Table 3.
HPV vaccination intervention study summaries (n = 34). OR: odds ratio, AOR: adjusted odds ratio, RR: risk ratio, ARR: adjusted risk ratio, HR: hazard ratio. Confidence intervals are presented for ratios only if a p value was not presented in the original paper.
| Author, year, title | Outcome (O) and methods (M) | Intervention (I) and control (C) conditions | Target population, sample size, and setting | Selected results measured in percentages | Selected results measured in ratios |
|---|---|---|---|---|---|
| Increasing Community Demand for HPV Vaccination | |||||
| Vaccination requirements for school attendance | |||||
| Bugenske E, et al. 2012. Middle school vaccination requirements and adolescent vaccination coverage.25 | O: Up to date for HPV vaccinations during one year M: Ecological study. Reviewed states' middle school vaccination for school entry and vaccination education requirements and categorized states by status based on Immunization Action Coalition data. State requirement status was then correlated with estimated coverage from NIS-Teen data. | I: State had policy mandating HPV vaccination for school entry or state had policy mandating education on HPV vaccination C: State had no policy on HPV vaccination or education | 20,066 13–17 year old males and females from the 2009 NIS Teen dataset, but restricted to females only (number of females not reported) 50 states + DC: I: 5 states + DC C: 45 states | Series initiation (I vs. C, p = not significant): I: 45.0% C: 44.2% | — |
| Dempsey A, et al. 2011. Human papillomavirus vaccination rates and state mandates for Tetanus-containing vaccines.26 | O: Series initiation during one year M: Ecological study. Each state categorized by whether adolescent Td and/or Tdap vaccines were mandated for school entry based on Immunization Action Coalition data. Mean HPV vaccine series initiation levels among adolescent females were compared between each mandate category. | I: State has Td or Tdap school mandate C: State has no Td or Tdap school mandate | 13–17 year old males and females from the 2009 NIS Teen data set, but restricted to females only (number of females not reported) 50 states + DC: I: 30 states + DC C: 20 states | Series initiation (I vs. C, p = .004): I: 47.3% C: 42.9% | — |
| Potter R, et al. 2014. Adolescent immunization coverage and implementation of new school requirements in Michigan, 2010.27 | O: Series initiation following implementation of new school mandates for Tdap/MCV4/varicella M: Ecological study. Data were derived from the Michigan statewide immunization information system. The study assessed the immunization status by age 13 of Michigan children enrolled in sixth grade in 2009 or 2010. | I: Enrolled in 6th grade post 2010 adolescent vaccination requirements C: Historical control | 128,627 6th grade females: I: 63,448 C: 65,179 Michigan | Series initiation by age 13: I: 34.3% C: 29.6% Series initiation by age 13 when another adolescent vaccination was administered at the first adolescent visit: I: 40.6% C: 36.7% Average required vaccine (Tdap/MCV4) coverage change after 2010 requirements: Difference of +20% between I and C | Series initiation by age 13, all females (I vs. C, p<.001): HR 1.18 Series initiation by age 13, females who had HPV co-administered at the first adolescent visit (I vs. C, p<.001): HR 1.22 Hazard ratios were proportionally greater for required vaccines' coverage (Tdap, MCV4) than HPV vaccine coverage. |
| Patient reminder and recall systems | |||||
| Chao C, et al. 2015. A randomized intervention of reminder letter for human papillomavirus vaccine series completion.28 | O: Series completion after 12 months M: Randomized controlled trial. Eligible females were members of the health plan who had at least one but no greater than two doses of the series. | I: Females or parents of females received quarterly reminder letters with date of first dose receipt, adolescent immunization schedule, a message to encourage next dose receipt, and a phone number for the patient's home medical center. C: Received standard of care with no reminder letter. | 12,205 9–26 year old females: I: 9,760 C: 2,445 Kaiser health plan members in Southern California | Series completion, 9–26 year olds (I vs. C, p<.01): I: 56.4% C: 46.6% Series completion, 9–17 years olds (I vs. C, p<.01): I: 66.2% C: 53.5% Series completion, 18–26 year olds (I vs. C, p<.01): I: 43.5% C: 37.0% | — |
| Kharbanda E, et al. 2011. Text message reminders to promote human papillomavirus vaccination.29 | O: On-time receipt of next dose (dose 2 after 6 months or dose 3 after 8 months) M: Prospective cohort study. Eligible subjects were identified through billing records and hospital-based immunization registries and enrolled through purposive sampling. Charts were reviewed by researchers to determine demographic data and receipt of doses. | I: Text message reminder, up to 3 weekly texts that the participant was due for her next dose C1: Controls who were offered intervention but opted-out C2: Historical controls | 1,512 parents of 9–20 year old females (some of sample may be 18–20 females themselves): I: 124 C1: 208 C2: 1,080 9 pediatric sites (5 academic, 4 private) in New York City | Received next dose on-time (I vs. C1, p = .001; I vs. C2, p = .003): I: 51.6% C1: 35.0% C2: 38.1% Intervention effect results were sustained at 4 months post-intervention. | Received next dose on-time (I vs. C1, p = .003; I vs. C2, p = .002): I vs. C1: AOR 2.03 I vs. C2: AOR 1.83 |
