Improving adolescent human papillomavirus (HPV) immunization uptake in school-based health centers through awareness campaigns

Abstract

Purpose: The aim of this study was to measure the effect of a multicomponent human papillomavirus (HPV) vaccine promotion campaign on adolescent HPV vaccine uptake at school-based health centers (SBHCs) in Seattle, WA.

Methods: Youth-led HPV vaccine promotion campaigns were introduced in 2016 in 13 schools with SBHCs in Seattle. Five other schools with SBHCs served as controls. Vaccination records for students were obtained from the Washington Immunization Information System from September 2012 to August 2018. We compared increase in HPV vaccine uptake in SBHCs between 1) intervention and control schools, and 2) pre- and post-intervention periods in intervention schools using generalized estimating equations.

Results: HPV vaccine uptake was high at baseline among students that use SBHCs for vaccines and has steadily increased between 2012 and 2018. Implementing the promotion campaign resulted in 14% higher (95% Confidence Interval (CI): 1%, 30%) HPV vaccine uptake in intervention SBHCs compared to control SBHCs, adjusting for time and confounders. Comparing pre-and post-intervention periods in intervention SBHCs, HPV vaccine uptake was 14% higher (95% CI: -4%, 35%) in the post-intervention period. SBHCs that received more active intervention activities saw 9% higher (95% CI: 1%, 21%) vaccine uptake compared to those that received passive intervention.

Conclusion: The vaccination promotion program implemented in a school-based setting resulted in higher HPV vaccine uptake in the post-intervention period compared to pre-intervention period, but this increase was not statistically significant. Even so, schools that received more intervention activities for longer periods of time had higher HPV vaccine uptake.

Keywords: Adolescents; Human papillomavirus; Human papillomavirus vaccine; Immunization registry; School-based health centers.

Trends in HPV vaccine uptake for intervention schools by dose number and gender

Trends in uptake of HPV vaccine doses for intervention high schools and middle schools in the left and right panels of the graph, respectively. Dose 1 is shown in red, dose 2 in green, and dose 3 in blue. Solid lines indicate vaccine uptake trends for females and dotted lines for males. Lines indicate trends in vaccination rates over time. HPV vaccine uptake for dose 3 decreases in the 2016–17 and 2017–18 school years after changes in vaccine recommendations from a 3-dose series to a 2-dose series in 2016.

Trends in HPV vaccine uptake, initiation, and completion in participating school-based health centers

Temporal trends in HPV vaccine uptake, initiation, and completion rates for participating school-based health centers. Panels in each row correspond to HPV vaccine uptake, initiation, and, completion respectively. Control schools are shown in red, intervention schools in blue. Absolute measures of HPV vaccination rate for individual schools in control or intervention group are indicated with dots to display between-school variability in each year. Lines indicate trends in vaccination rates over time. Each trend line corresponds to a SBHC. Vaccination rates in some control SBHCs are based on small numbers because few students visited SBHCs for vaccines in these schools.