Increasing HPV Vaccine Uptake in a Low Income Ethnic Minority Population

描述（由申请人提供）：洛杉矶县的宫颈癌发病率明显高于全国平均水平，拉丁裔和亚洲/太平洋岛民的发病率最高。HPV作为宫颈癌主要致病因子的发现以及随后HPV疫苗的开发彻底改变了宫颈癌预防的潜力。然而，美国适龄女孩的疫苗使用率仍然低得令人无法接受，包括最高风险群体。加州大学洛杉矶分校公共卫生学院和琼森综合癌症中心与洛杉矶县公共卫生部妇女健康办公室（OWH）合作，以解决洛杉矶宫颈癌的不平等负担。该研究的主要目标是在一项随机试验中评估一种理论驱动的，文化敏感的和个性化的干预措施，以增加洛杉矶服务不足的高危女孩的HPV疫苗接种。干预措施将通过OWH现有的电话教育和服务转介热线以六种语言（英语、西班牙语、广东话、普通话、韩语、亚美尼亚语）提供。针对适龄女孩（11-18岁）的母亲的多组分干预将包括简短的电话干预，提供基本的HPV疫苗信息，个性化定制的信息，以解决呼叫者对HPV疫苗接种的障碍，并有针对性地转诊到提供低成本/免费疫苗的诊所。还将向与会者邮寄一份专门印刷的发言稿，以加强电话信息。对照组将接受常规护理和关于HPV疫苗的标准CDC情况说明书。主要结果将是在与母亲进行3个月电话随访时评估的年龄合格女孩（至少接受一剂疫苗）中的疫苗启动情况。9个月随访将评估疫苗完成率（接受3剂系列）和疫苗剂量开始和完成的总体模式。该研究还试图描述目标人群中HPV相关知识、信念和障碍的特征，并了解介导因素（例如，知识，减少障碍），通过这些措施可以达到预期的效果。干预措施对样本亚组的不同影响（例如，文化上的差异也将被评估。这项研究是创新的，因为我们正在与县卫生系统合作，这是我们目标人群唯一现实的卫生保健来源。县公共卫生部门致力于增加HPV疫苗的接种和利用现有的县基础设施（OWH热线）进行干预，这将确保在试验完成后将干预措施制度化。

DESCRIPTION (provided by applicant): Cervical cancer incidence in Los Angeles County is significantly higher than the national average, with highest rates among Latinas and Asian/Pacific Islanders. The discovery of HPV as the primary causal agent in cervical cancer and subsequent development of HPV vaccines have revolutionized the potential for cervical cancer prevention. However, vaccine utilization rates in the US remain unacceptably low among age-eligible girls, including among the highest risk groups. The UCLA School of Public Health & Jonsson Comprehensive Cancer Center have teamed with the Los Angeles County Department of Public Health, Office of Women's Health (OWH) to address the unequal burden of cervical cancer in Los Angeles. The primary goal of the study is to evaluate, in a randomized trial, a theoretically driven, culturally sensitive and individually tailored intervention to increase HPV vaccine receipt among underserved, high risk girls in Los Angeles. The intervention will be delivered via the existing OWH telephone education and service referral hotline in six languages (English, Spanish, Cantonese, Mandarin, Korean, Armenian). The multi-component intervention, directed at mothers of age-eligible girls (11-18 years), will consist of a brief telephone intervention that will deliver basic HPV vaccine information, individually tailored messages to address callers' barriers to HPV vaccination, and tailored referral to a clinic offering low cost/free vaccine. A tailored print intervention reinforcing the telephone messages will also be mailed to participants. The control group will receive usual care and a standard CDC fact sheet on the HPV vaccine. The primary outcome will be vaccine initiation among age-eligible girls (receipt of at least one vaccine dose) assessed at a 3 month telephone follow-up with mothers. A 9 month follow-up will assess vaccine completion rates (receipt of 3-dose series) and overall patterns of vaccine dose initiation and completion. The study also seeks to characterize HPV related knowledge, beliefs and barriers in the target population, and understand the mediators (e.g., knowledge, barriers reduction) through which the intervention may have achieved its desired effect. Differential effects of the intervention on subgroups of the sample (e.g., more acculturated) will also be assessed. The study is innovative in that we are partnering with the county health system which is the only realistic source of health care for our target population. The commitment of the county department of public health to increasing HPV vaccine uptake and the utilization of existing county infrastructure (the OWH hotline) for intervention delivery will ensure institutionalization of the intervention upon trial completion.