| Patel A, et al. 2014. Staying on track: A cluster randomized controlled trial of automated reminders aimed at increasing human papillomavirus vaccine completion.30 | O: On-time series completion within 8 months of initiation M: Randomized controlled trial. Health centers were matched and randomized prior to participant recruitment but neither participants nor providers were blinded to study arm assignment. | I: Received automated reminders (text, e-mail, phone, private Facebook message, or standard mail). Each intervention participant received four messages (one if she selected standard mail), sent three days apart prior to doses two and three. C: Standard of care | 365 18–26 year old females: I: 180 C: 185 10 outpatient reproductive health centers in NC, UT, AZ, WA, CO, and CA: I: 5 centers C: 5 centers | On-time series completion (I vs. C, p = not significant): I: 17.2% C: 18.9% | — |
| Suh C, et al. 2012. Effectiveness and net cost of reminder/recall for adolescent immunizations.31 | O: Series initiation after 6 months, and up to date completion after 12 months M: Randomized controlled trial. In each practice, adolescents who had not received 1 or more targeted vaccinations (including HPV vaccine) were randomly selected and randomized to intervention or control conditions. | I: Families were sent a first letter and autodialer telephone call. Adolescents still in need of targeted immunizations 1 month later received a second autodialer telephone call. A final letter was sent to adolescents still needing immunizations 2 months after the initial R/R. C: Standard of care | 972 11–18 year old females: I: 503 C: 469 4 private pediatric practices in metropolitan Denver | Overall series initiation (I vs. C, p < .05): I: 26.5% C: 15.3% Up to date completion from 0 baseline doses (I vs. C, p < .05): I: 11.7% C: 4.4% Up to date completion from ≥1 baseline doses (I vs. C, p = not significant): I: 74.7% C: 73.9% | — |
| Szilagyi P, et al. 2013. A randomized trial of the effect of centralized reminder/recall on immunizations and preventive visits for adolescents.32 | O: Series initiation, dose 2, and completion after 1 year M: Randomized controlled trial. Publicly insured adolescent girls who had not received any dose of HPV vaccine were identified in participating primary care practices. The study randomly assigned adolescents to one of two intervention conditions or control condition. | I1: Reminder letters advised parents to call their adolescent's primary care practice to schedule an appointment. The letters provided the practice's telephone number. I2: Telephone reminders were sent at the same frequency as letters by an autodialer service. C: Standard of care | 2,037 10.5–17 year old females: I1: 682 I2: 699 C: 656 37 primary care practices in a non-profit managed care organization in upstate New York | Series initiation: I1: 27% I2: 27% C: 21% Dose 2: I1: 26% I2: 26% C: 18% Series completion: I1: 18% I2: 19% C: 14% | Series initiation (I1 vs. C, p = not significant; I2 vs. C, p = not significant): I1: HR 1.3 I2: HR 1.1 Dose 2 (I1 vs. C, p < .05; I2 vs. C, p < .01): I1: HR 1.5 I2: HR 1.6 Series completion (I1 vs. C, p = not significant; I2 vs. C, p < .05): I1: HR 1.4 I2: HR 1.5 |
| Bar-Shain D, et al. 2015. Direct messaging to parents/guardians to improve adolescent immunizations. 33 | O: Receipt of next dose after 6 months. M: Prospective cohort study. Eligible participants due/overdue for an HPV vaccine dose were identified through EHRs. | I: A stepwise messaging cascade was used. E-mail sent first, if provided. If no e-mail provided, then texted. If not able to receive a text, an automated recorded voice message was delivered. If no working phone numbers were available, a postcard was sent. | 2,897 11–18 year old males and females Academic tertiary public health system in Northeast Ohio | 22.9% (n = 745 doses delivered) of adolescents received a needed HPV vaccine dose Patients needing the third dose of HPV vaccine were significantly more likely to get vaccinated (31.0%) than patients needing the first (16.9%) or second doses (26.3%) in the series (p < .0001). | — |
| Morris J, et al. 2015. Comparison of reminder methods in selected adolescents with records in an immunization registry.34 | O: Series initiation and completion after 6 months. M: Prospective cohort study. Participants who were not up to date on at least one of the recommended adolescent vaccines were selected randomly from San Diego County Immunization Registry records. Once contacted, parents of participants were given a choice of reminder method. | I: Parents chose to receive at least one reminder: mail, e-mail, or text reminder. C1: Received an enrollment phone call, but declined to participate. C2: No contact control group (eligible, but not sampled). | 121,409 parents/guardians of 11–17 year old males and females: I: 1,797 (282 mail, 552 text message, 963 e-mail) C1: 3,253 C2: 116,356 San Diego County | Series initiation percent increase from baseline, females (compared from baseline, all p < .05): I1 e-mail: +9.7% I1 mail: +10.3% I1 text: +11.5% C1: +6.7% C2: +4.9% Series initiation percent increase from baseline, males (compared from baseline, all p < .05): I1 e-mail: +20.6% I1 mail: +17.6% I1 text: +29.1% C1: +16.3% C2: +10.9% Series completion percent increase from baseline, females (compared from baseline, all p < .05): I1 e-mail: +13.6% I1 mail: +15.0% I1 text: +21.6% C1: +8.7% C2: +6.2% Series completion percent increase from baseline, males (compared from baseline, all p < .05): I1 e-mail: +10.0% I1 mail: +9.5% I1 text: +16.1% C1: +8.6% C2: +6.4% | — |
