Improving HPV Vaccination Delivery in Pediatric Primary Care: The STOP-HPV Trial

改善儿科初级保健中的 HPV 疫苗接种：STOP-HPV 试验

• 批准号: 10094196
• 负责人: Alexander Gabriel Fiks
• 金额: $ 60.51万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-03 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10094196
• 关键词: Academy; Acute; Address; Adenocarcinoma In Situ; Adolescent; Age; American; Anogenital venereal warts; Area; Awareness; Cancer Prevention Intervention; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Childhood; Chronic; Clinical Trials; Communication; Data; Disease; Dose; Effectiveness of Interventions; Eligibility Determination; Feedback; Female; Guidelines; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Immunization; Individual; Intervention; Knowledge; Lead; Maintenance; Malignant Vaginal Neoplasm; Malignant neoplasm of anus; Malignant neoplasm of cervix uteri; Malignant neoplasm of penis; Malignant neoplasm of vulva; Measures; Medical; National Cancer Institute; Office Visits; Parents; Patients; Pediatric Research; Pediatrics; Performance; Persons; Pharyngeal structure; Population; President' s Cancer Panel; Preventive; Primary Health Care; Provider; Randomized Clinical Trials; Reporting; Research; Research Design; Research Personnel; Research Support; Series; Sex Behavior; Sexually Transmitted Diseases; Site; System; Teenagers; Testing; Time; Training; Training Programs; Vaccinated; Vaccination; Vaccines; Visit; Withdrawal; Work; base; boys; cancer diagnosis; cancer prevention; certificate program; cervical and anal cancer; cost; cost effective; cost effectiveness; effectiveness testing; experience; girls; implementation measures; improved; innovation; male; malignant oropharynx neoplasm; multi-component intervention; pediatrician; prevent; programs; provider factors; skills; vaccine hesitancy

Project Summary/Abstract As highlighted by NCI, low human papillomavirus (HPV) vaccination rates represent a major lost opportunity for population-wide cancer prevention. Nearly all cervical cancer, 90% of anal cancers, ~60% of certain types of oropharyngeal cancers, and 40% of cancers of the vagina, vulva, and penis are caused by HPV, a sexually transmitted infection. Each year, 6.2 million persons are newly infected with HPV and 26,000 new HPV-related cancers are diagnosed, resulting in >$4 billion in annual medical expenses. HPV vaccination has extremely high efficacy in preventing vaccine strain-specific genital warts, adenocarcinoma in-situ, throat, anal, and cervical cancer, but low vaccination rates leave many individuals susceptible to HPV disease. National guidelines recommend vaccination of girls and boys starting at age 11yrs with 3 doses of HPV prior to onset of sexual activity. Still, in 2014, only 60% of 13-17yr girls and 42% of boys had even initiated the series. Pediatric primary care office visits are the main site for HPV vaccination, yet many missed opportunities (MOs) for vaccination occur in primary care and contribute to low vaccination rates. MOs are office visits during which a patient is eligible for a vaccine, but does not receive it. Many factors cause MOs-- provider factors (e.g., time-constrained visits, lack of communication skills, and giving vaccinations only at preventive visits) and parent factors (e.g., vaccine hesitancy). Immunization experts recommend multi-component interventions to prevent MOs and raise rates because they magnify the benefits of single-component interventions. However it is difficult to determine which components work in a multi-component intervention. We propose a multi-phase study that will first test the impact of 3 promising components, and then test the impact of a bundle of the 3. Our preliminary studies suggest that 3 interventions have promise in reducing MOs for HPV vaccination: training providers and office staff on HPV vaccine communication, prompts for providers to remind them to vaccinate eligible teens at any visit, and performance feedback to providers about their MOs. Working with a national network of primary care practices (60 practices for this study; >99,000 teens), we will test the impact of each intervention and then the impact of the bundle of 3 interventions on reducing MOs and improving HPV vaccine rates. Our study has 4 aims: Aim 1: Measure the effect of each component of STOP-HPV on: (a) MO rates and (b) HPV vaccination rates; Aim 2: Measure the effect of the 3-part bundle on: (a) MO rates and (b) HPV vaccination rates; Aim 3: Assess maintenance of the bundle following withdrawal of support from the research team and Aim 4: Measure implementation costs and cost-effectiveness of the interventions. We will then disseminate the most effective components nationally using the American Academy of Pediatrics' maintenance of certification program which is available to 64,000 pediatricians across the US.

项目摘要/摘要 正如NCI强调的那样，低人类乳头瘤病毒（HPV）疫苗接种率代表了主要损失 预防癌症的机会。几乎所有宫颈癌，90％的肛门癌，约60％ 某些类型的口咽癌和40％的阴道，外阴和阴茎癌症是由 HPV，一种性传播感染。每年，有620万人新感染了HPV和26,000人 诊断出与HPV相关的新型癌症，导致年度医疗费用> 40亿美元。 HPV疫苗接种 在防止疫苗特异性疣，腺癌，喉咙，喉咙， 肛门和宫颈癌，但低疫苗接种率使许多人容易患有HPV疾病。 国家准则建议从11岁开始以3剂HPV疫苗接种女孩和男孩 性活动的发作。尽管如此，在2014年，只有13-17岁的女孩中只有60％和42％的男孩甚至开始了该系列。 小儿初级保健办公室就诊是HPV疫苗接种的主要网站，但许多错过的机会 （MOS）进行疫苗接种，在初级保健中发生，并导致低疫苗接种率。 MOS是办公室访问 患者有资格获得疫苗，但没有接受疫苗。导致MOS的许多因素 - 提供者因素 （例如，时间约束，缺乏沟通技巧以及仅在预防访问时进行疫苗接种） 和父因素（例如疫苗犹豫）。免疫专家建议多组分干预措施 防止MOS并提高速率，因为它们会放大单组分干预措施的好处。然而 很难确定哪些组件在多组分干预中起作用。我们提出了一个多相 研究将首先测试3个有希望的组件的影响，然后测试3束的影响。 我们的初步研究表明，3种干预措施有望减少MOS进行HPV疫苗接种： 培训提供者和办公室人员有关HPV疫苗通信的培训，提示提供者提醒他们 任何访问中有资格的青少年疫苗接种，并向提供者提供有关其MOS的绩效反馈。与 国家初级保健实践网络（本研究的60种实践；> 99,000名青少年），我们将测试影响 每种干预措施，然后捆绑3个干预措施对减少MOS的影响并改善HPV 疫苗率。我们的研究有4个目标：目标1：测量Stop-HPV每个组件的效果：（a）MO 费率和（b）HPV疫苗接种率；目标2：测量三部分捆绑包的效果：（a）mo速率和（b） HPV疫苗接种率；目标3：评估从撤回支持后捆绑的维护 研究团队和目标4：衡量干预措施的实施成本和成本效益。 然后，我们将使用美国学院在全国范围内传播最有效的组成部分 儿科维护认证计划可供美国64,000名儿科医生使用。