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作为宫颈癌的主要致病因子的发现和随后HPV疫苗的开发已经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，包括高危人群。加州大学洛杉矶分校公共卫生学院和约翰逊综合癌症中心与洛杉矶县公共卫生部门妇女健康办公室（OWH）合作，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、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疫苗接种率。干预措施将通过卫生保健中心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）母亲的多部分干预措施将包括简短的电话干预，提供基本的人乳头瘤病毒疫苗信息，个别定制的信息，以解决致电者对人乳头瘤病毒疫苗接种的障碍，以及量身定制的转诊到提供低成本/免费疫苗的诊所。还将向参与者邮寄一份量身定制的印刷品，以加强电话信息。对照组将接受常规护理和一份标准的疾病预防控制中心关于HPV疫苗的情况说明书。主要结果将是在与母亲进行为期3个月的电话随访时评估符合年龄的女孩开始接种疫苗（至少接种一剂疫苗）。为期9个月的随访将评估疫苗完成率（接受3剂系列）以及疫苗剂量开始和完成的总体模式。该研究还试图确定目标人群中HPV相关知识、信念和障碍的特征，并了解干预可能达到预期效果的中介因素（例如，知识、减少障碍）。还将评估干预对样本亚组（例如，更适应文化的群体）的不同影响。这项研究的创新之处在于，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。县公共卫生部门承诺增加人乳头瘤病毒疫苗的接种率，并利用现有的县基础设施（卫生保健热线）提供干预措施，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.