HPV Vaccination at the Time of Abortion Visit: A Quality Improvement Initiative

To evaluate the feasibility and efficacy of a workflow designed to increase the number of patients counseled and initiated on the HPV vaccination series among an underserved patient population presenting for abortion care.

A retrospective chart review was conducted for 6 months before implementation to determine baseline rates of counseling and vaccine uptake. A workflow was prospectively implemented for 31 weeks at a resident-run urban safety net hospital abortion clinic. Rates of HPV vaccine-eligible patients who were counseled on vaccination were recorded along with rates of those accepting the vaccine who initiated and completed the series.

Following implementation, the rate of eligible patients receiving counseling on the HPV vaccine increased from 23.8% to 68.7%. There was a 400% relative increase in the rate of patients receiving at least 1 dose of the vaccine from 6.8% to 34%. Forty-one (41.4%) patients due for a subsequent dose received at least 1 additional dose. Fifteen (14.7%) patients who received at least 1 dose of the HPV vaccine completed the series. The most common primary language among vaccinated patients was Spanish (66.7%). A majority (81.8%) identified their race as Hispanic or Latine, followed by Black (8%), and 13 ethnic backgrounds were self-identified.

Implementation of an HPV vaccination workflow in an abortion clinic was feasible and resulted in substantial increases in counseling and uptake of the vaccine. Abortion care represents an opportunity to address HPV vaccination gaps, particularly among medically under-resourced populations most at risk for cervical cancer disparities.