Clinician Perceptions of the Impact of Switching HPV Vaccine Initiation to 9-10 Years

Although HPV vaccine initiation as early as aged 9 years has been recommended, most clinicians initiate at ages 11 to 12 years. We assessed clinician-reported impact of early initiation on parental responses and vaccine discussions.

As part of an ongoing cluster randomized pragmatic trial across 31 Colorado and California pediatric practices, we allocated practices to switch HPV vaccine initiation to ages 9 to 10 years or to enhanced usual care (initiation at ages 11 to 12 years). All clinicians received online training on improving HPV vaccination; intervention arm clinicians also received training on initiating at ages 9 to 10 years. We surveyed all clinicians in both arms at 1, 6, 12, 18, 24, 30, and 36 months (all >80% response rates), and queried clinicians in the ages 9 to 10 years arm about vaccination at ages 9 to 10 vs 11 to 12 years.

Almost all intervention arm clinicians switched rapidly to the ages 9 to 10 years initiation; most control clinicians remained at ages 11 to 12 years. Parental concerns/questions, pushback, hesitancy, and adherence to recommendations did not differ significantly between study arms and were similar at ages 9 to 10 vs 11 to 12 years among intervention arm clinicians. Only about one-tenth of clinicians in both arms brought up sexual activity during HPV vaccine discussions; two-thirds in both arms indicated parents sometimes/often did. Intervention arm clinicians were more likely than controls to state discussions were shorter by a lot/little (55% vs 37%, P = .005) since study initiation.

Initiating HPV vaccination at ages 9 to 10 years instead of ages 11 to 12 years had little impact on parental questions/concerns, pushback, hesitancy, or clinicians' ability to convince hesitant parents. Initiation at ages 9 to 10 years was perceived by clinicians to shorten HPV vaccine discussions.