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 人类乳头瘤病毒(HPV)癌症可以通过接种疫苗来预防。然而，HPV疫苗的覆盖率是 远低于80%的国家目标，特别是在HPV癌症更常见的农村地区。人类乳头瘤病毒 疫苗传播干预是解决低接种率的一种有前景的方法。作为P01的一部分 计划项目“改善提供商公告沟通培训(Impact)”，项目1-3将 测试医疗保健系统中公告方法培训(AAT)干预的新增强功能 改善初级保健团队成员对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 通过量化其在农村和非农村地区的相对成本和健康影响的权衡，采取干预措施。 目标1是确定农村和非农村临床环境中上下文因素的差异，这些因素可能 影响AAT强化干预措施的实施和有效性。使用混合方法 方法，我们将在农村地区(n=20)和非农村地区(n=20)小学进行半结构化访谈 护理团队成员、质量改进决策者和健康管理人员，以及调查 全国初级保健团队成员样本(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疫苗传播和其他循证干预的结果 临床环境，包括项目1-3中研究的增强的AAT干预措施，以便于比较 做决定。我们将开发覆盖全国县的HPV微观模拟模型 对人群的干预措施反映了基线HPV疫苗接种、HPV传播和 发展到HPV癌症，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是帮助利益相关者 通过开发基于Web的交互式决策支持工具进行实施规划，以说明 HPV疫苗干预在农村和非农村临床环境中的价值和实施结果。我们会 让利益相关者参与评估决策支持工具的可用性，并增加 AAT干预一揽子计划。项目4涉及放大HPV的影响方案项目主题 疫苗传播干预措施对医疗保健系统的影响。我们的项目调查结果将把 在农村和非农村地区传播项目1-3中测试的干预措施的健康影响和费用 非常适合医疗保健系统决策者的需求的格式，以加速采用 前景看好的HPV疫苗交流干预措施，可在不同地理环境下预防癌症。

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.