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Background: HPV vaccine series initiation rates have increased modestly compared to other adolescent vaccines and did not increase from 2011 to 2012.
Methods: We evaluated the feasibility and preliminary efficacy of a multi-component intervention to increase HPV vaccine series initiation among adolescents enrolled in Florida Medicaid and Children’s Health Insurance (CHIP) programs. We assigned 11-17 year old boys and girls without HPV vaccine claims, residing in Gainesville or surrounding primary care service areas (PCSA), and having a preventive care visit in the past year to one of four study arms. We assigned all adolescents with records of visits at five participating Gainesville clinics to a health information technology (HIT) system (n=2071) designed to alert providers of interested unvaccinated adolescents during clinic visits. We mailed postcards to a random half (n=1031). For comparison, we selected a random sample of adolescents living in PCSAs surrounding Gainesville (n=4025) and randomly assigned half to receive postcards (n= 2018).
Results: Preliminary efficacy in the two months following the intervention start suggests that the HIT system improved vaccination rates by 1% [HIT arms: 5% vs. non-HIT arms: 4% – Risk Ratio (RR) = 1.3; 95% Confidence Interval (CI) = 1.0, 1.7]. An additional 1% increase may be achieved by supplementing the HIT system with postcards (HIT and postcard arm: 6% vs. standard of care arm: 4% – RR=1.5; 95% CI = 1.1, 2.0). Within HIT system arms, 71 youth who visited the study providers were invited to participate. Most parents consented (82%; n=58) and 63% of adolescents completed the survey. Of the 80% of youth (n=36) verifying they were unvaccinated, only half were interested in the vaccine (n=18).
Conclusions: The intervention was feasible within the Medicaid and CHIP populations. Preliminary evidence suggests increases in HPV vaccine series initiation with the HIT system arms potentially boosted with parent postcards.