'Get creative': Intervention aims to close gaps in HPV vaccine uptake

HPV vaccine uptake may improve if providers incorporate routine vaccination into postpartum care, according to research presented at the Infectious Diseases Society for Obstetrics and Gynecology meeting.

In the study, researchers noted that despite the fact the nine-valent HPV vaccine — 9vHPV — is safe and “highly effective at preventing cervical cancer,” vaccination rates in the United States are low. To address this, Ellen C. Murphy, MD, an OB/GYN resident at Mass General Brigham and corresponding author on the study, told Healio that primary care physicians should “get creative with vaccination administration.”

“If a patient accesses health care for a sore throat or another unrelated health concern, as hard as it can be, try to capitalize on that visit for preventative measures,” Murphy said. “HPV vaccination reduces cervical and other HPV-related cancers, and obstetrician/gynecologists are here to help increase vaccination rates in our patients, decrease vaccination disparity, and hopefully HPV-related morbidity and mortality.”

At her institution, Murphy and colleagues developed an intervention to increase HPV vaccine uptake using a Medical Staff Note. These medical notes, she said, are used for clinical practice changes or new guidelines for obstetrics care at Brigham and Women’s Hospital.

“With support of the obstetric leadership, both physician and nursing, I drafted a protocol for providers to implement routine screening for HPV vaccination eligibility, included educational materials for patients that providers could use, and recommended vaccine administration timing based on CDC guidelines,” Murphy said. “The protocol was specifically to initiate or catch up postpartum patients starting as inpatients after delivery and completing series in the postpartum period, capitalizing of the already-established 6-week postpartum visit.”

The email protocol was sent to independent obstetric providers in February 2021 to offer 9vHPV to postpartum inpatients aged younger than 26 years. Following the email protocol, Murphy and colleagues conducted a retrospective evaluation from March 2021 to March 2022 to assess vaccination rates and characteristics of vaccinated vs. unvaccinated patients.

Of the 560 postpartum inpatients included in the study, the researchers found that the majority — about 65% — were already vaccinated, 20.9% were not, and 14.1% had an unknown status.

Among the vaccine-eligible patients, 23.1% received an inpatient postpartum HPV vaccine.

The only significant predictor of vaccination for those who were eligible, the researchers wrote, was receiving care in a midwife practice (OR = 2.4; 95%, CI 1.02-5.74). Those who received inpatient vaccinations were largely publicly insured, Hispanic and Spanish-speaking, according to Murphy and colleagues.

Prior to pregnancy, a multivariate analysis revealed that unmarried patients (OR = 2.3; 95% CI 1.51-5.64) were more likely to be vaccinated, while white (OR = 0.2; 95%, CI 0.13-0.38) and Spanish-speaking (OR = 0.13; 95% CI 0.08-0.23) patients were “disproportionately under-vaccinated.”

When asked about the intervention’s feasibility, Murphy told Healio that “change is hard.”

“We are planning to learn more about the challenges of vaccination during this period and develop an intervention to improve rates. I think it comes down to completing priorities for both patients and providers,” Murphy said. “However, as obstetricians, we see our patients longitudinally during prenatal care. Educating patients regarding the vaccine during these visits, I think, will help normalize vaccine administration after delivery. It's all about integrating something extra into the workflow.”