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Background: Routine human papillomavirus (HPV) vaccination is recommended for females aged 11 or 12 years. Predictors of vaccine initiation (≥1 dose) have not been examined among STD clinic attendees, who are at high risk for HPV infection.
Methods: Electronic medical records for 11,153 females aged 13-18 years attending New York City (NYC) STD clinics between 2010-2013 were matched against the Citywide Immunization Registry (CIR), which contains immunization records for NYC residents ≤18 years. We assessed correlates of HPV vaccine initiation as of the date of visit to STD clinics among clinic attendees found in the CIR, using bivariable and multivariable logistic regression models. Race/ethnicity, age, census tract poverty, number of sex partners, and self-reported history of: genital warts (GW), STD other than GW, and abnormal pap smear were examined.
Results: Overall, 84% (9,328/11,153) of female STD clinic attendees were found in the CIR; 63% (5,838/9,328) had initiated HPV vaccination. Race/ethnicity, poverty, and history of STD were the only significant independent predictors of vaccine initiation. When adjusted for covariates, history of STD significantly increased odds of vaccine initiation (aOR=1.16, p=0.01); Hispanic females had the highest initiation rates (73%), and females of non-Hispanic (NH) white, NH-black and NH-other race/ethnicity had significantly lower odds of initiation compared with Hispanic females (NH-white: 54%, aOR=0.43, p<0.001; NH-black: 58%, aOR=0.51, p<0.001; NH-other: 62%, aOR=0.59, p<0.001). Additionally, females from medium- and high-poverty census tracts had significantly increased odds of vaccine initiation compared with females from low-poverty when adjusted for covariates (medium-poverty: 62% vs 56%, aOR=1.25, p=0.009; high-poverty: 69% vs 56%, aOR=1.49, p<0.001).
Conclusions: Among STD clinic attendees, HPV vaccine initiation was highest among Hispanic females and those of lower socioeconomic status, populations traditionally associated with poor health outcomes. This is an encouraging finding, but rates remain low and efforts to increase vaccination among all groups should continue.