Study: Outreach increases HPV vaccination completion rate

Patients at safety net clinics received enhanced brochures and follow-up calls about finishing the vaccine's three shots.

By Stephen Feller
Study: Outreach increases HPV vaccination completion rate
The HPV vaccine has been controversial since its introduction because it is recommended for girls who are not yet sexually active. Photo by

DALLAS, Oct. 19 (UPI) -- Researchers found in a study of girls in Texas that a multicomponent outreach program helped increase the rate of completion of the three-shot human papillomavirus, or HPV, vaccine.

HPV, a group of more than 200 related viruses, are the most common sexually transmitted infections in the United States. Among sexually active adults, more than 90 percent of men and 80 percent of women will be infected with HPV, according to the Centers for Disease Control and Prevention.


Although some HPV infections do not carry symptoms, aside from genital warts, and can go away in one or two years, others persist and can cause several types of cancer, including cervical, head, neck and anal cancers.

Most people get HPV infections shortly after becoming sexually active for the first time, according to the National Cancer Institute. The HPV vaccine has been controversial since its introduction in 2006 because it was recommended for girls beginning at age 10 or 11 -- before many have become sexually active -- because of the danger for developing cervical cancer.

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"HPV vaccine delivery is challenging because of the dosing schedule and parental hesitation about vaccines," Dr. Celette Sugg Skinner, a professor at the University of Texas Southwestern, said in a press release. "Given these challenges, we must offer both education and vaccine opportunities at all healthcare visits."


Researchers at UT Southwestern worked with 814 girls between ages 11 and 18 at four safety-net clinics in Dallas County between 2010 and 2011. The vaccine has since been recommended for boys, but at the time of the study was still only recommended for girls.

The study was conducted at publicly supported safety net clinics because rates of cervical cancer are higher among low-income populations, the researchers said.

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Participants were randomly assigned to receive either standard vaccine brochures or a multicomponent outreach program including an HPV-vaccine specific brochure, telephone calls to parents who declined, and follow-up calls for patients who were overdue for the second and third shots.

The researchers found no difference from previous research in the effect of the single brochure on girls who received it. They found that culturally sensitive brochures tailored for Hispanic families -- about 68 percent of the study's participants -- were more effective. Calls to parents who had declined the vaccine in the first place were not effective, but the researchers reported that follow-up calls about missed second and third shots increased the number of girls who received the full vaccine.

Researchers at UT Southwestern plan to find ways of improving outreach to black families, who made up about 28 percent of the study participants, some of which they are already testing out in an in-progress study. Preliminary rates have shown them to be somewhat effective, researchers said.

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In 2013, the vaccine was found to be significantly more effective than expected -- even with less than a third of girls vaccinated at the time. The CDC reported last year that only 57 percent of girls and 35 percent of boys between ages 13 and 17 had received at least one dose of the vaccine.

"Delivery of the HPV vaccine in safety-net settings is critically important because uninsured African-American and Hispanic women have higher rates of cervical cancer," said Dr. Jasmin Tiro, an associate professor of clinical sciences at UT Southwestern. "Teens should receive all three recommended doses to protect against HPV infections that can persist and lead to cervical cancer."

The study is published in the journal Pediatrics.

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