| Rand C, et al. 2015. Effectiveness of centralized text message reminders on human papillomavirus coverage for publicly insured adolescents.35 | O: Series initiation, dose 2, and completion after 8 months. M: Randomized controlled trial. Parents of adolescents who had no previous HPV vaccination were eligible to receive the intervention. | I: Up to 4 text messages were sent to parent/guardians with a reminder that their child was due to receive an HPV vaccine dose C: Sent 1 text with a general adolescent health message | 3,812 11–16 year old males and females: I: 1,893 C: 1,919 Non-profit managed care organization in upstate New York | Series initiation: I: 16% C: 13% Dose 2: I: 7% C: 6% Series completion: I: 2% C: 2% | Series initiation (I vs. C, p = 0.04): HR 1.3 Dose 2 (I vs. C, p = not significant): HR 1.2 Series completion (I vs. C, p = not significant): HR 1.3 |
| Patient education | |||||
| Hopfer S. 2011. Effects of a narrative HPV vaccination intervention aimed at reaching college women: A randomized controlled trial.36 | O: Series initiation after 2 months M: Randomized controlled trial. Participants were randomly sampled from the university clinic database. Two months after receiving intervention or control, participants were emailed asking whether they received vaccine or not. | I1: Video of vaccine decision narratives delivered by peers and experts/providers I2: Video of vaccine decision narratives delivered by peers I3: Video of vaccine decision narratives delivered by experts/providers C: Informational video with no narrative, informational website, or no message | 404 18 to 26 year old females: I1: 101 I2: 101 I3: 50 C: 152 1 university health clinic | Series initiation (I1 vs. C, p = .035; I2 vs. C, p = not significant; I3 vs. C, p = not significant): I1: 21.8% I2: 17.8% I3: 6.0% C: 11.8% | Series initiation (I1 vs. C, p = .036; I2 vs. C, p = not significant, I3 vs. C, p = not significant): I1: OR 2.07 I2: OR 1.61 I3: OR 0.48 |
| Vanderpool R, et al. 2013. “1-2-3 Pap” intervention improves HPV vaccine series completion among Appalachian women.37 | O: Series completion after 12 months M: Randomized controlled trial. Nurses provided dose 1 free of charge and offered study enrollment following dose 1. Enrolled women were randomized to intervention or control condition. | I: Watched 13 minute DVD video grounded in information, motivation, and behavioral skills theory. Participants also received follow up reminder calls for doses 2 and 3, similar to the control group. C: Standard of care (educational pamphlet and telephone reminders for doses 2 and 3) | 344 18 to 26 year old females: I: 178 C: 166 Recruited from multiple locations (local health departments, medical clinics, community colleges, outdoor festivals, Wal-Mart stores, businesses, and women's homes) in Appalachian Kentucky | Series completion (I vs. C, p = .03): I: 43.3% C: 31.9% | Series completion (I vs. C, p = .001): AOR 2.44 |
| Community-based interventions implemented in combination | |||||
| Kempe A, et al. 2012. Effectiveness and cost of immunization recall at school-based health centers.38 | O: Received any dose of HPV vaccine, and dose 2/completion among those who initiated at the school after six months M: Prospective cohort study. 6th grade girls with parental consent who needed at least one HPV vaccine dose were recalled at a school-based recall location. Immunization rates were examined from the state immunization information system. | I: Recalled to receive 1+ HPV dose(s) at a school-based recall location. Students were recalled up to 2 times by 1 of 3 methods: a pass sent to the student in their classroom, a phone call to the classroom, or a staff member of the health center walking into their classroom to escort them to the clinic. | 265 6th grade females 4 public middle school school-based health centers in Denver | Received any dose of HPV vaccine: 59% Females who needed a first HPV dose at baseline: Dose 2: 25% Series completion: 0% Parents were less likely to consent for their child to get HPV vaccine (62%) than other adolescent vaccines (no p values reported; Tdap: 78%; MCV4: 69%). | — |
| Patel D, et al. 2012. Human Papillomavirus vaccine intent and uptake among female college students39 | O: Series initiation after 6 months M: Randomized controlled trial. Participants were randomized to receive either intervention or control condition. HPV vaccine uptake at six months following enrollment was identified. | I: Received mailed educational fact sheet and mailed reminder C: Standard of care | 256 18–26 year old females: I: 128 C: 128 1 university health clinic at the University of Michigan | Series initiation (I vs. C, p = not significant): I: 5.5% C: not reported | Series initiation (I vs. C, p = not significant): RR .84 |
