IMPACT Project 4 – Budget impact, cost-effectiveness, and population outcomes of interventions to improve HPV vaccine communication and uptake in rural and nonrural communities

摘要-项目4 人乳头瘤病毒（HPV）癌症可以通过接种疫苗预防。HPV疫苗的接种范围 远低于80%的国家目标，特别是在HPV癌症更常见的农村地区。HPV 疫苗宣传干预措施是解决接种率低问题的一个有希望的办法。作为P01 计划项目，“改善供应商公告沟通培训（IMPACT）”，项目1-3将 在医疗保健系统中测试公告方法培训（AAT）干预的新增强功能， 改善基层医疗团队成员对HPV疫苗的沟通。项目4的总体目标是 促进决策者选择和采用AAT和其他有效的HPV疫苗接种 通过量化农村和非农村地区的比较成本和健康影响的权衡，采取干预措施。 目的1是确定农村和非农村临床环境中可能 影响增强的行政辅助技术干预措施的实施和有效性。使用混合方法 方法，我们将在农村（n=20）和非农村地区（n=20）进行半结构化访谈， 护理团队成员、质量改进决策者和卫生管理人员，以及调查a 初级保健团队成员的全国样本（n= 2，500），以检查农村和 非农村临床环境。目标2是评估预算影响、成本效益和人口 农村和非农村地区HPV疫苗宣传和其他循证干预措施的结果 临床环境，包括项目1-3中研究的增强AAT干预，以便于比较 决策。我们将开发一个国家特定的HPV微观模拟模型， 对反映基线HPV疫苗接种、HPV传播模式的人群进行干预， HPV癌症的进展，以预测预期的预算影响，成本效益和人口 农村和非农村临床环境中HPV疫苗干预的结果。目标3：帮助利益相关者 通过开发一个基于网络的交互式决策支持工具， 农村和非农村临床环境中HPV疫苗干预的价值和实施结果。我们将 让利益相关者参与评估决策支持工具对决策的可用性，并将其添加到 AAT干预包。项目4解决了IMPACT计划项目的主题，即扩增HPV 疫苗传播干预措施对卫生保健系统的影响。我们的项目成果将转化为 将项目1-3在农村和非农村地区测试的干预措施的健康影响和成本转化为传播 格式非常适合医疗保健系统决策者的需求，以加速采用 有希望的HPV疫苗传播干预措施，以预防不同地理环境中的癌症。

ABSTRACT – Project 4 Human papillomavirus (HPV) cancers are preventable through vaccination. Yet HPV vaccine coverage is well below the national goal of 80%, especially in rural areas where HPV cancers are more common. HPV vaccine communication interventions are a promising approach to address low uptake. As part of the P01 Program Project, “Improving Provider Announcement Communication Training (IMPACT),” Projects 1-3 will test novel enhancements of the Announcement Approach Training (AAT) intervention in healthcare systems to improve primary care team members' HPV vaccine communication. The overall objective of Project 4 is to facilitate decision makers' selection and adoption of AAT and other effective HPV vaccination interventions, by quantifying tradeoffs in their comparative cost and health impact in rural and nonrural areas. Aim 1 is to identify differences in contextual factors in rural and nonrural clinical settings that may influence the implementation and effectiveness of enhanced AAT interventions. Using a mixed-methods approach, we will conduct semi-structured interviews in rural (n=20) and nonrural areas (n=20) among primary care team members, quality improvement decision makers, and health administrators, as well as survey a national sample of primary care team members (n=2,500) to examine contextual differences across rural and nonrural clinical settings. Aim 2 is to evaluate the budget impact, cost-effectiveness, and population outcomes of HPV vaccine communication and other evidence-based interventions in rural and nonrural clinical settings, including the enhanced AAT interventions studied in Projects 1-3, to facilitate comparisons for decision making. We will develop a national county-specific HPV microsimulation model that overlays interventions onto populations reflecting patterns of baseline HPV vaccination, HPV transmission, and progression to HPV cancers to project the anticipated budget impact, cost-effectiveness, and population outcomes of HPV vaccine interventions in rural and nonrural clinical settings. Aim 3 is to aid stakeholder implementation planning by developing a web-based interactive decision support tool illustrating the value and implementation outcomes of HPV vaccine interventions in rural and nonrural clinical settings. We will engage stakeholders to evaluate the usability of the decision support tool for decision making and add to the AAT Intervention Package. Project 4 addresses the IMPACT Program Project theme of amplifying HPV vaccine communication interventions' impact in healthcare systems. Our project findings will translate the health impact and cost of interventions tested in Projects 1-3 in rural and nonrural areas into a dissemination format well-suited to the needs of decision makers in healthcare systems to accelerate the adoption of promising HPV vaccine communication interventions to prevent cancer in diverse geographic contexts.