UTMB is well-known for its history of caring for low-income patients from disadvantaged backgrounds who are at increased risk of HPV-related cancers. Its large catchment area of 25 counties includes 17 which are medically underserved or rural. Adolescents residing in these counties have much lower HPV vaccine completion rates than the 80% needed for herd immunity. Our evidence-based program has demonstrated over the last 2 cycles that a multi-pronged intervention consisting of patient navigation (PN), provider education, and community outreach can significantly improve HPV vaccine uptake and completion among this at-risk population. Overall Project Strategy: During the last 2 cycles, ...

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UTMB is well-known for its history of caring for low-income patients from disadvantaged backgrounds who are at increased risk of HPV-related cancers. Its large catchment area of 25 counties includes 17 which are medically underserved or rural. Adolescents residing in these counties have much lower HPV vaccine completion rates than the 80% needed for herd immunity. Our evidence-based program has demonstrated over the last 2 cycles that a multi-pronged intervention consisting of patient navigation (PN), provider education, and community outreach can significantly improve HPV vaccine uptake and completion among this at-risk population. Overall Project Strategy: During the last 2 cycles, we administered over 10,000 doses of the HPV vaccine through a collaboration with 3 large UTMB clinics. Moreover, over 90% of participants completed the series - much higher than the 52% rate in Texas and 62% rate in the US. In this expansion, we will add 2 more large clinics serving low-income patients. Review of electronic medical records demonstrated that adolescents seen in these clinics have 45% HPV vaccine completion rates. In the next cycle, we will continue to use those techniques proven to increase initiation and completion rates in the first 2 cycles. Bilingual PNs will offer in-person counseling to parents of all unvaccinated or partially vaccinated children 9-17 years of age. We will offer same day vaccination appointments and implement standing orders in all clinics. We will also include those seeing subspecialists that day, who usually do not offer this vaccine, to avoid missed opportunities for vaccination. Parents will be asked about other children in the family who may need to be vaccinated. Follow-up appointments will be scheduled before the patient leaves the clinic to ensure completion of all doses. PNs will use multiple systems (text, voice, automated) to remind patients about follow-up visits and immediately reschedule those who miss appointments. To eliminate cost barriers, there will be no charge to the patient for the vaccine. Most vaccine costs will be paid by Vaccines for Children, Medicaid or CHIP which will save CPRIT over $2 million. We will implement a broad-based education program for the entire care team to ensure there is a unified approach in the clinics and increase sustainability. Our team will give numerous in-services and lectures across UTMB, including personnel at UTMB's Community-Based Clinics and UTMB's network of regional clinics serving women and children. We will also educate different members of the health care team including physicians, nurse practitioners, nurses, and medical assistants by giving presentations on the local, regional and state level. Lectures will be given to medical and nursing students to ensure future providers are knowledgeable about how to counsel families of adolescents and address vaccine hesitancy. Finally, we will educate the community about the importance of being vaccinated through health fairs, back-to-school events and social media. These steps will ensure that both providers and parents understand the benefits of vaccinating adolescents between 9-17 years of age and the importance of completing the series. Specific Goals: Our primary Goal is to use a multipronged approach to increase the number of underserved adolescents 9-17 years of age seen in UTMB clinics who initiate, continue, and complete the HPV vaccine series. Overall, we will administer 8276 doses to 4500 individuals residing in 25 counties served by UTMB. Based on prior experience, we project that our intervention will result in an overall initiation rate of 85% and completion rate of 82% in the 5 participating clinics. Our second Goal is to continue our successful use of patient navigation services to facilitate initiation and completion of the vaccine series. PNs will counsel at least 7258 parents of adolescents from the 25 counties. Our third Goal is to educate at least 600 practicing physicians, nurses, medical assistants, health profession students, and other clinic staff on the vaccine through in-services, lectures, professional meetings, and visits with private practitioners. Significance and Impact: Overall, continuation of this project will have a significant impact on HPV vaccine initiation and completion rates among low-income patients served by UTMB who reside in rural and medically underserved areas of southeast Texas. Since adolescents derive the greatest benefit from HPV vaccination, it will decrease the rates of HPV-related cancers among this high-risk population. Furthermore, we anticipate that our program will result in widespread implementation of the techniques we have demonstrated to be highly effective at increasing HPV vaccination rates across all UTMB clinics that offer pediatric services. This will result in higher vaccination rates even after funding ends and ultimately will help decrease the number of HPV-related cancer cases in Texas.

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