| Cates J, et al. 2011. Evaluating a county-sponsored social marketing campaign to increase mothers' initiation of HPV vaccine for their pre-teen daughters in a primarily rural area.40 | O: Series initiation after 6 months M: Prospective cohort study. Counties were selected by a convenience sample to represent a broader 13 county district. Coverage data were abstracted in the study counties via the North Carolina Immunization Registry. | I: HPV vaccination educational information was placed in intervention healthcare provider offices and community locations, such as pharmacies, salons, and grocery stores. Materials included posters, brochures, a website, a radio PSA, media releases, hotline, “starting the conversation” guides for providers, buttons for providers, and sticky notes to provide provider reminders. C1: Received no campaign, but shared regional similarities to intervention counties C2: Received no campaign, rest of state's counties | 251,398 9–13 year old females: I: 19,963 C1: 13,716 C2: 218,259 109 counties in North Carolina: I: 4 counties C1: 9 counties (geographically similar to intervention counties) C2: 96 counties (geographically distinct from intervention counties) | Series initiation (all intervention counties vs. C1, p < .01; all intervention counties vs. C2, p < .01) I county 1: 7.08% I county 2: 6.76% I county 3: 3.23% I county 4: 1.86% C1: 5.18% C2: 5.04% | |
| Cates J, et al. 2014. Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys.41 | O: Series initiation after 3 months and 6 months post-intervention M: Prospective cohort study. Intervention counties were located in a 13-county region. Coverage data were abstracted in the study counties via the North Carolina Immunization Registry. | I: HPV vaccination posters and brochures were distributed to intervention county health departments and 194 providers; 2 radio PSAs aired in the counties; providers were given a free CME online training; providers were given a communication tip sheet; and a website was launched with links to credible resources about HPV vaccine C: Received no campaign | 25,869 9–13 year old males: I: 19,842 C: 6,027 28 counties in North Carolina: I: 13 counties C: 15 counties (geographically distinct from intervention counties) | Series initiation: I: 7.3% C: 5.2% Series initiation 6 months post-intervention: I: 6.8% C: 6.6% | Series initiation (I vs. C, p = .002): HR 1.34 Series initiation 6 months post-intervention (I vs. C, p = not significant): HR .99 |
| Szilagyi P, et al. 2011. Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates. 42 | O: Series initiation, dose 2, and series completion after 12 months M: Randomized controlled trial. Adolescents in eight urban primary care practices were randomly assigned to study group. Data were abstracted from medical records and the state registry following the conclusion of the intervention period. | I: Trained immunization navigators at practices implemented immunization tracking, telephone and/or mail reminder/recall, and home visits if participants remained unimmunized or behind on preventive care visits. C: Standard of care | 3,752 11–15 year old females: I: 1,903 C: 1,849 Eight primary care practices in Rochester, New York | Series initiation following intervention: I: 58.5% (+15.4 percentage point change from baseline) C: 42.9% (0 percentage point change from baseline) Dose 2 following intervention: I: 52.0% (+35.6 percentage point change from baseline) C: 36.2% (+19.8 percentage point change from baseline) Series completion following intervention: I: 36.5% (+33 percentage point change from baseline) C: 24.1% (+20.9 percentage point change from baseline) | Series initiation following intervention (I vs. C, p < .001): ARR 1.4 Dose 2 following intervention (I vs. C, p < .001): ARR 1.4 Series completion following intervention (I vs. C, p < .001): ARR 1.5 |
| Rickert V, et al. 2015. School-based HPV immunization of young adolescents: Effects of two brief health interventions.43 | O: Series initiation and series completion after three years and four months M: Randomized controlled trial with no control condition. Parents of young adolescents receiving care at a school-based health center were randomly assigned to 4 potential intervention conditions. Asking the rhetorical question “do you want to protect your child from cancer?” was intended as a “foot-in-the-door” technique to begin a conversation, and one or two sided messages were tested to evaluate message persuasiveness. | I1: No rhetorical question, 1 sided message I2: Rhetorical question, 1 sided message I3: No rhetorical question, 2 sided message I4: Rhetorical question, 2 sided message | 445 parents of 11–15 year old adolescents: I1: 116 I2: 109 I3: 106 I4: 114 5 school-based health clinics in Galveston, Texas: 3 in middle schools, 2 in high schools | — | Rhetorical questions were not significantly associated with series initiation (RR 1.15: CI 0.89, 1.50), dose 2 receipt, or series completion (ratios not reported). Message sidedness was not significantly associated with intention to vaccinate or series initiation, dose 2 receipt, or series completion (ratios not reported). |
