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

摘要-项目3 广泛接种HPV疫苗可以预防大多数HPV癌症，但美国青少年中的感染情况 仍然远远低于国家目标。为了增加吸收，我们开发了公告方法培训(AAT)。 AAT是一个1小时的沟通研讨会，我们的医生辅导员在其中培训初级保健团队 解决HPV疫苗接种的最关键障碍：不经常和无效的建议。AAT是 有效增加青少年的HPV疫苗接种率，并被认证为NCI研究测试 干预计划。扩展AAT最有希望的机会之一是实施 对医疗系统的干预，目前大多数美国儿科医生和家庭医生都在医疗系统工作。然而， 需要新的方法来提供AAT，以使干预在这些环境中有效地扩大规模。 因此，作为P01计划项目的一部分，《改善提供商公告沟通培训 项目3将加强AAT，以培训系统自己的临床冠军来提供AAT，从而 HPV疫苗传播培训能力建设。在目标1中，我们将确定以下机会 让临床冠军在他们自己的医疗系统中提供AAT。使用6 与医疗保健系统合作，我们将采访24家冠军企业，以了解：预期的障碍和 AAT交付的促进者；扩大AAT活动以扩大覆盖范围和可持续性的机会；以及 优先接受有关如何提供AAT的培训。在目标2中，我们将比较冠军的影响 AAT与传统AAT在HPV疫苗接种率和沟通上的差异。使用AIM 1的调查结果，我们将适应 我们现有的干预方案旨在培训冠军，在他们自己的系统中向诊所提供AAT。在双臂中 在非劣势试验中，我们将在我们的6个系统中随机选择40家诊所接受冠军AAT或传统AAT。 我们将在11岁的青少年中比较HPV疫苗接种的主要结果的干预措施。 12个月，随访12个月。我们假设冠军AAT将不逊于(即，同样有效) 传统的AAT。我们还将比较我们的干预措施对中期结果的影响，包括 研讨会参与者之间的沟通，以确定可能解释HPV疫苗改进的机制 领悟。在目标3中，我们将生成指导，以帮助医疗保健系统比较和实施 冠军AAT和传统AAT。我们将把我们关于执行措施的干预措施与 了解冠军AAT是否提供优势，例如为初级保健专业人员提供更高的覆盖范围， 与传统的AAT相比。最后，为了将项目3与其他Impact项目集成，我们将共享数据以 支持项目4的成本效益建模，并为P01-Wide贡献冠军AAT模块 AAT干预一揽子计划。通过这种方式，我们将为国家干预做好高度可扩展的准备 传播。项目3通过邀请临床冠军来解决Impact Program项目主题 在医疗保健系统的初级保健团队之间建立HPV疫苗沟通干预的能力。

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.