NEED: Even though the HPV vaccine has been available for over a decade, uptake and completion rates remain low due to lack of awareness and access. Cost is also a barrier among young adults after age 18 as they are no longer eligible for the Vaccines for Children program. Only 42% of US women 19-26 have received even one dose of the HPV vaccine. This demonstrates a critical need for additional interventions targeting adults. Rates are especially low among the low income, primarily Hispanic population who receive obstetric care from the University of Texas Medical Branch (UTMB). To address this, UTMB obtained CPRIT funding to develop an innovative postpartum vaccination program. Following the...

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NEED: Even though the HPV vaccine has been available for over a decade, uptake and completion rates remain low due to lack of awareness and access. Cost is also a barrier among young adults after age 18 as they are no longer eligible for the Vaccines for Children program. Only 42% of US women 19-26 have received even one dose of the HPV vaccine. This demonstrates a critical need for additional interventions targeting adults. Rates are especially low among the low income, primarily Hispanic population who receive obstetric care from the University of Texas Medical Branch (UTMB). To address this, UTMB obtained CPRIT funding to develop an innovative postpartum vaccination program. Following the delivery of their child, unvaccinated or partially vaccinated patients receive personal counseling from patient navigators. Those who agree receive a dose prior to discharge, with follow-up doses administered at clinics near their homes. This program resulted in a 300% increase in vaccine uptake among women from Galveston County during Cycle 1. Initiators had an impressive completion rate of almost 80 percent. Cycle 2 included women from 26 counties, many which are rural and medically underserved. Initiation and completion rates remained high at 76 and 73 percent. Continuation of this unique program is critical as the UTMB hospital serves a region of steady population growth that brings a continuous flow of new low-income women to the hospital each year. Our records indicate that only 29 percent of women recently admitted for delivery who are eligible for the vaccine have received even one dose. Thus, this program is desperately needed to reach a large population of women at increased at risk of cervical cancer. OVERALL PROJECT STRATEGY: During the third cycle, we will expand our program to the Rio Grande Valley and offer our unique intervention to even more low-income women at increased risk of cervical cancer. The majority of these patients most likely have not been vaccinated against HPV as they have limited or no access to preventive care before pregnancy. At both locations, patient navigators (PNs) will review the records of postpartum women and identify all eligible patients. Our focus will be on patients 11-26 years of age as this represents the highest risk group for future HPV infections. Those without evidence of prior HPV vaccination in their UTMB or state records will receive personal counseling. If they agree, they will receive a dose prior to discharge. To assure series completion, PNs will stay in close contact with patients and coordinate follow-up injections with postpartum visits, send appointment reminders by text and phone, and reschedule missed appointments as needed. A robust provider education component for physicians, residents, as well as medical and nursing students, will stress the importance of recommending the vaccine to eligible patients. Community outreach will include lectures at the Galveston County and Hidalgo-Starr County medical societies, visits to the offices of private physicians, and presentations at the statewide meeting of the American College of Obstetricians and Gynecologists. SPECIFIC GOALS: Our overarching goals are: 1) Reduce the risk of HPV-related cancers across Texas by increasing HPV vaccine knowledge and vaccine uptake among postpartum women delivering at the Galveston or RGV hospitals; and 2) Increase health care provider awareness and best practices of counseling about the HPV vaccine at every opportunity. In the first two years, we will interview providers at the Galveston and RGV hospitals to determine how well the postpartum intervention is accepted and identify any improvements needed to integrate HPV vaccination into patient care. We anticipate directly serving at least 4,000 patients and 1,100 professionals and indirectly reaching many more professionals through our dissemination efforts. SIGNIFICANCE AND IMPACT: In our first cycle, our innovative approach led to an initiation rate of nearly 80 percent among our largely economically disadvantaged and medically underserved target population. In the second cycle, we instituted standing orders for postpartum HPV vaccination and new guidelines for follow-up vaccinations at regional women's health clinics. In the third cycle, we will extend our program to low income, predominately Hispanic women delivering an infant near the US-Mexico border. Overall, this project has great potential to reduce the incidence of HPV infections and related cancers among an underserved population at increased risk for cancer-related morbidity and mortality. Thus, our project will provide primary cancer prevention to populations and geographic areas with great need for protection.

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