| Provider- or System-Based Interventions to Increase HPV Vaccination | |||||
| Provider reminders | |||||
| Ruffin M, et al. 2015. Impact of an electronic health record reminder on human papillomavirus vaccine initiation and timely completion.44 | O: Series initiation and timely series completion during a 3 year period M: Retrospective cohort study. Eligible females with at least one doctor appointment in the study period were eligible for inclusion. | I: Practices used an institution-created electronic health record system that provided electronic prompting for HPV vaccine doses. C: Practices used an electronic health record system that did not provide electronic prompting. | 15,021 9–26 year old females: I: 5,994 C: 9,027 9 community-based family medicine practices at 2 academic institutions in the Midwest: I: 5 practices C: 4 practices | Series initiation (I vs. C, p < .001): I: 35.0% C: 21.3% Timely series completion (I vs. C, p < .001): The intervention group had significantly greater on-time series completion. Percentiles presented graphically, see original paper for details | The intervention group had significantly higher odds of initiation at each level of covariates (AORs presented graphically, see original paper for detail). |
| Szilagyi P, et al. 2015. Effect of provider prompts on adolescent immunization rates: A randomized trial.45 | O: Series initiation, dose 2, and series completion after 12 months M: Randomized controlled trial. Primary care clinics at a local (GR-PBRN) and national (CORNET) level were randomized to receive intervention or standard-of-care control conditions. Intervention practices that lacked EHRs that could be programmed to deliver prompts utilized nurse/staff driven prompts. Following the intervention, participants within each site were randomly selected to have their charts reviewed and immunization data abstracted. | I: Practices used provider prompts (either through electronic health records or through nurse/staff) C: Standard of care | 1,771 11–17 year old females: GR-PBRN sites in New York: I: 397 C: 420 CORNET sites in New York: I: 478 C: 476 | GR-PBRN sites: Percentage point change in series initiation from baseline: I: 0 C: +1 Percentage point change in dose 2 from baseline: I: +1 C: 0 Percentage point change in series completion from baseline: I: 0 C: +2 CORNET sites: Percentage point change in series initiation from baseline: I: +5 C: +7 Percentage point change in dose 2 from baseline: I: +5 C: +3 Percentage point change in series completion from baseline: I: +2 C: −-2 | GR-PBRN sites: Change in series initiation from baseline (I vs. C, p = not significant): AOR 0.92 Change in dose 2 from baseline (I vs. C, p = not significant): AOR 1.01 Change in series completion from baseline (I vs. C, p = not significant): AOR 0.93 CORNET sites: Change in series initiation from baseline (I vs. C, p = not significant): AOR 0.96 Change in dose 2 from baseline (I vs. C, p = not significant): AOR 1.06 Change in series completion from baseline (I vs. C, p = not significant): AOR 1.13 |
| Provider assessment and feedback | |||||
| Gilkey M, et al. 2014. Increasing provision of adolescent vaccines in primary care: A randomized controlled trial.46 | O: Series initiation after 5 months and 1 year M: Randomized controlled trial. Primary care clinics randomized to receive one of two intervention conditions or control condition. Post-intervention, the state's immunization registry provided HPV vaccine coverage data for younger patients (ages 11–12 years) and older patients (ages 13–18 years) in the clinics. | I1: In-person AFIX consultation I2: Webinar AFIX consultation C: Standard of practice | 50,369 11–18 year old females at intervention sites: 11–12 year olds: 14,994 13–18 year olds 35,375 91 primary care clinics in North Carolina: I1: 30 clinics I2: 31 clinics C: 30 clinics | Overall difference in series initiation at 5 months compared to control, 11–12 year olds (I1 vs. C, p = .02; I2 vs. C, p < .01): I1: 1.5% I2: 1.9% Overall difference in series initiation at 5 months compared to control, 13–18 year olds (I1 vs. C, p = not significant; I2 vs. C, p = not significant) I1: 0.4% I2: -0.1% Overall difference in series initiation at 1 year compared to control, 11–18 year olds: All, p = not significant | — |
| Healthcare system-based interventions implemented in combination | |||||
| Cassidy B, et al. 2014. A quality improvement initiative to increase HPV vaccine rates using an educational and reminder strategy with parents of preteen girls.47 | O: Series initiation and series completion after 13 months M: Quasi-experimental design. Intervention was designed based on predictors of parental acceptance and Health Belief Model. Prior to the intervention, physicians and office staff received education on HPV and HPV vaccine. A historical control group of patients in the same practice provided a comparison. | I: Parents received a FAQ brochure and clinical protocol/script from physician. Also received practice-based telephone reminders for dose completion. C: Historical control group | 53 parents of 11–12 year old females: I: 24 C: 29 1 private pediatric practice in an urban location | Series initiation (I vs. C, p = .001): I: 75.0% C: 24.1% Series completion (I vs. C, p < .001): I: 62.5% C: 6.9% | Series initiation (I vs. C, p = significant): OR 9.43 (2.69–33.10) Series completion (I vs. C, p = significant): OR 22.50 (4.29–117.99) |
