Human papillomavirus vaccine policies among american Indian tribes in Washington State

Abstract

Study objective: American Indians experience high rates of cervical cancer, which is preventable by vaccination against human papillomavirus (HPV). We sought information on funding, barriers, education, and policies regarding HPV vaccination from clinics that serve tribal members in the Pacific Northwest.

Design: We surveyed staff either by telephone or by using a mailed survey at 31 tribal and Indian Health Service clinics serving the 29 federally recognized American Indian tribes in Washington State. The survey included 11 items on policies and use of the HPV vaccine.

Main outcome measures: Primary outcomes were funding options for HPV vaccine administration, barriers to vaccine delivery, potential gaps in education, and determination of tribal or clinic-specific policies.

Results: Thirty-one clinics provided information; 28 administered the vaccine. Vaccination was supported by federal, private, and tribal sources. Barriers were reported by 89% of clinics, most commonly patients' lack of knowledge, distrust of the medical system, and lack of funding. Patient and provider information was widely available. Thirteen clinics had either tribal or internal clinic vaccination policies, or both.

Conclusion: HPV vaccine is available, but complex policies on administration could result in tribal differences in vaccination rates.

Figure 1

Funding sources used by clinics Note: 20 out of 22 responses in the Other category referred to the Vaccines for Children program.

Figure 2

Barriers to HPV vaccination reported by clinics