Improving HPV Vaccination Delivery in Pediatric Primary Care: The STOP-HPV Trial

项目概要/摘要 正如NCI所强调的那样，人乳头瘤病毒（HPV）疫苗接种率低是一个主要的损失。 全民癌症预防的机会。几乎所有的宫颈癌，90%的肛门癌，约60%的 某些类型的口咽癌和40%的阴道、外阴和阴茎癌是由 HPV是一种性传播感染。每年有620万人新感染HPV，26，000人新感染HPV 新的HPV相关癌症被诊断出来，导致每年超过40亿美元的医疗费用。HPV疫苗接种 对预防疫苗株特异性生殖器疣、原位腺癌、咽喉、 肛门癌和宫颈癌，但低疫苗接种率使许多人容易感染HPV疾病。 国家指南建议女孩和男孩从11岁开始接种3剂HPV疫苗， 性行为的开始尽管如此，在2014年，只有60%的13- 17岁的女孩和42%的男孩甚至开始了这个系列。 儿童初级保健办公室访问是HPV疫苗接种的主要场所，但许多机会被错过 (MOs)接种疫苗的情况发生在初级保健中，导致接种率低。MO是指在 患者有资格接种疫苗，但没有接种。许多因素导致MO-提供者因素 (e.g.,就诊时间有限，缺乏沟通技巧，仅在预防性就诊时接种疫苗） 和父母因素（例如，疫苗犹豫）。免疫专家建议多组分干预 防止MOs和提高利率，因为它们放大了单一成分干预措施的好处。然而 难以确定在多组分干预中哪些组分起作用。我们提出了一个多阶段 这项研究将首先测试3个有希望的组件的影响，然后测试3个组件的捆绑的影响。 我们的初步研究表明，3种干预措施有望减少HPV疫苗接种的MO： 培训提供者和办公室工作人员关于HPV疫苗的沟通，提示提供者提醒他们 在任何访问中为符合条件的青少年接种疫苗，并向提供者提供有关其MO的绩效反馈。处理一个 全国初级保健实践网络（本研究60个实践; > 99，000名青少年），我们将测试其影响 每种干预措施的有效性，以及3种干预措施对减少MOs和改善HPV的影响 疫苗接种率。我们的研究有4个目的：目的1：测量STOP-HPV的每个组分对以下的影响：（a）MO 目标2：衡量三部分组合对以下方面的影响：（a）MO率和（B）HPV疫苗接种率 HPV疫苗接种率;目标3：评估在撤销对HPV疫苗的支持后， 目标4：衡量干预措施的实施成本和成本效益。 然后，我们将利用美国科学院在全国范围内传播最有效的成分。 儿科的认证计划，这是提供给64,000儿科医生在美国各地。

Project Summary/Abstract As highlighted by NCI, low human papillomavirus (HPV) vaccination rates represent a major lost opportunity for population-wide cancer prevention. Nearly all cervical cancer, 90% of anal cancers, ~60% of certain types of oropharyngeal cancers, and 40% of cancers of the vagina, vulva, and penis are caused by HPV, a sexually transmitted infection. Each year, 6.2 million persons are newly infected with HPV and 26,000 new HPV-related cancers are diagnosed, resulting in >$4 billion in annual medical expenses. HPV vaccination has extremely high efficacy in preventing vaccine strain-specific genital warts, adenocarcinoma in-situ, throat, anal, and cervical cancer, but low vaccination rates leave many individuals susceptible to HPV disease. National guidelines recommend vaccination of girls and boys starting at age 11yrs with 3 doses of HPV prior to onset of sexual activity. Still, in 2014, only 60% of 13-17yr girls and 42% of boys had even initiated the series. Pediatric primary care office visits are the main site for HPV vaccination, yet many missed opportunities (MOs) for vaccination occur in primary care and contribute to low vaccination rates. MOs are office visits during which a patient is eligible for a vaccine, but does not receive it. Many factors cause MOs-- provider factors (e.g., time-constrained visits, lack of communication skills, and giving vaccinations only at preventive visits) and parent factors (e.g., vaccine hesitancy). Immunization experts recommend multi-component interventions to prevent MOs and raise rates because they magnify the benefits of single-component interventions. However it is difficult to determine which components work in a multi-component intervention. We propose a multi-phase study that will first test the impact of 3 promising components, and then test the impact of a bundle of the 3. Our preliminary studies suggest that 3 interventions have promise in reducing MOs for HPV vaccination: training providers and office staff on HPV vaccine communication, prompts for providers to remind them to vaccinate eligible teens at any visit, and performance feedback to providers about their MOs. Working with a national network of primary care practices (60 practices for this study; >99,000 teens), we will test the impact of each intervention and then the impact of the bundle of 3 interventions on reducing MOs and improving HPV vaccine rates. Our study has 4 aims: Aim 1: Measure the effect of each component of STOP-HPV on: (a) MO rates and (b) HPV vaccination rates; Aim 2: Measure the effect of the 3-part bundle on: (a) MO rates and (b) HPV vaccination rates; Aim 3: Assess maintenance of the bundle following withdrawal of support from the research team and Aim 4: Measure implementation costs and cost-effectiveness of the interventions. We will then disseminate the most effective components nationally using the American Academy of Pediatrics' maintenance of certification program which is available to 64,000 pediatricians across the US.