| Fiks A, et al. 2013. Effectiveness of decision support for families, clinicians, or both on HPV vaccine receipt.48 | O: Series initiation, dose 2, and series completion after one year M: Randomized controlled trial. Practices cluster-randomized to receive clinician-intervention condition or none. Girls due for HPV dose 1, 2, or 3 were randomly assigned within each practice to receive family- focused reminders and educational telephone calls or none. Final vaccination rates were assessed at the end of the study period. | I1: Family-focused intervention (reminder and educational telephone calls) I2: Clinician-focused intervention (clinician education, electronic health record prompts, and audit/feedback) I3: Combined family-focused and clinician-focused interventions C: Standard of practice | 22,486 11–17 year old females: I1: 5,680 I2: 5,557 I3: 5,561 C: 5,688 22 primary care practices in New Jersey and Pennsylvania | Series initiation: I1: 18% I2: 24% I3: 25% C: 16% Dose 2: I1: 71% I2: 64% I3: 73% C: 65% Series completion: I1: 73% I2:67% I3: 76% C: 63% | Series initiation: I1 vs. C: HR 1.1, p = .03 I2 vs. C: HR 1.5, p = .003 I3 vs. C: HR 1.6, p = .001 Dose 2: I1 vs. C: HR 1.2, p < .001 I2 vs. C: HR 1.0, p = not significant I3 vs. C: HR 1.3, p = .008 Series completion: I1 vs. C: HR 1.4, p < .001 I2 vs. C: HR 1.1, p = not significant I3 vs. C: HR 1.5, p < .001 |
| Matheson E, et al. 2014. Increasing HPV vaccination series completion rates via text message reminders.49 | O: Receipt of next dose (dose 2 or series completion) and on-time receipt of next dose after 8 months M: Prospective cohort study. Participants were recruited via convenience sampling. Prior to implementation of the intervention, providers and clinical staff underwent education explaining HPV disease, the role of the vaccine in disease prevention, and current HPV vaccination coverage at the state, national, and practice level. Coverage data were extracted from the state immunization registry. | I: Enrolled in text message reminder system. Participant received three text message reminders per dose: one message 7 days prior to each HPV vaccine due date, one on the vaccine due date, and one 7 days after the due date C1: Indicated interest in participating but never enrolled in text message reminder system C2: Standard of care | 312 11–22 year old males and females and/or their parents: I: 37 C1: 43 C2: 232 1 pediatric practice in North Carolina | Dose 2 (I vs. C1, p < .001; I vs. C2, p < .001): I: 73% C1: 33% C2: 27% On-time dose 2 (I vs. C1, p = not significant; I vs. C2, p = .035): I: 38% C1: 21% C2: 21% Series completion (I vs. C1, p = .008; I vs. C2, p = .018): I: 16% C1: 0% C2: 5% On-time series completion (I vs. C1, p = .018; I vs. C2, p = .007): I: 14% C1: 0% C2: 3% | — |
| Moss J, et al. 2012. Increasing adolescent immunization by webinar: A brief provider intervention at federally qualified health centers.50 | O: Series initiation, dose 2, or series completion after 1 month M: Prospective cohort study. Clinical coordinators from 17 federally qualified health centers participated in a competition to increase uptake of recommended adolescent vaccines. Participating FQHCs were based on a convenience sample. Data on vaccine uptake came from the state immunization registry. | I: Vaccination coordinators attended a webinar that reviewed provider-based changes recommended by the CDC's AFIX program and received weekly follow-up emails. C: Pre-AFIX webinar conditions | 7,337 12–17 year old females: I: 3,673 C: 3,664 17 FQHCs in North Carolina | Series initiation (I vs. C, p = .029): I: 54.0% C: 52.4% Dose 2 (I vs. C, p = .001): I: 36.1% C: 35.0% Series completion (I vs. C, p = .001): I: 22.0% C: 21.0% | — |
| Perkins R, et al. 2015. Effectiveness of provider-focused intervention to improve HPV vaccination rates in boys and girls.51 | O: Series initiation and receipt of next dose during the intervention period and after 6 months M: Randomized controlled trial. Rates were compared at baseline and two follow-up periods in the intervention and control health centers. | I: Clinics received provider-focused intervention consisting of: (1) repeated contacts (i.e. meetings every 4–6 weeks during the project period) to establish trust and accountability and to support providers to make practice-wide changes, (2) focused education on the morbidity and mortality from HPV, vaccine safety, and vaccine efficacy, (3) individualized feedback on vaccination rates relative to the practice-wide, state, and national rates, and (4) incentives in the form of maintenance of board certification requirements. Intervention practices then came up with their own intervention plans, which included utilizing reminder/recall, strongly recommending the vaccine, standing orders, provider reminders, and school based health centers. C: Standard of care | 13,118 11–21 year old males and females: I: 4,093 (1,749 females, 2,344 males) C: 9,025 (4,037 females, 4,988 males) 8 FQHCs: I: 2 FQHCs C: 6 FQHCs | — | Series initiation during intervention, females (I vs. C, p < .001): OR 1.6 (not sustained at 6 months post-intervention) Series initiation during intervention, males (I vs. C, p < .001): OR 11 (sustained at 6 months post-intervention) Next dose completed, females (I vs. C, p < .05): OR 1.4 (sustained at 6 months post-intervention) Next dose completed, males (I vs. C, p < .05): OR 23 (sustained at 6 months post-intervention) |
