O3216: A Multi-Component, Practice-Based Intervention to Increase Human Papillomavirus Vaccination: An AAP PROS Network RCT

Background: Despite high efficacy of human papillomavirus (HPV) vaccines in preventing HPV-related cancers, vaccination rates are low and missed vaccination opportunities are common. The Guide to Community Preventive Services and experts recommend multi-component interventions to address barriers simultaneously. We assessed the impact of a multi-component intervention-- online communication training for clinicians and staff, feedback on missed HPV vaccination opportunities, and staff and electronic health record (EHR) prompts to cue clinicians-- on missed HPV vaccination opportunities.

Methods: As part of the NIH-funded STOP-HPV trial, we implemented a 6-month (2/23/2022 – 8/9/2022), multi-component intervention within 24 pediatric primary care practices recruited from the AAP Pediatric Research in Office Settings (PROS) network. Practices were in 13 U.S. states and included16 independent practices and 8 practices belonging to one of two large health systems. Our intervention included online training of clinicians and staff in 3 areas: HPV vaccine communication including addressing vaccine hesitancy (3 online modules), performance feedback on missed HPV vaccine opportunities (1 online module and 3 personalized feedback reports), and clinician prompts (2 online modules about EHR and staff prompts). Using a pre-post design, we analyzed EHR data to measure the change in HPV vaccine missed opportunity rates (missed opportunities were defined as the proportion of visits at which vaccine-eligible adolescents did not receive an HPV vaccine) during the intervention compared to a 12-month baseline period. We also compared missed HPV vaccination opportunities for these 24 intervention practices to 48 practices from the same sampling frame that were not part of the study.

Results: During well-child visits, missed opportunities for HPV vaccination improved during the intervention by 4.8 percentage points (95% CI: -7.2%, -2.4%) for initial HPV vaccination and by 2.2 percentage points (95% CI: -4.4%, -0.0%) for subsequent HPV vaccination (Table). No difference was observed at acute/chronic visits. Missed opportunities for initial HPV vaccination at well-child visits were almost identical for intervention versus comparison practices before the intervention but were 6.6 percentage points (95% CI: -9.3%, -3.8%) better in intervention versus comparison practices throughout the 6-month intervention period (Figure). While intervention practices did better than comparison sites for subsequent HPV vaccination at well visits, results were not significantly different from comparison practices (Figure).

Conclusion: This multi-component intervention consisting of communication training, performance feedback on missed HPV vaccine opportunity rates, and clinician prompts improved HPV vaccination delivery during well-child visits. We did not see improvements at acute/chronic visits, possibly because our study was implemented during a very busy respiratory season including the peaking of the COVID-19 Omicron variant. Our findings demonstrate that a multi-component intervention had a positive impact on HPV vaccination in diverse practice settings.