IMPACT Project 3 – Engaging clinical champions to improve HPV vaccine communication and uptake in healthcare systems

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ABSTRACT – Project 3 Widespread HPV vaccination could prevent most HPV cancers, but uptake among US adolescents remains far below national goals. To increase uptake, we developed Announcement Approach Training (AAT). AAT is a 1-hour communication workshop in which our physician facilitators train primary care teams to address the most critical barrier to HPV vaccination: infrequent and ineffective recommendations. AAT is effective for increasing HPV vaccine uptake among adolescents and is certified as an NCI Research-Tested Intervention Program. One of the most promising opportunities for scaling up AAT is to implement the intervention in healthcare systems, where most US pediatricians and family physicians now work. However, new approaches to delivering AAT will be needed to bring the intervention to scale effectively in these settings. Thus, as part of the P01 Program Project, “Improving Provider Announcement Communication Training (IMPACT),” Project 3 will enhance AAT to train systems' own clinical champions to deliver AAT, thereby building capacity for HPV vaccine communication training. In Aim 1, we will identify opportunities to engage clinical champions in delivering AAT within their own healthcare systems. Working with 6 partnering healthcare systems, we will interview 24 champions to understand: anticipated barriers and facilitators to AAT delivery; opportunities to extend AAT activities to increase reach and sustainability; and preferences for receiving training on how to deliver AAT. In Aim 2, we will compare the impact of Champion AAT to Traditional AAT on HPV vaccine uptake and communication. Using Aim 1 findings, we will adapt our existing intervention package to train champions to deliver AAT to clinics in their own systems. In a 2-arm non-inferiority trial, we will randomize 40 clinics in our 6 systems to receive Champion AAT or Traditional AAT. We will compare interventions on the primary outcome of HPV vaccine initiation, among adolescents ages 11- 12, at 12-month follow-up. We hypothesize that Champion AAT will be non-inferior to (i.e., as effective as) Traditional AAT. We will also compare our interventions on intermediate outcomes, including changes in workshop participants' communication, to identify mechanisms that may explain improvements in HPV vaccine uptake. In Aim 3, we will generate guidance to help healthcare systems compare and implement Champion AAT and Traditional AAT. We will compare our interventions on implementation measures to understand whether Champion AAT offers advantages, such as higher reach to primary care professionals, compared to Traditional AAT. Lastly, to integrate Project 3 with other IMPACT projects, we will share data to support cost-effectiveness modeling in Project 4 and contribute the Champion AAT module to the P01-wide AAT Intervention Package. In this way, we will prepare our highly scalable intervention for national dissemination. Project 3 addresses the IMPACT Program Project theme by engaging clinical champions to build capacity for HPV vaccine communication interventions among primary care teams in healthcare systems.