| Pahud B, et al. 2015. A pilot program to improve vaccination status for hospitalized children.52 | O: Series initiation after 1 month M: Observational study. Randomly selected hospitalized children/adolescents were enrolled in the study. Immunization records of participants were assessed to determine vaccination status at baseline and whether they needed to be caught up on the schedule. | I: For those determined to be not up-to-date, a personalized vaccine plan was created and shared with the parents/guardians of the child. If parents requested the vaccine dose while the child was hospitalized, the care team delivered it. If not, the doses needed were sent to the child's PCP and also sent home with the family. | 72 11+ year old males and females: I: 34 1 children's hospital in Kansas City, MO | Series initiation: I: 20.6% | — |
| Chung R, et al. 2015. Keen on teen vaccines: Improvement of adolescent vaccine coverage in rural North Carolina.53 | O: Series initiation and completion after one year M: Prospective cohort study. All practices within the intervention county that provided immunizations to adolescents and that were using the North Carolina Immunization Registry (NCIR) were eligible for inclusion. Intervention conditions were introduced in two phases and outcomes were compared to 4 matched comparison counties. | I: Multicomponent intervention consisted of provider education, immunization registry based mailed reminder and recall, patient education, provider incentives, and school-based parent education. C: 4 comparison counties | 11–18 year old adolescents: Sample size not reported 5 counties in North Carolina: I: 7 practices within one county C: 4 non-intervention counties. | Overall series initiation, 11–12 year old females Range of percentage increases: 27.4%–43.4% Overall series initiation, 11–12 year old males: Range of percentage increases: 14.2%–32.1% Overall series initiation, 13–18 year old females and males: Data not presented Overall series completion, 13–18 year old females: Data not presented Overall series completion, 13–18 year old males: Range of percentage increases: 1.6%–4.2% | Overall series initiation, 11–12 year old females (I vs. C, p = significant, not reported): AOR 1.19 (1.02–1.40) Overall series initiation, 11–12 year old males (I vs. C, p = significant, not reported): AOR 1.23 (1.02–1.51) Overall series initiation, 13–18 year old females and males: Data not presented, not significant Overall series completion, 13–18 year old females: Data not presented, not significant Overall series completion, 13–18 year old males (I vs. C, p = significant, not reported): AOR 1.46 (1.07–1.99) |
| Staras S, et al. 2015. Increasing human papillomavirus vaccine initiation among publicly insured Florida adolescents.54 | O: Series initiation after 3 months. M: Quasi-experimental. Two interventions were tested: a gender-specific postcard campaign was developed to address the gender diversity in vaccine series initiation and differential parental concerns, and an in-clinic health information technology system designed to assess interest in learning about the vaccine. Adolescents were randomly assigned to one of three intervention conditions, or standard of care. | I1: Received postcards sent in August and October. I2: Used health information technology (HIT) system to verify vaccination history and indicate interest in learning about vaccine. HIT system summarized responses for providers. I3: Received postcard and HIT system. C1, C2, C3: Standard of care. | 14,148 11–17 year old adolescent males and females: I1: 2,839 I2: 1,774 I3: 886 C1: 2,824 C2: 3,889 C3: 1,936 Primary care clinics serving Medicaid and Children's Health Insurance Program beneficiaries in Florida | Series initiation, females: I1: 5.5% I2: 6.0% I3: 7.5% C1: 3.6% C2: 4.0% C3: 3.1% Series initiation, males: I1: 5.7% I2: 7.0% I3: 7.2% C1: 5.4% C2: 4.8% C3: 4.7% Overall, 288 of 5,663 in the intervention group (5%) initiated the HPV vaccine series. | Series initiation, females (I1 vs. C, p = significant, not reported; I2 vs. C, p = not significant, not reported; I3 vs. C, p = significant, not reported): I1: AOR 1.6 (1.1–2.4) I2: AOR 1.3 (0.9–2.0) I3: AOR 2.0 (1.1–3.7) Series initiation, males (I1 vs. C, p = not significant, not reported; I2 vs. C, p = significant, not reported; I3 vs. C, p = significant, not reported): I1: AOR 1.1 (0.8–1.5) I2: AOR 1.4 (1.0–2.0) I3: AOR 1.6 (1.0–2.5) |
