School vaccination program increased HPV coverage for adolescents in France

Key takeaways:

• Vaccination coverage among adolescents increased after implementation of a three-component intervention in France.
• HPV vaccination at school raised vaccination coverage by 5.5 percentage points.

In France, HPV vaccination at school significantly increased vaccination coverage among adolescents aged 11 to 14 years, according to study results published in JAMA Network Open.

“In France, where HPV vaccination has been recommended for all adolescents aged 11 to 14 years since 2021 after being initially recommended only for girls since 2007, with two injections and a catch-up of three injections up to 19 years of age, full vaccination coverage was 41.5% among girls aged 16 years and 8.5% among boys aged 16 years in 2022,” Nathalie Thilly, PhD, from the department of methodology, promotion and investigation, at Lorraine University in CHRU-Nancy, France, and colleagues wrote. “It is therefore of great importance to identify effective means of increasing HPV vaccination coverage. To date, too few interventions have included a multilevel approach, despite research showing its effectiveness, or indeed have reported their effect on vaccination coverage.”

Thilly and colleagues conducted an open-label, cluster-randomized trial from July 2021 to April 2022 with data from 30,739 adolescents aged 11 to 14 years from 91 French municipalities. Researchers evaluated the effectiveness of the PrevHPV intervention, a three-component intervention on HPV vaccination coverage, in this population. All municipalities received one, two, three or no components of the intervention.

The PrevHPV intervention included the following components:

• educating and motivating middle schoolers aged 11 to 14 years and their parents;
• training general practitioners on up-to-date HPV information and motivational interviewing techniques; and
• free HPV vaccination at school.

Primary outcome was HPV vaccination coverage among adolescents 2 months after the intervention concluded.

Overall, 50% of municipalities were in the two lowest socioeconomic quintiles, and two-thirds of municipalities had poor access to general practitioners. In total, 62.3% of municipalities implemented at least one PrevHPV intervention component, and 57.8% had at least one trained general practitioner.

At 2 months after the intervention, median vaccination coverage increased by 4 percentage points among adolescents. HPV vaccination at school increased adolescent vaccination coverage by an estimated 5.5 percentage points (P < .001). Researchers observed no effect of the intervention on adolescents’ education and motivation or general practitioners’ training.

In subgroup analyses, researchers observed a significant interaction between HPV vaccination at school and general practitioner access, with a higher effect with poor access (8.62 vs. 2.13 percentage points; P = .007).

“The results of the PrevHPV trial, and the evaluation of its implementation in particular, could provide vital information on how to best carry out this policy and improve vaccination coverage,” the researchers wrote.