Abstract
Changes in the routine immunization schedule are common and may pose challenges to primary care clinics. We sought to assess the experiences of U.S. providers and clinic staff during the introduction of 9-valent HPV vaccine. In 2015–2016, we conducted a survey in a probability sample of 127 pediatric (40%) and family medicine (60%) clinics in three U.S. states. The 211 respondents included clinicians (63%) and staff (37%). Overall, 83% of clinics stocked 9-valent HPV vaccine, with adoption ranging from 60% among early respondents to 100% among later respondents. Almost all respondents believed that providers in their clinics would recommend the 9-valent vaccine as strongly as (66%) or more strongly than (33%) the quadrivalent vaccine. Over half (61%) had no concerns about the 9-valent vaccine, while others reported concerns about increased parental hesitancy (29%), private insurance coverage (17%), or other issues (10%). Respondents from pediatric versus family medicine clinics more often reported a concern (OR = 2.06, 95% CI 1.02–4.15). Among the 169 respondents who stocked 9-valent vaccine, about half (56%, n = 94) anticipated that providers in their clinics would recommend a “booster” dose of 9-valent HPV vaccine for adolescents who had completed the 3-dose series with prior versions. Among the 42 respondents who did not stock 9-valent vaccine, few (17%, n = 7) believed providers would recommend adolescents delay vaccination until it was available. In conclusion, providers and staff generally had positive views of 9-valent HPV vaccine and many had no concerns. For others, responses regarding parental hesitancy, insurance coverage, and the use of booster doses suggests opportunities for enhancing future educational support.
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References
Cohen, N. J., Lauderdale, D. S., Shete, P. B., Seal, J. B., & Daum, R. S. (2003). Physician knowledge of catch-up regimens and contraindications for childhood immunizations. Pediatrics, 111(5), 925–932.
Leask, J., Kinnersley, P., Jackson, C., Cheater, F., Bedford, H., & Rowles, G. (2012). Communicating with parents about vaccination: A framework for health professionals. BMC Pediatrics, 12, 154. doi:10.1186/1471-2431-12-154.
Fontenot, H. B., Domush, V., & Zimet, G. D. (2015). Parental attitudes and beliefs regarding the nine-valent human papillomavirus vaccine. Journal of Adolescent Health, 57(6), 595–600.
Markowitz, L. E., Dunne, E. F., Saraiya, M., Lawson, H. W., Chesson, H., & Unger, E. R. (2007). Quadrivalent human papillomavirus vaccine—recommendations of the advisory committee on immunization practices (ACIP). Morbidity and Mortality Weekly Report Recommendations and Reports, 56(RR-2), 1–24.
Centers for Disease Control and Prevention (CDC). (2010). FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 59(20), 630–632.
Petrosky, E., Bocchini, J. A., Hariri, S., Chesson, H., Curtis, C. R., Saraiya, M., et al. (2015). Use of 9-Valent human papillomavirus (HPV) vaccine: Updated HPV vaccination recommendations of the advisory committee on immunization practices. Morbidity and Mortality Weekly Report, 64(11), 300–304.
Meites, E., Kempe, A., & Markowitz, L. E. (2016). Use of a 2-dose schedule for human papillomavirus vaccination: Updated recommendations of the advisory committee on immunization practices. Morbidity and Mortality Weekly Report, 65(49), 1405–1408.
Markowitz, L. E., Dunne, E. E., Saraiya, M., Chesson, H. W., Curtis, C. R., Gee, J., et al. (2014). Human papillomavirus vaccination recommendations of the advisory committee on immunization practices (ACIP). Morbidity and Mortality Weekly Report Recommendations and Reports, 63(RR-05), 1–30.
Desai, M., & Begg, M. D. (2008). A comparison of regression approaches for analyzing clustered data. American Journal of Public Health, 98(8), 1425–1429.
Brewer, N. T., Gottlieb, S. L., Reiter, P. L., McRee, A. L., Liddon, N., Markowitz, L., & Smith, J. S. (2011). Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic area. Sexually Transmitted Diseases, 38(3), 197–204.
Liddon, N. C., Hood, J. E., & Leichliter, J. S. (2012). Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: Findings from the 2006–2008 National Survey of Family Growth. Vaccine, 30(16), 2676–2682.
Gilkey, M. B., Moss, J. L., Coyne-Beasley, T., Hall, M. E., Shah, P. D., & Brewer, N. T. (2015). Physician communication about adolescent vaccination: How is human papillomavirus vaccine different? Preventive Medicine, 77, 181–185.
Kasting, M. L., Wilson, S., Dixon, B. E., Downs, S. M., Kulkarni, A., & Zimet, G. D. (2016). A qualitative study of healthcare provider awareness and informational needs regarding the nine-valent HPV vaccine. Vaccine, 34(11), 1331–1334.
Healy, C. M., Montesinos, D. P., & Middleman, A. B. (2014). Parent and provider perspectives on immunization: Are providers overestimating parental concerns? Vaccine, 32(5), 579–584.
Farmar, A.-L. M., Love-Osborne, K., Chichester, K., Breslin, K., Bronkan, K., & Hambidge, S. J. (2016). Achieving high adolescent HPV vaccination coverage. Pediatrics, 138(5), e20152653.
Centers for Disease Control and Prevention (CDC). (2016). You are the key to HPV cancer prevention. Retrieved July 28, 2017, from https://www.cdc.gov/vaccines/ed/hpv/index.html.
Conroy, K., Rosenthal, S. L., Zimet, G. D., Jin, Y., Bernstein, D. I., Glynn, S., & Kahn, J. A. (2009). Human papillomavirus vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination. Journal of Womens Health, 18(10), 1679–1686.
Schluterman, N. H., Terplan, M., Lydecker, A. D., & Tracy, J. K. (2011). Human papillomavirus (HPV) vaccine uptake and completion at an urban hospital. Vaccine, 29(21), 3767–3772.
NCQA. HEDIS 2016. (2016). Retrieved July 28, 2017, from http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2016.
Centers for Disease Control and Prevention. (2016). Supplemental information and guidance for vaccination providers regarding use of 9-valent HPV vaccine. Retrieved July 28, 2017 from https://www.cdc.gov/hpv/downloads/9vhpv-guidance.pdf.
Funding
Data collection was supported by a grant from the Robert Wood Johnson Foundation (71272 for MB). Authors’ time was supported by grants from the National Cancer Institute (K22 CA186979 for MG; R25 CA116339 for WC).
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Kornides, M.L., Calo, W.A., Heisler-MacKinnon, J.A. et al. U.S. Primary Care Clinics’ Experiences During Introduction of the 9-Valent HPV Vaccine. J Community Health 43, 291–296 (2018). https://doi.org/10.1007/s10900-017-0420-x
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DOI: https://doi.org/10.1007/s10900-017-0420-x