PREVENT - Practice-based Approaches to Promote HPV Vaccination

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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.