| Bundy D, et al. 2013. The ImmProve Project: leveraging electronic health record data to promote immunization delivery.55 | O: Up-to-date status for HPV series and time to receipt of next dose after 9 months M: Interrupted time series cohort study for intervention 1, and randomized controlled trial for intervention 2. All enrolled providers received education and training on the CDC schedule and how to utilize the intervention materials. For intervention 1, all patients in this cohort received the intervention condition; for intervention 2, providers were randomized to control condition or intervention. | I1: Electronic health record derived immunization prompts, in the form of clinical decision support when overdue children presented for care I2: Quarterly provider-specific bulletins listing overdue patients C1: Historical control for comparison with I1 C2: Standard of care for comparison with I2, patients were exposed to I1 | 12.5–14.5 year old females: Sample size not reported 1 hospital-based pediatric primary care clinic | — | Up-to-date status (I1 vs. C1): No significant increase (estimates not reported) Time to receipt of next dose (I2 vs. C2, p = not reported): HR 1.27 (0.91–1.77) |
| Enhancing Access to HPV Vaccination Services | |||||
| Vaccination programs in schools | |||||
| Daley M, et al. 2014. School-located vaccination of adolescents with insurance billing: cost, reimbursement, and vaccination outcomes.56 | O: Series initiation after one school year M: Randomized controlled trial. Students at schools that hosted school-located vaccination clinics that billed health insurance were randomly sampled. Randomly sampled students at randomly selected schools provided a comparison group. Immunization records for the samples were thoroughly updated using school, parent, and registry records. | I: Schools hosted 3 days of vaccination clinics, timed by the dosing schedule of HPV vaccine. Clinics billed insurance for vaccination services provided. C: No intervention | 2,000 6–8th grade females: I: 1,000 (n = 600 6th graders, n = 400 7th and 8th graders) C: 1,000 14 Denver, Colorado non-charter public schools: I: 7 schools C: 7 schools | Series initiation, 6th graders (p = not reported): I: 34% C: 18% Series initiation, 7th and 8th graders (p = not reported): I: 20% C: 7% Series completion, 6th graders (I vs. C, p < .001): I: 13.2% C: 2.0% Series completion, 7th and 8th graders (I vs. C, p = not significant): I: 9.3% C: 5.8% | Series initiation, 6th graders (p = significant, not reported): ARR 1.69 (1.21, 2.36) Series initiation, 7th and 8th graders (p = significant, not reported): ARR: 2.56 (1.34, 4.88) |
| Stubbs B, et al. 2014. Evaluation of an intervention providing HPV vaccine in schools.57 | O: Number of doses received and site at which doses were received after 9 months M: Prospective cohort study. School officials identified 6 regions in the county, and for each they selected a middle school to host clinics that provided HPV vaccine. Other schools in the county served as satellite schools whose students could receive HPV vaccine at the host school clinics in their region. | I1: Host schools had several one-day, on-site HPV vaccination clinics for students in partnership with local health department I2: Satellite school students had access to host school clinics in their region | 7,916 10–17 year old females: I1: 1,781 I2: 6,135 28 schools in Guilford County, North Carolina: I1: 6 schools I2: 22 schools | Number of doses received at any location: No doses: 97.9% One dose: 0.2% Two doses: 0.3% Series completion: 1.7% (high completion if initiated: 80% of those who initiated received all 3 doses) Any dose received, by location: I1: 6.2% I2: 1.0% | Any dose received, by location (I1 vs. I2, p < .05): OR 6.56 |
| Reducing out-of-pocket costs | |||||
| Harper D, et al. 2014. The influence of free quadrivalent human papillomavirus vaccine (HPV4) on the timely completion of the three dose series.58 | O: Effect of economic incentive (free vaccine) on number of doses received and on-time series completion. M: Nested retrospective cohort study. The medical center's vaccine program distributed free HPV vaccine provided by a local foundation for females who otherwise had no source of payment for the vaccine. Patient characteristics, vaccination history, and payer source for each of the three HPV doses were abstracted from electronic records. | I: Exclusively received free vaccine doses sponsored by foundation C1: Exclusively received vaccine doses paid for by public insurance C2: Exclusively received vaccine doses paid for by private insurance | 494 10–26 year old females: 136 10–18 year olds 358 19–26 year olds I: 47 C1: 447 C2: 447 1 safety net health care system in Kansas City, Missouri | On-time series completion, 10–18 year olds: I: 0% C1: 14% C2: 32% On-time series completion, 19–26 year olds: I: 21% C1: 12% C2: 32% Adolescents (10–18) did not receive sufficient numbers of grant-sponsored doses to conclude if free HPV4 affected on-time completion rates. No significant differences were found in adult (19–26) on-time completion rates among adults receiving 3 doses by payer source of the vaccine. | Adolescents (10–18) did not receive sufficient numbers of grant-sponsored doses to conclude if free HPV4 affected on-time completion rates. On-time series completion with at least one dose paid for by grant sponsorship, 19–26 year olds: OR 1.56, p = not significant |