Results of a multilevel intervention trial to increase human papillomavirus (HPV) vaccine uptake among adolescent girls

Abstract

Background: Uptake of the human papillomavirus (HPV) vaccine is low in Appalachian Ohio and areas with high cervical cancer rates. Methods: We conducted a group-randomized trial among 12 counties in Appalachian Ohio randomized to receive either an HPV vaccine (intervention counties) or influenza vaccine (comparison counties) multilevel intervention (MLI). Parents (n = 337) who had a daughter aged 9 to 17 years who had not received the HPV vaccine were recruited from commercial lists. Clinics (N = 24) and 119 providers from these clinics were also recruited. The primary outcome was medical record-confirmed receipt of the first shot of the HPV vaccine 3 months after receiving the intervention among daughters of parents enrolled in the study. Secondary outcomes included receipt of the first HPV vaccine shot by 6 months and changes in provider knowledge. Results: According to medical records, 10 (7.7%) daughters of intervention participants received the first shot of the HPV vaccine within 3 months of being sent the intervention materials compared with 4 (3.2%) daughters of comparison group participants (P = 0.061). By 6 months, 17 (13.1%) daughters of intervention participants received the first HPV vaccine shot compared with eight (6.5%) daughters of comparison group participants (P = 0.002). Provider knowledge about HPV increased (P < 0.001, from baseline to after education). Conclusions: The MLI increased uptake of the HPV vaccine among girls aged 9 to 17 years; however, uptake was low. Impact: To improve HPV vaccine uptake, attention to additional levels of influence (e.g., policy, community) and more elements within levels (e.g., reminders, automated prompts) may be needed.