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

项目摘要/摘要 正如NCI强调的那样，人类乳头瘤病毒(HPV)疫苗接种率低是一个主要损失 为全人口预防癌症提供机会。几乎所有的宫颈癌，90%的肛门癌，~60%的 某些类型的口咽癌以及40%的阴道癌、外阴癌和阴茎癌是由 人乳头瘤病毒，一种性传播感染。每年有620万人新感染HPV，2.6万人感染 新的HPV相关癌症被诊断出来，导致每年40亿美元的医疗费用。HPV疫苗接种 在预防疫苗株特异性生殖器疣、原位腺癌、喉咙、 但是，低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，然后 性行为的开始。尽管如此，2014年，只有60%的13-17岁的女孩和42%的男孩发起了这一系列活动。 儿科初级保健办公室访问是接种HPV疫苗的主要地点，但许多机会错失了 接种疫苗的主要目标(MO)发生在初级保健中，导致疫苗接种率较低。MOS是在办公室访问期间 哪些患者有资格接种疫苗，但没有接种。造成MOS的因素很多--提供者因素 (例如，时间有限的访问、缺乏沟通技能以及仅在预防性访问时接种疫苗) 以及父母因素(例如，疫苗迟疑)。免疫专家建议采取多成分干预措施 预防MOS并提高利率，因为它们放大了单一成分干预的好处。然而， 很难确定哪些成分在多成分干预中起作用。我们提出了一个多阶段的 研究认为，首先将测试3个有希望的组件的影响，然后测试3个组件捆绑的影响。 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： 关于HPV疫苗沟通的培训提供者和办公室工作人员，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，并向提供商提供关于其MO的绩效反馈。使用 国家初级保健实践网络(本研究为60个实践；&gt；99,000名青少年)，我们将测试其影响 每项干预措施的影响，然后是3项干预措施对减少MOS和改善HPV的影响 接种率。我们的研究有四个目标：目标1：测量Stop-HPV各组分对：(A)MO的影响 (B)人乳头状瘤病毒疫苗接种率；目标2：衡量3部分捆绑对：(A)MO率和(B)的影响 人乳头状瘤病毒疫苗接种率；目标3：评估在取消对人乳头状瘤病毒疫苗接种率的支助后对该捆绑疫苗的维持情况 研究小组和目标4：衡量实施成本和干预措施的成本效益。 然后我们将使用美国科学院在全国范围内传播最有效的组件 儿科维护认证计划，面向全美64,000名儿科医生。

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.