PREVENT - Practice-based Approaches to Promote HPV Vaccination

摘要 人乳头瘤病毒(HPV)感染是超过3.6万例新发宫颈癌病例的主要原因。 在美国，每年都有生殖器癌和口咽癌。同时预防多价疫苗接种 HPV感染自2006年以来一直存在，疫苗接种量远低于国民健康水平 2030年人口目标(80%的13-15岁青少年接种了最新的HPV疫苗)。青少年 农村地区的疫苗接种率特别低(约比城市地区低11%)。与城市相比 居民，农村居民HPV相关癌症的发病率较高，并面临着独特的HPV障碍 接种疫苗，包括有限地接触提供者，更少的疫苗提醒，更长的前往诊所的旅行时间，以及 关于接种HPV疫苗的社会规范不太受欢迎。此外，农村青少年比他们的孩子更不可能 城市对口单位将收到HPV疫苗提供者的推荐。农村医疗团队是 通常受限于缺乏系统的方法来识别和跟踪符合条件的患者和/或他们的父母 外展。虽然很多人都知道以临床为基础的方法来改善城市人群中的HPV疫苗接种 居民，农村居民，包括农村拉美裔人口，对他们的有效性了解较少， 农村地区增长最快的亚群人口。拟议的研究旨在解决这些问题 通过调整和测试有效宣传疫苗接种重要性的方法来设置障碍 提高农村人口和其中的亚群(如西班牙裔)的HPV疫苗接种率 人)。我们的研究包括对改编提醒的随机对照试验，以满足以下需求 多样化的农村人口。我们将建立诊所系统，促进符合条件的儿童/青少年接种疫苗 并向父母/照顾者传递信息，他们的模式和内容专门为农村和农村量身定做 西班牙裔人口。我们在安全网中推广HPV疫苗接种的研究和实践 (预防)，结合形成性的患者和临床知情研究来设计和评估自动化 使用低成本方法(自动电话和短信)的数据驱动提醒干预。我们 将常规护理与自动患者提醒以及使用更高强度的干预手臂进行比较 自动消息加上在语言和文化上量身定做的干预措施，以提供实时提醒， Automated Plus Live患者提醒。预防的设计和评估将涉及到定制信息 为农村和多民族农村患者的父母和照顾者提供的模式和内容。这项研究将有助于 作为首批制定和测试推广HPV疫苗接种策略的有效性的机构之一 西部山区多样化的农村患者。我们强大的研究团队展示了成功的合作伙伴关系 在农村人口中开展初级保健实践。一旦付诸实施，我们的干预可能会减少 美国HPV相关癌症的城乡差异。

ABSTRACT Human papillomavirus (HPV) infection is the leading cause of over 36,000 new cancer cases of cervical, ano- genital, and oropharyngeal cancers in the United States each year. While multi-valent vaccinations to prevent HPV infections have been available since 2006, uptake of the vaccine is well below national Healthy People 2030 targets (80% of adolescents at ages 13-15 years up-to-date with HPV vaccination). Adolescent vaccination rates are especially low in rural areas (about 11% lower than in urban areas). Compared to urban residents, rural residents have a higher incidence of HPV-related cancers and face unique barriers to HPV vaccination, including limited access to providers, fewer vaccine reminders, longer travel time to clinics, and less favorable societal norms about HPV vaccination. Moreover, rural adolescents are less likely than their urban counterparts to receive a provider recommendation for the HPV vaccine. Rural healthcare teams are often limited by a lack of systematic methods to identify and track eligible patients and/or their parents for outreach. While much is known about clinic-based approaches to improve HPV vaccination among urban residents, less is known about their effectiveness among rural residents, including rural Hispanic populations, the fastest growing sub-population in rural settings. The proposed study is designed to address these barriers by adapting and testing approaches to effectively communicate the importance of vaccination to improve HPV vaccination rates for rural populations, and the sub-populations within (e.g. Hispanic persons). Our study includes a randomized controlled trial of adapted reminders to address the needs of diverse rural populations. We will create clinic systems to prompt vaccination for eligible children/adolescents and deliver messages to parents/caregivers, whose mode and content is specifically tailored for rural and rural Hispanic populations. Our study, Practice-based Approaches to Promote HPV Vaccination in the Safety Net (PREVENT), incorporates formative patient- and clinic-informed research to design and evaluate an automated data-driven reminder intervention using low-cost approaches (automated phone calls and text messages). We will compare usual care to Automated Patient Reminders, and to a higher-intensity intervention arm using automated messages plus linguistically and culturally tailored interventions to deliver live reminders, Automated Plus Live Patient Reminders. PREVENT’s design and evaluation will involve tailoring message mode and content for parents and caregivers of rural and ethnically diverse rural patients. This study will serve as one of the first to develop and test the effectiveness of strategies to promote HPV vaccination among diverse rural patients in the Mountain West. Our strong research team demonstrates successful partnerships with primary care practices in rural populations. Once implemented into practice, our intervention could reduce rural/urban disparities in HPV-associated cancers in the US.