HPV vaccine series completion in a midwestern HIV/PrEP population

HPV vaccination rates in the United States have plateaued, despite its efficacy in preventing cervical, anal, vaginal, and oropharyngeal cancers. We assessed HPV vaccination rates at the University of Nebraska Medical Center's Specialty Care Center (SCC) following 2019 ACIP/CDC guidance. We retrospectively evaluated patients aged 19-45 who established care at SCC prior to 31 December 2024. The primary outcome was HPV vaccination series completion. Exploratory outcomes included receipt of > 1 HPVvaccine dose, abnormal diagnostic tests, HPV-related cancers, and composite HPV-associated outcomes. Descriptive statistics summarized cohort characteristics, and Chi-square tests compared outcomes. There were 1068 patients included, 402 completing the HPV vaccination series and 553 receiving >1 dose, with no significant difference between patients with HIV and those on HIV PrEP. There were 236 abnormal diagnostic tests in 181 unique patients. Patients receiving > 1 HPV vaccination had more abnormal cervical Pap smears (p = 0.044) and condyloma (p = 0.002) compared to no/unknown HPV vaccination. However, comparison of HPV-associated outcomes versus vaccination timing showed most outcomes occurred either prior to vaccination or in patients with no documented vaccination. Earlier HPV vaccination was associated with a lower incidence of HPV-associated complications, reinforcing clinical effectiveness and the need to prioritize patient follow-up to ensure vaccine series completion.