Learning Objectives for this Presentation:
Learning Objectives: By the end of the presentation participants will be able to describe provider knowledge and attitudes toward offering HPV vaccine, and major barriers encountered.

Background:
With the recent addition of several vaccines to the Advisory Committee on Immunization Practices' immunization schedule, the cost of fully immunizing a child from birth - 18 years has increased from $23 in 1980 to $1600 in 2007 (for females). New York City's Bureau of Immunization has received numerous concerns from providers about their ability to offer recommended vaccines.

Objectives:
•To determine whether providers are offering HPV vaccine and to what age groups.
•To document barriers encountered to offering HPV vaccine, including financial concerns.

Methods:
A survey was conducted among all providers listed in the Citywide Immunization Registry of attitudes towards HPV vaccine and potential barriers to implementation. It was distributed by fax, e-mail, and was posted on partner websites, and could be completed on-line or by phone.

Results:
190 responses were received. Most providers (99.4%) are familiar with and recommend (95.6%) HPV vaccine, but only 87% offer it. 88.9% offer it preferentially to 13-18 year olds rather than to 11-12 year olds. 26.8% offer it differentially based on insurance coverage. 55.9% reported barriers to providing vaccine, with 69.7% reporting insurance issues, including reimbursement rates below vaccine acquisition cost and inadequate to cover overhead, denial/late payment of claims, followed by patient cost (51.5%), parental concerns and vaccine misconceptions (48.5%), including safety, duration of protection, and fears that vaccine availability would encourage early sexual activity, and consent issues (24.2%).

Conclusions:
The findings indicate the importance of resolving vaccine insurance and provider reimbursement issues, as well as correcting provider/public misconceptions about HPV vaccine, in eliminating barriers and increasing use of this, and all recommended vaccines.