The discovery in the 1980s linking the human papillomavirus (HPV) to nearly all cases of cervical cancer led to the groundbreaking development of a cancer-prevention vaccine, approved for use in females in 2006 and for males in 2009. The U.S. Centers for Disease Control and Prevention (CDC) now recommends that the HPV vaccine — which can prevent cervical, anal, vulvar, vaginal, penile and certain throat cancers, as well as genital warts — be offered routinely to adolescents and young adults ages 11-26. The vaccines are administered in two (ages 11-14 years) or three (age 15 or older) doses over the course of about 6-12 months.
But 12 years after the HPV vaccine was introduced, usage rates among adolescents remain disappointingly low, says Dr. Roshan Bastani, UCLA Fielding School of Public Health professor, director of the UCLA Kaiser Permanente Center for Health Equity and director for disparities and community engagement in the UCLA Jonsson Comprehensive Cancer Center. Nationally, in 2016, just 60 percent of 13-17 year olds had received the first dose of the vaccine, and only 43 percent had completed the series, according to CDC data.
Dr. Bastani attributes this in part to missteps in the way the vaccine was introduced. “The fact that it was initially promoted by the pharmaceutical industry and certain legislators raised suspicions among some people,” she says. “In addition, HPV is a sexually transmitted virus and there were early media reports of concern among parents that receipt of the vaccine would encourage their child to engage in sexual activity. Our own research and that of others around the country has shown that most parents do not hold such beliefs. We do know that many providers do not routinely recommend the vaccine to their patients, and that some providers are not comfortable having a discussion about a sexually transmitted virus with parents of young adolescents.”
To learn how health systems can effectively increase HPV vaccination rates, Dr. Bastani heads a $6.6 million, five-year study funded by the Patient-Centered Outcomes Research Institute (PCORI). The study is being done through a partnership with the Northeast Valley Health Corporation (NEVHC), a multisite federally qualified health center (FQHC) serving a low-income population in Los Angeles’ San Fernando and Santa Clarita valleys. Bastani’s team — including Drs. Beth Glenn, Alison Herrmann and Catherine Crespi from the Fielding School and Debra Rosen and Dr. Gina Johnson from NEVHC — will compare three strategies:
More than 17,000 HPV vaccine eligible adolescents will receive services at participating NEVHC clinics during the five-year study period. The impact of each strategy will be assessed through a review of NEVHC’s electronic medical records.