Tuesday, March 18, 2008

Provider Attitudes Towards Human Papillomavirus (HPV) Vaccine and Barriers to Implementation in New York City

David B. Eagle and Jane R. Zucker. Bureau of Immunization, New York City Department of Health and Mental Hygiene, 2 Lafayette Street, 19th Floor, New York, NY, USA

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.

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.

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

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.

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%).

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.