Improving HPV Vaccination Rates: A Stepped-Wedge Randomized Trial.

Area of Science:

• Public Health
• Preventive Medicine
• Vaccinology

Background:

• Human Papillomavirus (HPV) infection is a major cause of cervical and other cancers.
• Low HPV vaccination rates remain a public health concern, necessitating effective intervention strategies.
• Multilevel interventions in primary care settings show promise for improving vaccination uptake.

Purpose of the Study:

• To evaluate the effectiveness of the Development of Systems and Education for Human Papillomavirus Vaccination (DOSE HPV) intervention.
• To assess the impact of a multilevel intervention on HPV vaccine initiation and completion rates among adolescents.
• To determine if the intervention's effects on HPV vaccination persist beyond the intervention period.

Main Methods:

• A stepped-wedge randomized trial design was employed across five primary care practices.
• The DOSE HPV intervention included provider education, communication training, data feedback, and systems changes.
• Vaccination rates were analyzed using random-effects generalized linear regression models, comparing preintervention, intervention, and postintervention periods.

Main Results:

• The intervention significantly increased the likelihood of HPV vaccination at eligible visits for adolescents aged 9-12 by over 10 percentage points.
• Completion of the HPV vaccine series by age 13 improved by 4 percentage points (P < .001).
• Population-level vaccine initiation increased from 75% to 90%, and completion increased from 60% to 69% from preintervention to postintervention.

Conclusions:

• Multilevel interventions incorporating provider education, data feedback, and systems changes can enhance HPV vaccine series initiation and completion.
• The DOSE HPV intervention demonstrated sustained improvements in vaccination rates, extending beyond the intervention period.
• Early initiation of the HPV vaccine series, coupled with comprehensive interventions, is crucial for improving public health outcomes.