The HPV vaccination offers a potentially powerful primary prevention strategy to decrease the incidence of cervical cancer. However, the HPV vaccination initiation and series completion rates among Texas adolescents remain extremely low. In 2013, only 39% of Texas girls aged 13-17 and 15% of boys aged 13-17 completed the HPV vaccine three dose series. This falls well short of the Texas Cancer Plan target of 50%.

We will initially conduct formative assessments to identify and understand factors that influence HPV vaccine practices of health care providers and HPV vaccine coverage in six South Texas Rural Health Services clinics that serve residents from four me...

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The HPV vaccination offers a potentially powerful primary prevention strategy to decrease the incidence of cervical cancer. However, the HPV vaccination initiation and series completion rates among Texas adolescents remain extremely low. In 2013, only 39% of Texas girls aged 13-17 and 15% of boys aged 13-17 completed the HPV vaccine three dose series. This falls well short of the Texas Cancer Plan target of 50%.

We will initially conduct formative assessments to identify and understand factors that influence HPV vaccine practices of health care providers and HPV vaccine coverage in six South Texas Rural Health Services clinics that serve residents from four medically underserved rural counties (Dimmit, LaSalle, Frio and Medina).

Using a community engaged approach, we will review patient charts to assess HPV vaccination coverage; survey health care providers that serve pediatric patients to assess HPV vaccine knowledge, attitudes and behaviors, and practice policy; and interview health care providers to understand individual motivation and barriers to implementing HPV immunizations as recommended by the ACIP and The Guide to Community Preventive Services on Vaccines. Needs assessment data will establish baseline levels of HPV vaccination and health care provider knowledge and practices.

It will also inform the development of a provider directed intervention (PDI) to improve timely HPV immunization (initiation and completion) among adolescent patients. The PDI will emphasize meeting the ACIP recommendations for HPV vaccination and best practices for adolescent vaccination, and include: academic detailing, audit and feedback, provider reminders and patient decision support tools to enhance provider communication and recommendation of the HPV vaccine. We will also establish Immunization Champions to implement health care system based strategies such as clinic-based education and client reminders/recalls to enhance patient access to vaccine services.

In addition to the PDI and health care system-based strategies, we will also integrate community-wide education (CE) and outreach to increase the HPV vaccine initiation and completion rates among youth by targeting health care professionals and the community. We will work with two AHECs in south central Texas to disseminate evidence-based HPV vaccine information to health care professionals in four rural counties. We will also hire and train two bilingual, bi-cultural CHW, one per AHEC, to lead the CE and outreach efforts using the EF curriculum.

The goal of this project is reach 4,000 community residents and 100 health care professionals through outreach efforts. We will provide a minimum of 1,200 adolescents and parents with HPV and HPV vaccination information through the use of clinic-based education strategies; and serve 60 healthcare practitioners through our provider directed intervention. We anticipate that these efforts will results in 480 adolescents initiating the vaccine and 270 completing the vaccine series. We will also provide enhanced access to service to approximately 1,122 people by reducing out of pocket costs and offering transportation. Thus, the total number of persons served is 4,212 and our cost is equal to $307/person served.

We combine multiple evidence-based strategies to increase rates of HPV vaccine initiation and series completion among 11-18 year old males and females in four medically underserved rural counties in south central Texas. Our multi-pronged approach promotes best practices for adolescent vaccination by training health care professionals to disseminate accurate information on HPV and the HPV vaccine and make a strong recommendation for HPV vaccination to patients and parents, and using Immunization Champions to implement healthcare system-based interventions to enhance access to vaccination services.

In addition, community-wide education (CE) and outreach will be used to promote HPV vaccination services, increase parents, caregivers and adolescent’s acceptance of HPV vaccination and foster community-clinic linkages. All training materials, decision support tools and community education materials will be culturally relevant to predominantly rural Hispanic residents in the region and be made available in English and Spanish.

Our collaborative approach leverages local knowledge, skills, and resources and that in turn increase the potential for sustainability and scalability. Increased vaccination coverage among adolescents will help reduce morbidity and mortality from infectious diseases and can help reduce or eliminate health disparities associated with these diseases, particularly HPV and cervical cancer.

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