Feasibility and Acceptability of Recommending HPV Vaccine at Ages 9-10 Years

The human papillomavirus (HPV) vaccine is routinely recommended at ages 11-12 and may be given as early as ages 9-10 years. We assessed primary care clinician and staff experiences with feasibility and acceptability of initiating at ages 9-10 years.

This explanatory sequential mixed-methods study was part of an ongoing randomized trial comparing initiation at ages 9-10 years (intervention) vs 11-12 years (control) across 17 practices in Colorado (CO; 9 intervention) and 16 practices in California (CA; 8 intervention). We surveyed intervention practice clinicians at 1 month after study initiation and conducted semi-structured interviews at 3 months after study initiation. We used descriptive statistics to analyze surveys and content analysis for interviews.

66 (92%) CO and 39 (87%) CA clinicians completed 1-month surveys; 59 (90%) in CO and 30 (77%) in CA were routinely initiating vaccines at age 9 or 10 years. Most reported that vaccination at ages 9-10 years was not burdensome, and issues were largely unchanged, including parental concerns and discussion times. Interviewees (18 clinicians, 17 staff) reported that many parents seemed receptive to discussing HPV vaccination at ages 9-10 years, pushback often stemmed from child expectations for a vaccine-free visit at age 9 years rather than vaccine concerns, and discussions at ages 9-10 years were shorter because sexual activity was not perceived as salient. Many preferred the option to space out vaccines by administering a single vaccine at age 9 years and fewer at age 11 years.

Clinicians and staff perceived recommending the HPV vaccine at ages 9-10 years as feasible for clinicians, compatible with workflows, and generally acceptable to parents.