| HPV Vaccination |
Recommendation 1. Reduce missed opportunities for HPV vaccination among eligible adolescents.
Supporting activities:
State health department: Train providers how to reduce missed opportunities by offering more adolescent Assessment, Feedback, Incentives, and eXchange trainings (CDC’s quality improvement program for childhood vaccination) and expanding the training to focus more on HPV vaccine. State and local health departments: Collect recruitment materials and best practice strategies for reducing missed opportunities to vaccinate, and disseminate via the NC Center for Public Health Quality iMAP database. Local health departments: Offer HPV vaccination to adolescents who receive care in other health department programs, including sexual health and family planning clinics, WIC, and dental clinics. Increase use of the NCIR’s reminder/recall function for routine and catch-up adolescent vaccines. Healthcare providers: Modify patient intake procedures to identify adolescents who are eligible for preventive health services, including HPV vaccination, and monitor performance on the reduction of missed opportunities. Use NCIR’s reminder/recall function to contact adolescents who are eligible to receive initial or subsequent doses of HPV vaccine. CCNC: Use patient care alerts for adolescent vaccination, especially during summer months when young patients can more easily access healthcare services. State Immunization Branch: Update NCIR to permit reminder/recall for the first dose of HPV vaccine.
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Recommendation 2. Encourage pediatricians, family practitioners, nurses, and other healthcare professionals to recommend HPV vaccine.
Supporting activities:
Healthcare professional organizations: Disseminate tools that train healthcare providers to make efficient and effective recommendations of HPV and other adolescent vaccines, including education about vaccine timetables, contraindications, and concomitant vaccination. Healthcare providers: Commit to a policy of making clear and strong recommendations for all adolescents ages 11 to 18 to receive HPV vaccine and other adolescent vaccines.
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Recommendation 3. Increase provision of adolescent vaccines in alternative settings, including pharmacies and schools.
Supporting activities:
Pharmacies and CCFNC: Continue to research the protocol and feasibility of HPV vaccine administration in pharmacy settings. Local health departments: Develop and implement school-located mass vaccine programs (e.g., as demonstrated in Brunswick County) through collaboration with the NC Institute for Public Health. School health centers: Stock adolescent vaccines (i.e., tetanus, diphtheria, and pertussis booster, meningococcal vaccine, and HPV vaccine) and encourage adolescents to seek these services in school health centers. NCSCHA: Encourage school health centers to stock HPV vaccine, in addition to other adolescent vaccines. Share successful strategies to improve the return of parent consent forms.
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Recommendation 4. Increase funding to establish universal coverage of all CDC-recommended vaccines, including HPV vaccine, to children up to age 18.
Supporting activities:
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| Cervical Cancer Screening |
Recommendation 5. Improve recruitment of women rarely- or never-screened for cervical cancer.
Supporting activities:
State and local health departments: Collect recruitment materials and disseminate via the NC Center for Public Health Quality iMAP database. Local health departments: Recruit into screening programs women who receive care in other health department programs, including sexual health and family planning clinics, WIC, dental clinics, and immunization clinics. Healthcare providers: Use recruitment materials from iMAP and best practice strategies to identify and provide Pap tests to women without recent screenings. CCFNC: Update and disseminate the Cervical Cancer Resource Directory to local health departments, primary care providers, and community based organizations.
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Recommendation 6. Reduce missed opportunities for cervical cancer screening.
Supporting activities:
State health department: Work with other administrators from other programs that target women’s health services (e.g., WISEWOMAN and WIC) to develop age-specific packages of preventive services such as screening for breast and cervical cancer, blood pressure, and body mass index. State BCCCP office and State Health Information System office: Develop computer applications that facilitate in-reach recruitment efforts and provision of comprehensive packages of health screening services. Healthcare providers: Modify intake procedures to identify women who should receive screening. Healthcare professional associations: Develop a maintenance of certification Part IV quality improvement project for implementing comprehensive screening packages. CCNC: Use care alerts to promote screening.
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Recommendation 7. Encourage adherence to USPSTF guidelines for cervical cancer screening.
Supporting activities:
State health department: Collaborate with State Lab officials to expedite adoption of HPV DNA co-testing. State health department: Finalize, publish, and disseminate new BCCCP program manual for local program providers. Healthcare professional associations: Educate providers on USPSTF guidelines for cervical cancer screening and discourage over-screening through professional conferences, association newsletter updates, and other information sharing opportunities. Healthcare providers: Provide Pap tests to women in accordance with USPSTF guidelines (i.e., not more often than every three years). Central Cancer Registry: Prepare periodic evaluation reports of women’s cancers and screenings to inform the State Five Year Cancer Plan as well as the CDC federal reporting requirements. These reports will highlight the extent to which healthcare providers meet cervical cancer screening guidelines.
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Recommendation 8. Expand NC BCCCP funding.
Supporting activities:
State health department: Prepare evaluation data and report to justify program expansion from $3M to $9M allocation from the CDC. CCFNC Coalition partners: Advocate for legislation to allow individuals due a state income tax refund to contribute all or part of their tax refund to the NC Breast and Cervical Cancer Control Program.
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| General |
Recommendation 9. Increase understanding of the importance of cervical cancer prevention, especially among populations at higher-risk for cervical cancer.
Supporting activities:
State health department: Seek funding and technical support for health communication campaigns. Local health departments: Share health communication materials with appropriate local populations. NC Office of Minority Health and Health Disparities: Expand the scope of the Community Focused Eliminating Health Disparities grants to include: 1) cervical cancer as a priority area; and 2) public awareness activities. Screening messages should target African American and Hispanic women, particularly those who have been in the US less than 5 years, and HIV-positive women. Vaccination messages should address beliefs around HPV vaccine safety and effectiveness, venues where patients can access the vaccine, and recommendations for routine use among 11–12 year old boys and girls.
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