This application is to fund a fourth cycle of the highly successful postpartum HPV vaccination program at the University of Texas Medical Branch (UTMB) conducted in collaboration with the University of Texas Rio Grande Valley (UTRGV). In the next cycle, we will expand our catchment area to 32 counties which span four Public Health Regions (PHR 4/5N, 6/5S, 7, and 11) in east and south Texas. Seven of the counties we will serve are federally recognized medical underserved areas (MUAs) and 18 are MUA/Rural. Many of these women are at higher risk of cervical cancer than the rest of Texas (10.6 cases per 100,000 population in PHR 5/east Texas and 10.4 in PHR 11/Rio Grande Valley as comp...

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This application is to fund a fourth cycle of the highly successful postpartum HPV vaccination program at the University of Texas Medical Branch (UTMB) conducted in collaboration with the University of Texas Rio Grande Valley (UTRGV). In the next cycle, we will expand our catchment area to 32 counties which span four Public Health Regions (PHR 4/5N, 6/5S, 7, and 11) in east and south Texas. Seven of the counties we will serve are federally recognized medical underserved areas (MUAs) and 18 are MUA/Rural. Many of these women are at higher risk of cervical cancer than the rest of Texas (10.6 cases per 100,000 population in PHR 5/east Texas and 10.4 in PHR 11/Rio Grande Valley as compared to the 8.3 overall rate in Texas). Postpartum women receiving care at these two universities are especially at risk. Over two-thirds of those who deliver an infant at UTMB and 93% at UTRGV are Hispanic or Black, groups at increased risk of cervical cancer morbidity and mortality. Both universities have a steady stream of new patients, most who are unvaccinated or incompletely vaccinated against HPV. In fact, a survey of female patients between 2020-2022 found that only about 40% of those in our target population had received at least one dose in comparison to the Texas average of 55%. Barriers include the prohibitive cost of the vaccine, lack of access to accurate information, lack of a provider recommendation, and inadequate follow-up after the series is initiated. Our postpartum intervention addresses all these barriers by having patient navigators (PNs) educate patients and offer the vaccine at no cost while they are in the hospital after delivery and at postpartum visits. PNs remind patients about follow-up appointments and keep in close contact until all doses are complete. Finally, our team will continue to educate medical and nursing students, residents, and community physicians on the importance of counseling all eligible patients on this vaccine and teach them how to administer it. • Overall Project Strategy: Our tremendous success in the first three cycles demonstrates that the postpartum period is an excellent time to identify women not protected against HPV and provide them with this life-saving vaccine. Our unique approach has been especially effective among low-income patients who often do not seek out vaccination services on their own. Since women remain in the hospital for 24-72 hours after delivery, there is adequate time for our PNs to review their medical records for prior vaccination and provide those who are unvaccinated or incompletely vaccinated one-on-one counseling regarding the importance of bringing them up-to-date. This approach allows patients to form relationships with the PNs who then provide continuing assistance after discharge and help ensure that the series is completed. Extensive provider education allows us to indirectly reach even more individuals. In the next cycle, we will expand our geographic reach even further by adding two more counties in the Rio Grande Valley near the Texas-Mexico border. Expanding our services from 30 to 32 counties is highly feasible as we have already developed efficient methods for reviewing medical records, approaching and counseling patients, and providing follow-up services. • Specific Goals: An established team of PNs already working on this project in both locations will continue to implement our proven approach to increasing vaccination rates among low-income women. They will review 6000-7000 medical records of age-eligible women from the 32 participating counties who deliver an infant and determine if they have been previously vaccinated. We will identify and educate at least 2826 women on the importance of receiving this vaccine. PNs will provide appointment assistance and reminders by phone and text until patients complete all required doses. During the three years of the project, we will provide a minimum of 1754 initial doses and 3241 follow-up HPV vaccine doses. We will also educate 500 providers though our collaborations with medical societies and heath professional training programs. • Significance and Impact: Our unique approach will allow us to continue to administer the HPV vaccine to a vulnerable population with low vaccination rates from a wide geographic area in Texas. During our first three cycles of funding, we demonstrated that the postpartum period is an opportune time to offer the HPV vaccine as this approach addresses numerous barriers. Thus far, we have delivered almost 15,000 doses to 6229 women. Furthermore, initiation and completion rates have surpassed state and national averages. By adding two new counties to our network, we will serve even a larger area and deliver more vaccines to women who would not otherwise have access. This will allow us to prevent even more cases of HPV-related cancers across a vast region of Texas.

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