. 66%; M: 6% vs. 54%) and completing the series (F: 13% vs. 47%; M: 3% vs. 28%) is even lower compared to Hispanic adolescents nationwide.

The goal of our project is to increase HPV vaccination (initiation and completion) among underserved, predominantly low-income, Hispanic adolescent and young adult patients in four primary care practices in Hidalgo County, utilizing a provider directed intervention (PDI), health care systems-based interventions (HCSBI), and community education and outreach. The project will focus on four Nuestra Clinica del Valle (NCDV) clinics in Hidalgo County.

We will conduct formative assessments to identify and understand factors that influence HPV vaccine practices of health care providers and coverage rates in the clinics. Using a participatory approach, we will (1) review patient records to assess HPV vaccine coverage; (2) survey providers to evaluate baseline HPV vaccine knowledge, attitudes and behaviors, and practice policy; and (3) observe patients and clinic staff to understand vaccination practices in each clinic and identify barriers.

Findings will be used to set baseline levels of HPV vaccination and health care provider knowledge, and inform the development of the PDI and HCSBI to improve timely HPV immunization (initiation and completion) among patients. The PDI will emphasize meeting the ACIP recommendations for HPV vaccination and best practices for vaccination. We will also utilize existing infrastructure to implement community level education and outreach for Hidalgo County residents and training for health care professionals.

The three year project will provide a minimum of 900 patients (adolescents and young adults) with clinic-based education and serve 60 healthcare provider with our PDI. We aim for 770 total patients (adolescents and young adults) initiating the vaccine and 394 completing the vaccine series. We will also provide enhanced access to service to approximately 1,793 people by reducing out of pocket costs and offering transportation vouchers. We also aim to reach 5,800 community residents and 300 health care professionals through community education and outreach. The project will serve 6,217 total persons and at a cost of $209 per person served.

The five collaborative partners in this project are the Institute for Health Promotion Research; Lower Rio Grande Valley, Area Health Education Center; NCDV; Texas A&M University, Colonias Program; and The Texas Immunization Partnership. Our partners each make distinct contributions to the project that will have greater impact on our target population than if each acted individually. We innovatively combine multiple, evidence-based strategies and build upon existing partnerships and infrastructure between academic, public and private health clinics, and community stakeholders to increase HPV vaccine initiation and completion rates among adolescents and young adults in a medically underserved county.

Our comprehensive approach promotes vaccination best practices by training providers and clinic staff to disseminate information on HPV and the HPV vaccine, improves patient-provider communication regarding the importance of timely vaccination, and enhances healthcare systems supports related to increasing the delivery of HPV vaccinations to clinic patients. By increasing vaccine initiation and completion among Hispanic adolescents and young adults, this program has the potential to not only reduce cervical cancer incidence and mortality among Latinas in Hidalgo County, but also health disparities associated with HPV and cervical cancer.

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